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We continue to monitor the impact of monkeypox in the communities we serve and want to keep you informed about the resources available to our patients. Providers caring for individuals with possible exposure to the monkeypox virus now have two vaccination pathways to consider:

• UVA Health COVID and Special Pathogens Clinic | We are now offering Jynneos vaccines to patients eligible to receive monkeypox expanded post-exposure prophylaxis (PEP++). Vaccination is for patients with certain risk factors (see list below) who are more likely to have been recently exposed to monkeypox, but do not have a documented known exposure.
• How to Refer | An appointment is required, and you can refer eligible patients by placing an ‘Ambulatory Referral Monkeypox Vaccine’ order in Epic [REF228]. To conserve limited vaccine supplies and avoid waste, patients are being scheduled on select clinic days. 
• Blue Ridge Health District (BRHD)| Patients with a known monkeypox exposure are eligible to receive the Jynneos vaccine for postexposure Prophylaxis (PEP) as part of contact tracing efforts. The sooner an exposed person gets the vaccine, the better. Monkeypox vaccinations are also available at BRHD for community members who are at high risk of being exposed to it (PEP++). 
• How to Refer | When appropriate, clinicians can direct patients to the monkeypox vaccine interest survey (link) to register on BRHD website. Patients residing in other Virginia health districts can register for an appointment by logging onto VASE+ and searching under the “Monkeypox” tab for their zip code.

Patients Eligible for PEP++

Effective September 26, the following groups of people became eligible to receive PEP++ in Virginia:

• All people, of any sexual orientation or gender, who have had anonymous or multiple (more than 1) sexual partners in the last two weeks
• Sex workers of any sexual orientation or gender
• Staff, of any sexual orientation or gender, at establishments where sexual activity occurs 
• Any person, of any sexual orientation or gender, who is living with HIV/AIDS
• Any person, of any sexual orientation or gender, diagnosed with any sexually transmitted infection in the past three months

Dosing Update

Jynneos is an attenuated live virus vaccine approved by the FDA for the prevention of monkeypox in those 18 years and older, given as two subcutaneous injections of 0.5 mL separated by 28 days. On August 9, the FDA issued an emergency use authorization (EUA) for the JYNNEOS vaccine, which will allow for an expanded U.S. supply. Under the EUA, an alternative regimen of 0.1ml administered intradermally is available for people aged 18 years or older. The EUA also expanded vaccine eligibility to people younger than 18 years of age using the standard vaccine dosing regimen. Patients will require two doses of this vaccine at least 28 days apart.

Important Reminder for Patients

We don’t yet know if Jynneos fully protects against monkeypox, so it is important to remind patients to continue to take preventative measures recommended by the CDC to reduce risk even after they are vaccinated.

Looking ahead, we will keep you informed about important developments related to monkeypox. Thank you for the care you are providing to patients who are impacted by this concerning virus. 

Sincerely,

Reid B. Adams, MD, FACS
Chief Medical Officer 

Costi Sifri, MD
Hospital Epidemiologist, UVA Medical Center

Debbie Ann Shirley, MD, MPH
Medical Director, COVID and Special Pathogens Clinic