Critical Elements of an Mpox Vaccination Model at the Largest Public Health Hospital System in the United States

Abstract

In the spring of 2022, mpox spread to non-endemic countries, including the United States. In New York City (NYC), vaccine demand grew as quickly as case counts. With the leadership of the Regional Emerging Special Pathogens Treatment Center (RESPTC) at NYC Health and Hospitals/Bellevue (NYC H+H)-part of the largest public hospital system in the United States-an innovative vaccination model was established that overcame challenges involving health inequities, inadequate access, and lack of vaccine uptake, to successfully administer JYNNEOS vaccines to over 12,000 patients. Transmission has slowed since its peak in August 2022, which has been attributed to successful vaccination campaigns, infection-induced immunity, and behavioral changes among those at highest risk; however, a Centers for Disease Control and Prevention (CDC) assessment released on 4 April 2023 suggests jurisdictions with low vaccination levels (<35%) remain at risk for an mpox resurgence. Here, we summarize the critical aspects of our mpox vaccination model in NYC, which include integration into routine clinical care, prioritization of health equity, and reutilization of COVID-19 vaccination systems, to provide valuable insights for healthcare institutions as we move into the next stage of this ongoing outbreak.

Keywords: JYNNEOS; community outreach; emergency preparedness; mpox; mpox vaccine; public health emergency; special pathogen preparedness; vaccine equity; vaccine rollout; vaccine uptake.

Figure 1

(A) The number of mpox vaccine doses administered at NYC H+H sites from 1 May 2022 through 26 April 2023. NYC H+H quickly stood up its vaccination capabilities, as evidenced by an 8-fold increase in doses administered from July 2022 to August 2022. (B) Cumulative number of mpox doses administered at NYC H+H site. Over 14,000 mpox vaccine doses were administered to NYC H+H patients across NYC.

Figure 2

Timeline of significant adjustments to the vaccination protocol, May 2022—November 2022. The first mpox vaccine administered by NYC H+H occurred on 25 May 2022. Since then, the eligibility was expanded to PEP++ on 23 June 2022, and then PrEP on 6 October 2022. The switch to intradermal vaccine administration occurred on 24 August 2022.