Mpox (Monkeypox) immunisation

Clinical guidance

• Vaccine routes:
  • Subcutaneous (preferred): a standard primary vaccination course of mpox vaccine requires 2x 0.5 mL subcutaneous doses, given 4 weeks apart. Subcutaneous injection is the preferred route of administration, including as the first dose of post-exposure prophylaxis (PEP).
  • Intradermal (dose sparing): an alternative route is by 2x 0.1 mL intradermal doses, given 4 weeks apart. Subcutaneous and intradermal routes are interchangeable for the 2-dose primary vaccination. However, due to sufficient dosages for subcutaneous injections, it is not recommended to offer an intradermal injection route.
• Vaccination before exposure to mpox:
  • Those who are at-risk and planning to attend festivals or events, or to travel to a country experiencing a significant mpox outbreak, should aim to start the 2-dose vaccination series 4 to 6 weeks prior.
• Vaccination after exposure to mpox: post-exposure prophylaxis (PEP):
  • Assess risk levels associated with client health when vaccinating for PEP.
  • If indicated, PEP with mpox vaccine should be given as soon as possible after the first exposure to a confirmed mpox case. Post-exposure prophylaxis (PEP) is recommended for medium and high-risk contacts as soon as possible, and up to 14 days following exposure to an infectious case.
  • Where a decision is made to provide PEP, a single dose of mpox vaccine should be given via the subcutaneous route. If mpox has not occurred and there is an ongoing exposure risk, the second dose of mpox vaccine should be given as close to (but not before) 28 days after the first dose, to complete a primary course for long-term protection.
• Mpox vaccine effectiveness
  • Current data from the Australian Immunisation Handbook estimates vaccine effectiveness ranges from 36 per cent to 86 per cent after a single dose, and 66 per cent to 86 per cent for a complete 2-dose course in people considered at high risk of mpox.
  • Effectiveness of post- exposure prophylaxis is estimated at 73 per cent to 89 per cent. Vaccination within 4 days of first exposure to an infectious case will provide the highest likelihood of disease prevention. 
  • Vaccine effectiveness for intradermal administration (80.3 per cent) appears to be comparable to subcutaneous administration (88.9 per cent).
• Those who require an mRNA COVID-19 vaccine and MVA-BN mpox vaccine (JYNNEOS) should consider spacing apart these vaccines by four weeks. This is particularly relevant for young males or people with specific relevant concerns.
• Refer to Mpox for further information, including disease epidemiology, testing, notification and contact tracing.
• Detailed clinical guidance is available in the mpox chapter of the online Australian Immunisation Handbook (external site) and the ATAGI interim statement on the use of vaccines for prevention of mpox in 2024 (external site).
• Sign up to Vaccine Updates (external site) for important announcements

Reporting to the Australian Immunisation Register (AIR)

Immunisation providers should report all vaccines administered to the Australian Immunisation Register (AIR). Providers are required to report the administration of all government-funded vaccines ordered through Onelink (external site) to the AIR. Accurate reporting of all vaccines administered ensures individuals have a complete and up-to-date vaccination history.

For more information, refer to Immunisation provider information and resources or Vaccine Ordering.

Vaccine Ordering

JYNNEOS® is the mpox vaccine used in Australia. This vaccine is available to order on the Onelink ordering platform (external site).

As the vaccine has a short shelf life, order limits are in place for most providers

Eligible immunisation providers who hold a Onelink Australia account can order mpox vaccines via Onelink (external site) in accordance with the eligibility information and ordering limits set within the system.

Please be aware that the vaccine has a short expiry, so order limits have been put in place to prevent over-ordering and subsequent wastage.

Providers or services that see high numbers of vaccine-eligible individuals are exempt from this order limit.

Cold chain management

Immunisation providers are responsible for ensuring vaccines received and stored at their premises, are managed by staff trained in cold chain management and who follow the National vaccine storage guidelines: Strive for 5 (external site)

The WA Health Guidelines for the Management of Cold Chain for Immunisation Service Providers is an important resource for all persons managing vaccines at provider sites. 

If you have any questions or concerns about vaccine ordering, please email vaccineorders@health.wa.gov.au. Whole cartons (boxes of 20 vials) are labelled with the vaccine manufacture’s expiry date which is based on frozen storage. Vaccines are thawed to +2 to +8C in batches, to fulfil order requests. The date and time of thawing will be placed on a label adjacent to the frozen expiry and batch details. Vaccine is thawed in batches (not on order demand), and thawed expiry shelf life is up to 24 weeks.

Do not refreeze the vaccine once thawed.

Orders of less than 20 vials will be repackaged by Onelink and relabelled with the original details (including batch number and manufacturer expiry date), along with the revised expiry date and time of the thawed product. If you receive an order without these relevant details, please contact vaccineorders@health.wa.gov.au.

Recording and reporting disposal

All cold chain breaches (CCBs), vaccine expiry or other potential wastage of government-funded vaccines must be reported immediately.

• Regional providers should submit reports CCB and Vaccine Wastage Form (external link)
• Metropolitan providers should submit reports using the separate Boorloo Public Health Unit Cold Chain Breach Form - Government funded vaccines (external link)
• Report expired vaccines by selecting the ‘Vaccine expiry’ as the incident type. 

All reports are forwarded to the relevant Public Health Unit (PHU) for assessment. Do not discard vaccines unless you are instructed to do so by a WA Health representative. 

Refer to the Vaccine ordering for further information or contact your PHU.

Immunisation providers who can administer the vaccine include:

• general practitioners
• registered nurses
• nurse practitioners.

Under the CEO of Health Structured Administration and Supply Arrangement (SASA), Aboriginal Health Practitioners, enrolled nurses, midwives and pharmacists are not authorised to administer mpox vaccines in Western Australia.

Some immunisation sites that administer mpox vaccines include:

• Community health immunisation clinics
• General practice clinics
• Hepatitis WA
• M Clinic
• Regional Public Health Units
• Royal Perth Hospital Sexual Health Clinic
• Sexual Health Quarters
• South Terrace Sexual Health Clinic
• Travel clinics
• WA AIDS Council (WAAC)

WAAC and M Clinic have partnered with Perth Steam Works and Connections Nightclub to provide free weekly pop-up vaccination clinics (external site) at their venues. Appointments are not needed.

Education requirements

Education requirements for WA Health professionals are set by the Communicable Disease Control Directorate (CDCD) to support providers with their understanding of the immunisation education needed for their role.

Subscribe to Vaccine Updates (external site) for important announcements and updates.

The Therapeutic Goods Administration (TGA) (external site)  monitors the safety of vaccines after they are supplied in Australia, including through reports of suspected adverse events following immunisation.

Reporting an adverse event following immunisation (AEFI)

The WA Vaccine Safety Surveillance (WAVSS) system is the central reporting service in WA for significant adverse events following immunisation (AEFI) or vaccine administration errors (VAEs). 

Providers should report any severe or potentially significant AEFI and VAE via the WAVSS reporting system as soon as possible, at SAFEVAC (external site) including: 

• any significant (or rare and unexpected) AEFI in both children and adults
• any vaccine reaction that requires assessment by a doctor or nurse
• any vaccine reaction that has affected a family’s confidence in future immunisation.

You can report adverse events even if you are not sure whether the vaccine caused the event.

For more information refer to Adverse event following immunisation (AEFI).

All clinical incidents (including VAEs) that occur within a WA Health Service Provider (HSP) and require treatment must be reported via WAVSS and in accordance with Clinical Incident Management Policy (MP 0122/19).