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Mpox Vaccination for Vulnerable Populations

CE / CME

Protection Beyond Outbreaks: Routine Mpox Vaccination for Vulnerable Populations

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: July 17, 2024

Expiration: July 16, 2025

CME/CE Information

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CDC: Mpox Vaccines Administered in US (as of 1/10/2024)

Carlos del Rio, MD, FIDSA:
Now let’s consider how to increase mpox vaccine uptake to protect more people.

This slide depicts how many mpox vaccine doses have been administered by state in the United States as of January 2024, providing a sense of where things stand with vaccine uptake.

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Comparing Mpox Vaccination Uptake With HIV PrEP-to-Need Ratio

Carlos del Rio, MD, FIDSA:
As we saw with COVID-19, mpox has had a disproportionate impact not only on people with HIV, but also on racial/ethnic minorities in the United States. The disproportionate impact of diseases like mpox in minority populations is something that continues to plague us, and we continue to see how these diseases exacerbate existing health disparities. Reducing the burden of a disease like mpox starts by providing health equity, and vaccination is a way to provide health equity.

One of my former bosses, who was a champion of immunization, used to say that by vaccinating children, you are giving them what he called immunological equity. I love that phrase because, quite frankly, equity is at the epicenter of addressing the disproportionate impact of these epidemics and pandemics. The level of mpox mortality that occurred in the United States could have been prevented if were able to provide appropriate and equitable care to everyone.

Aniruddha Hazra, MD:
I agree. Mpox, like any other communicable disease throughout history in the United States, tracks along racial and socioeconomic fault lines. When examining plots showing mpox vaccination-to-case ratios by race/ethnicity in the United States, the same disparities that are observed with HIV PrEP-to-need ratios are apparent. People who need mpox vaccination the most are those who are least likely to receive it.

Click for audio from Aniruddha Hazra, MD.

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Strategies to Promote Mpox Vaccine Uptake: Meeting People Where They Are

Aniruddha Hazra, MD:
Much of the community-based work that successfully reached people in major cities throughout 2022 involved bringing the mpox vaccine to people, either in the community through mobile or pop-up vaccine units or by colocating vaccination with other services utilized by at-risk individuals, rather than waiting for them to come to the clinic for vaccination. There was a strong effort to meet communities where they were at, understanding that many at-risk individuals may not come to a clinic to get vaccinated.

Carlos del Rio, MD, FIDSA:
Yes, particularly during the time of limited vaccine supply, many clinics, including sexual health and HIV clinics, really did a fantastic job of reaching out to the community and working together with public health groups to try and get the vaccine to as many people at risk as possible.

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Strategies to Promote Mpox Vaccine Uptake: Other Interventions

Aniruddha Hazra, MD:
Other strategies that have been effective include collaborating with community clinics and organizations as well as expanding the reach of education and providing information in clear language that is well understood and received by communities that are most vulnerable to mpox.

Another challenge that requires high levels of community engagement is making sure people come back for the second dose 4 weeks after the first dose because greater than 80% efficacy requires both doses.

During the mpox outbreak, the public health community was able to leverage what was learned from COVID-19 vaccine outreach and uptake 1 year prior to support delivery of the full vaccine series.

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Mpox Vaccine Hesitancy: Best Practices

Carlos del Rio, MD, FIDSA:
Yes, outreach is extremely important, especially for overcoming health inequities. It is not enough to have a vaccine available, HCPs need to deliver it to the most vulnerable populations because at the end of the day, vaccines do not prevent disease, vaccination does.

Aniruddha Hazra, MD:
Exactly, implementation is critically important, as is addressing vaccine hesitancy. Speaking with community advisory boards within the communities that you serve to learn the best ways to deliver both vaccine-related messaging and the vaccine itself is an effective way to work toward overcoming vaccine hesitancy.  

In my view, the CDC has done an excellent job delivering on-point messaging throughout the mpox outbreak, including identifying and defining the populations disproportionately impacted. They have also created a great set of resources in their Social Media Toolkit page.

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I am aware of strategies to overcome barriers to mpox vaccination uptake such as vaccine hesitancy.

Resources

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