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Mpox information for health care providers

What providers need to know about mpox clinical guidance, vaccine (JYNNEOS), and treatment eligibility and administration.
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Clinical guidance

Suspect cases of mpox should be tested and positive results should be reported to DPH. The DPH Division of Epidemiology is available 24/7 at 617-983-6800 to discuss testing and recommendations to prevent further spread.

Vaccination

JYNNEOS vaccine administration

JYNNEOS vaccine is licensed as a series of two doses administered 28 days (4 weeks) apart. The standard regimen involves a subcutaneous route of administration with an injection volume of 0.5mL. The standard regimen is the FDA-approved dosing regimen for those 18 years and older. As of August 9, 2022, the standard regimen is authorized for people under the age of 18 under an Emergency Use Authorization.

An alternative regimen involving intradermal (ID) administration with an injection volume of 0.1mL may be used under an Emergency Use Authorization (EUA) in people 18 years and older. Both the standard (0.5mL SQ) and the alternative (0.1mL ID) regimen have been found to be effective for mpox prevention. There is adequate supply of JYNNEOS vaccine. Therefore, clinicians can preferentially administer JYNNEOS via the subcutaneous route.

More than two JYNNEOS vaccine doses are not currently recommended. There is no evidence of waning immunity following vaccination. JYNNEOS vaccine is not recommended for patients who have currently have mpox or have recovered from mpox. Prior infection provides immune protection.

Eligibility

Mpox vaccination is recommended for:

  • People who had known or suspected exposure to someone with mpox
  • People who had a sex partner in the past 2 weeks who was diagnosed with mpox
  • People who are gay, bisexual, or other men who have sex with men, or are transgender or nonbinary and in the past 6 months have had any of the following:
    • A new diagnosis of one or more sexually transmitted diseases (e.g., chlamydia, gonorrhea, or syphilis)
    • More than one sex partner
  • People who had any of the following in the past 6 months:
    • Sex at a commercial sex venue (like a sex club or bathhouse)
    • Sex related to a large commercial event or in a geographic area (city or county for example) where mpox virus transmission is occurring
  • People who had a sex partner with any of the above risks
  • People who anticipate experiencing any of the above scenarios
  • People who are traveling to a country with a clade I outbreak or new clade II outbreak and anticipate any of the following activities during travel:
    • Sex with a new partner
    • Sex at a commercial sex venue (e.g., a sex club or bathhouse)
    • Sex in exchange for money, goods, drugs, or other trade
    • Sex in association with a large public event (e.g., a rave, party, or festival)
  • People who are at risk for occupational exposure to orthopoxviruses (e.g., certain people who work in a laboratory or a healthcare facility).

As post-exposure prophylaxis (PEP), JYNNEOS vaccine should be given as soon as possible, ideally within four days of exposure. Administration four through 14 days after exposure may still provide some protection against mpox and lessen the severity of disease.

When an individual at risk requests vaccine, they should not be asked which of these criteria applies. It is sufficient to say that they consider themselves to be at risk for mpox.

ACAM2000

ACAM2000 vaccine is licensed to prevent smallpox and recommended by the ACIP for certain people at risk for exposure to orthopoxvirus infections. It has not been used in the ongoing clade II monkeypox outbreak that started in 2022. Although the United States has a large supply of ACAM2000, this vaccine has more side effects and contraindications than JYNNEOS. Local health departments and providers in Massachusetts are not requesting ACAM2000.

Vaccine ordering & compliance

The JYNNEOS vaccine (NDC: 50632-0001-03) is orderable via the MIIS and is shipped in a 10-pack of single dose vials.

Direct shipments of JYNNEOS vaccine are supplied to providers frozen and can be kept in a freezer until the labeled expiration date on the box. Once the JYNNEOS vaccine is thawed, it must be refrigerated between 2-8°C and is viable for up to 4 weeks. Always label JYNNEOS vaccine with the 4-week Beyond Use Date when moving the vial into the refrigerator.

State-supplied JYNNEOS doses may only be administered to the following patient populations:

  • Individuals who are 18 years of age, irrespective of insurance status, or
  • Adults 19 years of age and older, who are uninsured or underinsured* and seen at a public provider site (i.e. community health center, local health department, county jail).

The Vaccine Program recognizes that it is sometimes difficult to receive confirmation regarding whether an individual is truly underinsured or uninsured at the point of vaccine administration. If an individual presents themselves as underinsured or uninsured (even if this cannot be verified in real time through best efforts of the provider site), they can be considered as underinsured/uninsured and eligible to receive a state-supplied dose of mpox vaccine at a public provider site.

Privately purchased JYNNEOS vaccine is available for ordering through commercial wholesalers, for administration to any individual falling outside of the two categories listed above.

* An underinsured individual is defined as a person who has health insurance that does not cover any vaccines, a person whose insurance covers only selected vaccines, or a person whose insurance does not provide first-dollar coverage for vaccines. First-dollar coverage includes copays, coinsurance and deductibles.

Additional information:

Availability

For a list of mpox vaccine providers and appointment information, visit How to obtain vaccine.

Treatment

Many people infected with mpox virus have a mild, self-limiting disease course in the absence of specific therapy. The prognosis for mpox, however, depends on multiple factors such as previous vaccination status, initial health status, concurrent illnesses, and comorbidities. Promptly consult DPH about any mpox cases for which severe manifestations might occur (e.g., in people with advanced HIV infection or severe immunocompromise).

Tecovirimat (TPOXX)  

Tecovirimat (also known as TPOXX or ST-246) is an antiviral medication that is FDA-approved for the treatment of human smallpox disease caused by variola virus in adults and children. The use of tecovirimat to treat mpox virus is investigational.

Two randomized clinical trials (PALM007 in August 2024 and STOMP in December 2024) assessing the safety and efficacy of tecovirimat showed that the medication was safe but did not reduce the time to resolution of mpox lesions in study participants who received tecovirimat compared to placebo. These findings suggest that most patients with mild to moderate mpox will recover with supportive care and pain management.

Tecovirimat is available for treatment of patients with severe mpox disease or risk factors for severe mpox disease through an Expanded Access Investigational New Drug (EA-IND) protocol from the U.S. Centers for Disease Control (CDC). The use of tecovirimat through the EA-IND is for patients with laboratory-confirmed or suspected mpox that are severely immunocompromised, or have active skin conditions that place them at high risk for disseminated infection, or pregnant or lactating, or children (<18 years), or patients with protracted or life-threatening manifestations of mpox. Clinicians may obtain and provide TPOXX for their patients meeting these criteria by participating in the CDC EA-IND process. 

Tools: partner notification

Mobile Messaging Service for Partner Notification
Find information about using mobile messaging services to offer clients a new way to notify partners and to help partners to schedule appointments for testing and treatment.

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