People who are categorised by public health authorities as a high or medium-risk contact are recommended to receive mpox vaccine as soon as possible, and within 14 days of exposure.
For detailed guidance on contact management, seek the advice of the local public health unit and see the Communicable Diseases Network of Australia (CDNA) Series of National Guidelines on mpox.
If indicated, post-exposure prophylaxis (PEP) with mpox vaccine should be given as soon as possible after the first exposure to a confirmed mpox case. Vaccination within 4 days of first exposure to an infectious case will provide the highest likelihood of disease prevention. Vaccination between 4 and 14 days after exposure is likely to attenuate disease.
People who have previously received a smallpox vaccine (before the 2022 mpox outbreak), and who are eligible for PEP, should receive PEP as soon as possible, regardless of the timing of the previous smallpox vaccine dose.
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 2nd dose of mpox vaccine should be given as close to (but not before) 28 days after the 1st dose, to complete a primary course for long-term protection. The 2nd dose may be given as either 0.5 mL via the subcutaneous route or 0.1 mL via the intradermal route.
The details of dosage and administration are outlined in Vaccines, dosage and administration.
Women who are pregnant or breastfeeding
Women who are pregnant or breastfeeding
PEP during pregnancy may be considered after a risk–benefit assessment.
Safety data for the use of MVA-BN in pregnancy are limited, but no concerns have been identified to date.4 Any decision on the use of a vaccine should take into account the likelihood of mpox in pregnancy, and the risks to both the mother and fetus.
Infants and children
Infants and children
Where PEP is indicated for a child, off-label use of MVA-BN mpox vaccine is possible.
Clinical trials evaluating the safety and immunogenicity of MVA-BN in paediatric populations are currently underway. So far, no serious safety concerns have been reported in observational studies involving the use of MVA-BN for PEP in children, though data are limited.5
MVA-BN mpox vaccine can be used in children when the benefits of vaccination outweigh the potential risks. To help parents make this assessment, they should be provided with information about the risks of mpox in children, the potential benefits of vaccination in the local epidemiological context and the current limitations of safety data in children. Providers considering administering mpox vaccine to people aged <18 years should consider following the United States Centers for Disease Control and Prevention (CDC) guidance Clinical Considerations for Mpox in Children and Adolescents.
Acknowledging limited data, and based on first principles, co-administration of mpox vaccine with childhood vaccines is acceptable if clinically indicated.