A smallpox vaccination is being offered to people who are most at risk to help protect them against monkeypox.
1. What are the eligibility criteria for the vaccine?
While anyone can get monkeypox, cases in the UK are predominantly in gay, bisexual and other men who have sex with men (GBMSM), with the virus being passed on in closely connected sexual networks. As a result, the UKHSA currently recommends the vaccine for those men at higher risk of getting the virus, such as those who have multiple partners, participate in group sex or attend ‘sex on premises’ venues.
The infection is only transmitted easily by close and intimate contact, including skin-to-skin contact so the vaccine is only being offered to those people who are likely to have very close or frequent contact with cases. By offering the vaccine to these individuals, it is hoped that spread of the infection will be curtailed, thus reducing the risk to the whole population. The vaccine is not being offered to GBMSM who have fewer partners who have much lower chance of coming into close contact with a case.
2. Are iCaSH taking bookings for the vaccine?
We are contacting patients who are eligible for vaccination to offer them an appointment.
If you think you may be eligible for vaccination and are registered with an iCaSH clinic but have not yet been contacted, or you are not registered with a sexual health service, the NHS has launched a new online national monkeypox vaccination site finder to make it as easy as possible for eligible people to get their monkeypox vaccine. This means that anyone who is eligible can go online at: www.nhs.uk/find-a-monkeypox-vaccination and find their nearest site and information on how they can get an appointment. You will be screened for eligibility prior to receiving the vaccine.
Please don't call us as we will not be able to book you an appointment for vaccination.
3. When will I be contacted for vaccination?
If you think you are eligible for vaccination and have not yet been contacted, please go to the online national monkeypox vaccination site finder at: www.nhs.uk/find-a-monkeypox-vaccination to find the site nearest to you which offers vaccination, together with information on how to access the vaccine there. You will be screened for eligibility prior to receiving the vaccine. Please don't call us as we will be unable to book you an appointment for vaccination.
While you are waiting for your vaccine, or if you have just received one, please be aware of the risks, and remain alert to the symptoms, of monkeypox, and be careful when attending events and situations where close contact may occur, especially if you have had a new or multiple sexual partners. Symptoms can take up to 3 weeks to develop, so keep checking yourself after intimate contact with others. Common signs and symptoms of monkeypox infection include fever, headache, muscle aches, exhaustion, swollen lymph nodes, and development of a new rash. This could be a single blister like spot (or a small number) on the genitals, anus and surrounding area, lesions in the mouth, and symptoms of proctitis (anal or rectal pain or bleeding).
4. What vaccine is used for monkeypox?
A smallpox (Modified Vaccinia Ankara (MVA)) vaccination is being offered to people who are most at risk to help protect them against monkeypox. As monkeypox is caused by a virus similar to smallpox, vaccines against smallpox are expected to prevent or reduce the severity of the monkeypox infection. When you are given the vaccine, your immune system (the body’s natural defence system) produces antibodies against the smallpox virus. These antibodies should also protect you against the monkeypox virus.
The vaccine contains a virus which has been modified so that it cannot grow or multiply in the human body. This MVA vaccine was developed as a much safer form of the smallpox vaccine used widely in the UK and abroad into the 1970s. The MVA vaccine does not contain smallpox virus and cannot spread or cause smallpox. For more information about the vaccine, please click here [PDF].
5. Will I just need a single dose or will I need a course of vaccines?
The current priority is to give as many eligible people as possible some immunity to the virus and we are therefore prioritising offering first doses. However, in line with UKHSA guidance, we are now offering a second dose, at least 2 months after the first dose, to those at highest risk in order to optimize protection against the virus, while continuing efforts to maximize uptake of the first dose within this group. This is a fair way to provide some protection to the whole community. If you had your first dose at an iCaSH clinic, we will contact you when it is your turn to get your second dose; please don't call us.
6. I had my first vaccination elsewhere but would like to have my second dose at an iCaSH clinic. How do I arrange this?
Please go to the national NHS monkeypox vaccination site finder at: www.nhs.uk/find-a-monkeypox-vaccination where all iCaSH sites offering vaccination are listed, together with a contact email address. Please contact us via this email address and, on receipt of your email, we will send you a link to an online Expression of Interest and Clinical Assessment information to complete and submit. On receipt and review of this, we will get in touch with you to follow-up and, if appropriate, arrange vaccination.
7. Does the vaccine work?
No vaccine is 100% effective but while the vaccine may not always prevent an individual getting monkeypox, the symptoms experienced are likely to be milder. The first dose prepares your immune system so it can respond much more quickly if you come into contact with monkeypox. After 2 doses of vaccine, almost all people develop antibodies and so should have a good level of protection against monkeypox.
The vaccine also takes time to work. Protection will start to build after a few days and should reach highest levels after about 4 weeks.
8. I have an underlying health condition/underlying health conditions. Can I have the monkeypox vaccine?
The only people who cannot receive the vaccine are those who suffered a sudden life-threatening allergic reaction to a previous dose of the vaccine, or any ingredient of vaccine before. The vaccine contains trace amounts of chicken protein, benzonase and gentamicin and ciprofloxacin (antibiotics).
You should also tell your clinician if you have atopic dermatitis (a form of eczema), as the risk of side effects from the monkeypox vaccine may be higher. They will discuss with you whether or not going ahead with vaccination is appropriate.
9. I have a weak immune system. Is it safe for me to have the monkeypox vaccine?
Yes. The vaccine should pose no risk to those who are immunosuppressed, including those with HIV infection who have a low CD4 cell count, as it contains a virus which has been modified so that it cannot grow or multiply in the human body. Vaccination should generally proceed in accordance with recommendations as individuals with immunosuppression are also at significant risk of the complications of monkeypox infection. However, the vaccine may not protect you as well which means you could be vulnerable to catching monkeypox, even if you’ve been vaccinated.
10. I am feeling unwell. Can I be vaccinated?
If you are ill with a high temperature you may need to be assessed to determine if you are displaying early signs of monkeypox. If your illness is not related to monkeypox, you may still be offered the vaccine. The presence of a minor infection without a fever, such as a cold, should not require postponement of vaccination, but talk to your clinician first.
If you are acutely unwell with more significant symptoms, you may be advised to delay vaccination. This is to both reduce risks of exposing others to your illness and to avoid wrongly attributing any signs or symptoms of your illness to the adverse effects of the vaccine.
11. I have had monkeypox. Can I be vaccinated?
It isn’t known if having had monkeypox infection protects against future infection, but it is considered that re-infection is unlikely, particularly in the short term. Because of this, although previous monkeypox infection does not mean the vaccine will be harmful, given the constraints on vaccine supply, vaccination of confirmed monkeypox cases is not currently recommended, even once recovered.
12. I have previously had a smallpox vaccine. Can I be vaccinated?
Individuals who have received a smallpox vaccine prior to the 2022 monkeypox infection outbreak are not currently being prioritized for vaccination as they are considered likely to have a degree of immunity against monkeypox infection and so be less likely to be infected by the virus.
13. Can I have the monkeypox vaccine with other vaccines such as human papillomavirus (HPV) and hepatitis vaccines and, if so, is there a specific interval that must be observed between each one?
The smallpox vaccine can safely be given at the same time as other important vaccines including those against HPV and hepatitis. There is no need to observe an interval between the different vaccines.
The vaccine can also be taken safely by those who are taking for pre-exposure prophylaxis (PrEP) for HIV.
14. How is the vaccine administered?
The vaccine will usually given by injection into the upper layer of the skin itself (i.e. via the intradermal route). This uses a much lower dose of the vaccine than giving it via the other more conventional intramuscular (i.e. injection into the muscle of the upper arm) or subcutaneous (i.e. injection below the skin) routes, in a similar way to many other injections. When vaccines are injected into the skin, rather than the muscle, the important proteins in the vaccine are more accessible to the cells of the immune system. This means that your body can make a good response to the vaccine even with a much smaller dose, allowing us to vaccinate more people. This is important given the limited supply of vaccine available. Intradermal administration is approved by the UKHSA and has been endorsed by the UK's Joint Committee on Vaccination and Immunisation (JCVI). It is also now being used in the US.
Almost everyone is able to have the vaccine via this route but there are 3 main exceptions, in which case the vaccine will be given via the intramuscular route:
- People aged under 18 years
- People with weakened immune systems, including those with HIV who have a CD4 cell count less than 200
- People with keloid scars
For more information about intradermal administration, please click here.
15. What are the possible side effects of the vaccine?
The vaccine has a very good safety profile. Like all medicines, it can cause side effects, but most of these are mild and short-lived and not everyone gets them. Unlike the old smallpox vaccine, vaccination does not leave a scar.
Common side effects include pain and itching at the injection site and headache, muscle ache, sickness and tiredness. About 1 in 10 people will have chills and fever, but these should not last more than a few days. If you experience any of the side effects listed above, you should rest and you can take the correct dose of paracetamol to help relieve the symptoms. Some people who receive the vaccine intradermally may have a small mark at the injection site for some months.
If you already have atopic dermatitis (a form of eczema), you may experience more intense local skin reactions (such as redness, swelling and itching) and other general symptoms (such as headache, muscle pain, feeling sick or tired), as well as a flare-up or worsening of your skin condition.
Some other conditions have been more rarely reported in people who received the vaccine. In the spirit of openness, the vaccine information leaflet mentions all these conditions – even those reported from single cases – but this does not mean that the vaccine was responsible. If you get any side effects of concern, talk to your clinician.