Vaccination to help protect against mpox (monkeypox)
Mpox (monkeypox) is a rare viral infection that usually causes a high temperature (fever) and a body rash that lasts a few weeks.
The risk of getting mpox in Scotland is low.
The World Health Organization (WHO) has recommended that 'monkeypox' should now be referred to as 'mpox'. The name change is to address concerns around stigmatising language associated with the disease. Learn more about the change in the press release from WHO.
Who is offered the mpox vaccine?
The vaccine is recommended for people whose sexual networks mean they are more likely to come into contact with mpox. These include:
- gay, bisexual, men who have sex with men (GBMSM), those who have multiple partners, take part in group sex, attend sex on premises venues, or have had a bacterial STI such as chlamydia, gonorrhoea or syphilis in the past year
- some trans and non-binary people who are in similar sexual networks to GBMSM
- some healthcare workers in high-risk settings where they may care for a patient with mpox
How many doses will be offered?
A full course of 2 doses of vaccine given at least 28 days apart is recommended for those at risk of mpox exposure.
Where can I get the vaccine?
If you're eligible, some specialist sexual health clinics are offering the MVA vaccine.
Healthcare workers at higher risk will be offered the vaccine from their employer.
Mpox is caused by a virus similar to the one that causes smallpox. So vaccines designed for smallpox are expected to prevent or reduce the severity of mpox.
The vaccine used in Scotland contains a virus that's been modified so that it cannot grow in the human body. This Modified Vaccinia Ankara (MVA) vaccine is a much safer form of the smallpox vaccine. MVA vaccines do not contain smallpox virus and cannot spread or cause smallpox.
The MVA (Imvanex) vaccine has been authorised for immunisation against mpox as well as smallpox by the Medicines and Healthcare products Regulatory Agency (MHRA). As no UK branded vaccine is available, you may be offered the US labeled equivalent of the MVA (Imvanex) vaccine, which is called Jynneos. This is the same vaccine as Imvanex and is also approved for mpox.
Read the IMVANEX patient information leaflet
Read the JYNNEOS patient information leaflet
The vaccine helps the immune system (the body’s natural defence system) produce its own protection in the form of antibodies against the smallpox virus.
The UK Health Security Agency (UKHSA) and the Joint Committee on Vaccination and Immunisation (JCVI) recommend the MVA vaccine to help prevent mpox.
Vaccines are recommended to protect against disease. After vaccination, you should continue to be aware of the risks and symptoms of mpox.
How is the vaccine given?
Most vaccines are given by injection into the muscle of the upper arm (intramuscular) or the tissue just above it (subcutaneous).
Some vaccines can also be injected into the upper layer of the skin. This is known as intradermal vaccination. This is how the MVA vaccine to protect against mpox may be given.
What is intradermal vaccination?
Intradermal vaccination is a slightly different way of giving the MVA vaccine. You'll be given a much smaller dose, using a smaller needle and syringe. The dose is about one fifth of the amount given by other methods.
The injection may take a few seconds longer and should produce a small blister that disappears within a minute. This method is commonly used for skin testing and vaccination against tuberculosis (TB).
It’s expected to be just as effective as the other ways of giving the MVA vaccine. Intradermal vaccination is approved by the JCVI. The JCVI advises UK health departments on immunisation. Intradermal vaccination is also being used in the United States.
Why is intradermal vaccination used?
When vaccines are injected into the skin, rather than the muscle or tissue just above it, the important proteins in the vaccine are more accessible to the cells of your immune system.
This means that your body can make a good response to the vaccine, even with a much smaller dose.
This technique has been commonly used during outbreaks of other infections, such as yellow fever.
Can everyone have the vaccine this way?
Most people can get the intradermal vaccination. However, you will not be offered intradermal vaccination if you:
- are a child
- have a weakened immune system
- have keloid scars
Most people living with HIV with undetectable viral load on ART can have the vaccine this way. You also need to have a CD4 count above 200.
Which clinics will give the vaccine this way?
Intradermal vaccination using the smaller dose is being offered in clinics by trained staff, especially in larger clinics.
Some smaller clinics may continue to use a subcutaneous or intramuscular injection.
Is the vaccine safe?
MVA vaccines meet the required standards of safety and effectiveness. Vaccine safety continues to be monitored once it's in use.
Are there any reasons I can't have the vaccine?
You should not have the vaccine if you've previously had a sudden life-threatening allergic reaction (anaphylaxis) to either:
- a previous dose of the MVA vaccine
- any ingredient of the vaccine, including those present in very small amounts such as chicken protein, benzonase, gentamicin or ciprofloxacin
It's also important to tell the person giving you the vaccine if you:
- have a high temperature
- have atopic dermatitis (atopic eczema)
- are living with HIV or any other condition or treatment leading to a weakened immune system
- are pregnant, planning to have a baby or breastfeeding
You can also let them know if you:
- have a minor infection such as a cold
- are taking or have recently taken any other medicines
- have recently received any other vaccine
You can be given this vaccine even if you've received a smallpox vaccination in the past. But you may be at increased risk of side effects, so speak to the person giving you your vaccine.
Are there any side effects?
Like all medicines, the vaccine can cause side effects, but not everybody gets them. The common side effects are:
- a headache
- aching muscles
- joint pain, pain in the extremities (hands and feet)
- loss of appetite
- pain, redness, swelling, hardness, itching, discolouration, a lump or bruising at the injection site
Around 1 in 10 people may have chills and fever, but these should not last more than a few days. If you experience any of these side effects, you should rest and take paracetamol. Always follow the manufacturer's instructions. Do not take medicines containing aspirin if you're under 16.
The most common side effects reported are at the site of injection. Most are mild to moderate in nature and cleared without any treatment within 7 days.
Fainting after vaccination is quite common. You should wait for 15 minutes after the vaccination before you drive.
If you do faint, stay flat on your back with your legs raised. If this doesn’t make you feel better, then call for help.
If you have atopic dermatitis (atopic eczema), you may experience:
- more intense skin reactions such as redness, swelling and itching
- other general symptoms such as headache, muscle pain, feeling sick or tired
- a flare-up or worsening of your skin condition
Can I pay for an MVA vaccine privately or at a pharmacy?
No, the MVA vaccination is only available through the NHS to eligible groups and it's a free vaccination.
If you have been exposed to mpox
If you've had significant contact with someone with mpox, you may also be offered the vaccine. This includes healthcare workers in high-risk settings, who are caring for someone with confirmed mpox.
The vaccine is most effective when given within 4 days from the date of exposure. However, it can be given up to 14 days after exposure if you're at high risk of ongoing exposure or at risk of more severe disease. This may reduce your symptoms but may not prevent disease.
Two doses are recommended for longer term protection against mpox. The second dose can be given at least 28 days after the first.
Are there side effects of the intradermal vaccination?
Common side effects after intradermal vaccination are:
- mild fever and tiredness
- moderate redness, swelling and itching at the injection site
Around a third of people who get the intradermal vaccination may develop a small dark mark at the injection site for some months.
This information is only a guide. If you're concerned about any side effects, speak to your health professional or phone NHS 24 on 111 for free.
Immediate action required: Phone 999 immediately if:
You've had the vaccine and:
- you have difficulty breathing
- you have prolonged fainting, confusion or unconsciousness
- your face, neck and/or tongue are swelling
These symptoms may be a sign of a serious allergic reaction and typically happen within 15 minutes of vaccination. Simple faints are much more common after vaccination.
Reporting side effects
You can report suspected side effects of vaccines and medicines through the Yellow Card Scheme:
- on their website
- by using the Yellow Card app
- by phoning 0800 731 6789 (Monday to Friday, 9am to 5pm)
Read the vaccination to help protect against mpox leaflet at Public Health Scotland
16 March 2023
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