Rao Agam K, Minhaj Faisal S, Carter Rosalind J, Duffy Jonathan, Satheshkumar Panayampalli S, Delaney Kevin P, Quilter Laura A S, Kachur Rachel E, McLean Catherine, Moulia Danielle L, Kuhar David T, de Perio Marie A, Spicknall Ian H, Bell Beth P, Sánchez Pablo J, Hutson Christina L, Cohn Amanda C
MMWR Morb Mortal Wkly Rep. 2025 Jun 19;74(22):385-392. doi: 10.15585/mmwr.mm7422a3.
Since the worldwide eradication of smallpox in 1980, orthopoxvirus vaccines had been used nearly exclusively by persons at risk for occupational exposure to orthopoxviruses, including Monkeypox virus, the virus that causes mpox. However, during recent years, the epidemiology of mpox has been changing in countries where the animal reservoirs are believed to live and where endemic transmission has been known to occur for decades. CDC issues outbreak-specific vaccination recommendations based on the epidemiology at the time specific cases or clusters are identified; however, because of the increased risk for U.S. mpox outbreaks, the Advisory Committee on Immunization Practices (ACIP) reviewed results from a previously performed modified Grading of Recommendations Assessment, Development, and Evaluation of the 2-dose JYNNEOS (smallpox and mpox vaccine, live, nonreplicating) vaccination series and an Evidence to Recommendations (EtR) framework addressing multiple domains (e.g., benefits, harms, and target population values and preferences). Based on this assessment, ACIP recommended the use of JYNNEOS (a live, replication-deficient vaccinia virus vaccine) for persons aged ≥18 years at risk for mpox during an mpox outbreak (irrespective of clade). Because the cause of future mpox outbreaks and the populations affected by these outbreaks remain uncertain, public health authorities will continue to issue outbreak-specific vaccination guidance when outbreaks occur. A clade IIb mpox outbreak that began in 2022 continued to cause substantial morbidity and mortality >1 year later. Although CDC had issued outbreak-specific vaccination guidance, it was anticipated that the outbreak would be protracted. For this reason, ACIP reviewed a second EtR framework about outbreaks and in 2023 recommended JYNNEOS for persons aged ≥18 years at risk for acquiring mpox during the multinational clade IIb outbreak. As of 2025, cases continue to occur; however, the future need for the recommendation will be reassessed as the outbreak evolves. Mpox vaccination is not routinely recommended for health care personnel during mpox outbreaks, including during the ongoing clade IIb outbreak.
自1980年天花在全球范围内被消灭以来，正痘病毒疫苗几乎仅用于有职业暴露于正痘病毒风险的人群，包括猴痘病毒（即导致猴痘的病毒）。然而，近年来，在据信存在动物宿主且已知有地方流行传播数十年的国家，猴痘的流行病学情况一直在变化。美国疾病控制与预防中心（CDC）根据特定病例或聚集性病例被发现时的流行病学情况发布针对疫情的疫苗接种建议；然而，由于美国猴痘疫情风险增加，免疫实践咨询委员会（ACIP）审查了先前进行的2剂次JYNNEOS（天花和猴痘疫苗，活的、非复制型）疫苗接种系列的改良推荐评估、制定和评价结果，以及一个涉及多个领域（如益处、危害以及目标人群的价值观和偏好）的证据到推荐（EtR）框架。基于这一评估，ACIP建议在猴痘疫情期间，对于年龄≥18岁且有猴痘感染风险的人群（无论进化枝）使用JYNNEOS（一种活的、复制缺陷型痘苗病毒疫苗）。由于未来猴痘疫情的成因以及受这些疫情影响的人群仍不确定，公共卫生当局在疫情发生时将继续发布针对疫情的疫苗接种指导。始于2022年的IIb进化枝猴痘疫情在1年多后仍继续导致大量发病和死亡。尽管CDC已发布针对疫情的疫苗接种指导，但预计疫情将持续很长时间。出于这个原因，ACIP在2023年审查了关于疫情的第二个EtR框架，并建议在多国IIb进化枝疫情期间，对于年龄≥18岁且有感染猴痘风险的人群使用JYNNEOS。截至2025年，病例仍在持续出现；然而，随着疫情的发展，将重新评估该推荐的未来需求。在猴痘疫情期间，包括在当前的IIb进化枝疫情期间，通常不建议医护人员接种猴痘疫苗。
