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  • 1.  strategy for MPX vaccination

    Posted 08-23-2022 14:18
    Hi all - We just received an allotment of JYNNEOS vaccine for our RW population.  We received 80 vials but have a population of 250 plwh.  
    What is your current strategy for vaccination - intradermal for all, subcutaneous for all, intradermal if CD4 > 350/subcu for those < 350.  Thoughts?

    Sixteenth Street CHC
    Medical Director of HIV

    Brian Hilgeman
    Sixteenth Street Community Health Centers
    Muskego WI

  • 2.  RE: strategy for MPX vaccination

    Posted 08-23-2022 15:25
    We are doing intradermal Jynneos for all unless they are keloid formers or object to intradermal. We started last week and are hearing from a lot of people with persistent redness, swelling, itching, and sometimes pain at the site a week later. It is less well tolerated than subcutaneous. I tell people this means their immune system is responding as it should. Long ago we did a trial of intradermal hep B vaccine and although it worked, it sometimes left a scar. We are warning people about prolonged local reactions and possible scarring with intradermal Jynneos. Also we are only able to get 4 (and occasinally 3) doses from a vial, never 5.

    Peter Shalit
    Seattle WA

  • 3.  RE: strategy for MPX vaccination

    Posted 08-24-2022 07:30
    We are required to switch to intradermal per our health department who supplies the vaccine to us but may of course still give it subQ for persons <18 years old or with history of keloid scars. The original study showed increased rates of erythema and induration, which matches with Peter's comment. If it were up to me, I would probably do the split method of giving subQ for immunocompetent folks and ID for immunocompromised persons. However, if you don't think you will be getting more than 80 vials anytime soon, then I think doing 100% ID is reasonable in order to maximize number of persons who can get vaccinated overall.

    Caitlin Prather, PharmD, BCACP, AAHIVP, TTS
    Clinical Pharmacist in Fairfax, VA