The Ministry of Health has updated the Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers (Version 3.0 – September 30, 2022) to reflect expanded eligibility for Imvamune®.
The following is a summary of the updates:
Use of Imvamune® in Ontario
- Given the current epidemiology in Ontario, Imvamune® is being offered as a two-dose primary series, with at least 28 days between first and second doses for individuals currently eligible for pre-exposure or post-exposure vaccination.
- The following groups are now eligible for first doses of Imvamune® vaccine for pre-exposure prophylaxis:
a. Two-spirited, non-binary, transgender, cis-gender, intersex, or gender-queer individuals who self-identify or have sexual partners who self-identify as belonging to the gay, bisexual, pansexual and other men who have sex with men (gbMSM) community AND at least one of the following:
- Had a confirmed sexually transmitted infection within the last year;
- Have or are planning to have two or more sexual partners or are in a relationship where at least one of the partners may have other sexual partners;
- Have attended venues for sexual contact (i.e. bath houses, sex clubs) recently or may be planning to, or who work/volunteer in these settings; or
- Have had anonymous sex (e.g. using hookup apps) recently or may be planning to; and/or
- Are a sexual contact of an individual who engages in sex work.
b. Individuals who self-identify as engaging in sex work or are planning to, regardless of self-identified sex or gender.
c. Household and/or sexual contacts of those identified for PrEP eligibility in parts (a) and (b) above AND are moderately to severely immunocompromised or pregnant may be at higher risk for severe illness from a monkeypox infection may be considered for PrEP and should contact their healthcare provider (or their local public health unit) for more information.
d. Research laboratory employees working directly with replicating orthopoxviruses, are eligible to receive two doses of Imvamune® vaccine at least 28 days apart as PEP or PrEP if there is an ongoing risk of exposure. For PrEP, referral letter is required.
Individuals who have had a Previous Monkeypox (MPOX) Infection:
- Individuals who have been a confirmed case of MPOX in the current outbreak are NOT recommended to receive the Imvamune® vaccine at this time; this is based on the limited utility of the vaccine given that these persons are expected to have natural immunity due to recent infection.
Individuals with History of Previous Smallpox Vaccine:
- Individuals eligible for Imvamune® as PreP or PEP who previously received either an older generation replicating (live) smallpox vaccine or Imvamune® vaccine can be re-vaccinated:
a. For individuals with a history of receiving 1 dose of a live smallpox vaccine, a single dose of Imvamune® is recommended.
b. For individuals who completed a 2-dose series of Imvamune® more than 2 years ago, a single booster dose of Imvamune® is recommended.
c. For individuals who completed a 2-dose series of Imvamune® within the last 2 years, no further doses are recommended.