Intended for healthcare professionals


Monkeypox: Gay and bisexual men with high exposure risk will be offered vaccine in England

BMJ 2022; 377 doi: (Published 22 June 2022) Cite this as: BMJ 2022;377:o1542
  1. Elisabeth Mahase
  1. The BMJ

Gay and bisexual men at high risk of exposure to monkeypox will be offered the smallpox vaccine (Imvanex) to help control the recent monkeypox outbreak, the UK Health Security Agency (UKHSA) has said.1

The updated strategy, endorsed by the Joint Committee on Vaccination and Immunisation (JCVI) and published on 22 June, says that eligibility will depend on a number of factors but will be similar to the criteria for HIV pre-exposure prophylaxis (PrEP). Additionally, clinicians will be able to recommend vaccination for someone who has multiple partners, participates in group sex, or attends “sex on premises” venues.

From 6 May to 20 June 2022, 793 cases of monkeypox had been confirmed in the UK. Of these, 18 were in Scotland, three in Northern Ireland, six in Wales, and 766 in England.2

More healthcare staff will also be eligible for the vaccine, as the list now includes staff working in hospitals outside high consequence infectious disease (HCID) units designated to care for monkeypox patients, as well as staff in laboratories where pox viruses are being handled.

Until now the vaccine has been available only to close contacts of people with a monkeypox diagnosis, to health workers set to care for patients with monkeypox, and to staff working in sexual health services who have may have assessed suspected cases.3

The UKHSA has said that although anyone can contract monkeypox, data from the latest outbreak show higher levels of transmission in sexual networks of gay, bisexual, and other men who have sex with men. Additionally, although the virus is not defined as a sexually transmitted infection, it can be passed on by close and intimate contact that occurs during sex.

Mary Ramsay, UKHSA head of immunisation, said, “Our extensive contact tracing work has helped to limit the spread of the monkeypox virus, but we are continuing to see a notable proportion of cases in gay, bisexual, and other men who have sex with men. By expanding the vaccine offer to those at higher risk, we hope to break chains of transmission and help contain the outbreak.”

NHS England is expected to provide information soon on how eligible people will be able to get vaccinated.

Empowering communities

Commenting on the strategy, Paul Hunter, professor in medicine at the University of East Anglia, said, “Offering vaccine to men who have sex with men [MSM] at high risk of exposure is the right thing to do.

“I would just add that monkeypox is spreading because of frequent multiple close and intimate contacts. Even though we are not seeing much spread outside of MSM, monkeypox doesn’t care whether those contacts are same sex or mixed sex, and so I think we should be ready to start offering the vaccine to female sex workers as well.”

Alex Sparrowhawk, health promotion specialist at the Terrence Higgins Trust charity, said, “This targeted vaccination programme is a positive move forward while the data still shows monkeypox is disproportionately affecting gay and bisexual men in the UK.

“We encourage everyone, regardless of your sexuality, to be vigilant about new spots, ulcers, and blisters, and are continuing to closely monitor the latest data in order to play our part in providing the latest guidance and health information on monkeypox to empower the communities most affected to best protect their health.”

Robbie de Santos, director of communications and external affairs at the charity Stonewall, said, “While we know anyone can catch monkeypox, we welcome the vaccine being offered to those gay and bi men who are eligible, who are currently at a higher risk of getting the virus. It is important that gay and bi men get the vaccine when offered, to protect themselves and others.”