Assessment of intradermal dosing of the smallpox vaccine for monkeypox
Published 22 August 2022
© Crown copyright 2022
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/monkeypox-assessment-of-intradermal-dosing-of-the-smallpox-vaccine/assessment-of-intradermal-dosing-of-the-smallpox-vaccine-for-monkeypox
Dear colleagues
We are writing to let you know that 3 NHS sites – the Chelsea and Westminster NHS Foundation Trust, the Central and North West London NHS Foundation Trust, and Locala Health and Wellbeing in Greater Manchester – will begin small scale piloting of intradermal dosing of the vaccine used to combat monkeypox in the coming days.
This dosing approach was recently approved in the US by the Federal Drug Administration (FDA) for its monkeypox response, based on the scientific evidence that 0.1ml of the current vaccine administered intradermally provides the same immunological response to 0.5ml administered subcutaneously or intramuscularly. Read the study report. The European Medicines Agency Emergency Task Force has also approved the approach.
The UK Health Security Agency (UKHSA) and the Joint Committee on Vaccination and Immunisation (JCVI) have reviewed the same evidence and both agree that changing the method of administration will potentially enable an up to 5-fold increase in the number of people that can be offered vaccination with the same amount of vaccine and the same immunological protection.
The study also shows that local reactions such as erythema, induration and itchiness at the injection site are more commonly reported in intradermal administration, compared with subcutaneous administration. However, pain at the injection site was less commonly reported and systemic reactions were generally similar across both groups.
We are working with these 3 clinics to assess the operational feasibility of using intradermal injections, including staffing models, vaccination throughput, volume and patient experience. The clinics will also signpost recipients to complete online diary cards to monitor any adverse events. We will continue to update you on progress, learning and evaluation.
In addition to the proposal for intradermal dosing, the JCVI also supports UKHSA’s recommendation to reserve the post-exposure protective offer of vaccination for contacts at highest risk of severe illness at this time. We are therefore temporarily recommending that the offer of post-exposure vaccination should only be given to children under the age of 5 years, people with immunosuppression and pregnant women. These individuals will continue to be offered the standard 0.5ml dose of the vaccine (subcutaneously or intramuscularly) until we have completed the evaluations and while awaiting further data.
Finally, I would like to thank you all – our Director of Public Health colleagues and all those working in sexual health services and across the NHS – for your hard work in responding to this monkeypox outbreak to date.
Yours sincerely
Professor Dame Jenny Harries
Chief Executive, UKHSA