Mpox state-wide protocol for the supply and administration of the JYNNEOS vaccine.
1.3 Training requirements 3.4 Record keeping for LHD mass vaccination clinics 4.3 Locations where vaccine can be administered expanded 4.4 Addition of intradermal route of administration 7. Revised to include intradermal route, additional precautions for all Appendix F included – post-exposure prophylaxis
2.1 Electronic consent via VAM3.3 Movement of vaccine3.4 VAM downtime4.1 Vaccine eligibility4.3 Additional designated clinics6. Additional sites for ID vaccination7.1 Administration of adrenaline by nurses in the event of an adverse event.
Monkeypox renamed to mpox 3.4. Removal of the vaccination administration management system (VAM) and record keeping requirements updated 4.3. Updated designated Vaccine sites
2.2. Update of prescriber setting requirements to Requirements for vaccine administration
4.2. Additional groups for vaccination updated
4.3. Updated designated Vaccine sites
This protocol provides information on JYNNEOS, a vaccine indicated for the prevention of smallpox and mpox disease in adults 16 years of age and older. JYNNEOS has been made available in Australia under Section 18A of the Therapeutic Goods Act 1989 (Cth).
Vaccination will be offered to those who are determined to be at high risk of mpox infection, or susceptible to detrimental sequelae should they develop disease. At the direction of the NSW Chief Health Officer (CHO), vaccination may be advised for those at occupational risk of smallpox or mpox exposure, including staff working in high level biocontainment facilities or laboratory workers who are likely to be in close contact / care of patients or handling biohazardous samples from infected patients.
This protocol is for use by health practitioners who have been identified by the CHO as vaccination providers and will order or administer the Vaccine. Compliance with this protocol is mandatory.
Authorised settings for administration of the Vaccine are limited to those designated by the CHO. Vaccination in other settings is not legally permitted.
This protocol contains protocols for:
The requirements set out in this protocol are directions of the CHO for the purposes of the Therapeutic Goods (Medicines – MVA-BN) (Emergency) Exemption) (No.3) 2022 (as amended from time to time).
The following training requirements must be met by health practitioners prior to administration of the JYNNEOS vaccine:
Health practitioners operating under this Protocol must:
All prescribers and vaccine administrators must ensure that consent has been obtained from the patient.
An authorised nurse/midwife immuniser may supply and administer JYNNEOS vaccine.
JYNNEOS vaccine may be prescribed and administered by a medical practitioner.
Registered nurses, who are not authorised nurse/midwife immunisers, may administer at the direction and under the authority of a medical practitioner or under a medication standing order allowing the administration of the Vaccine.
All designated vaccine locations must have processes in place to periodically assess compliance with this pProtocol and take appropriate action where any aspect of non-compliance is identified. The CHO may request evidence of the compliance with this Protocol and relevant records which all vaccination settings are required to keep under this Protocol.
JYNNEOS is a 3rdgeneration smallpox vaccine. It is a live vaccine produced from the strain modified vaccinia Ankara-Bavarian Nordic (MVA-BN), an attenuated, non-replicating orthopoxvirus, and cannot replicate in the human body. The Vaccine is expected to protect against both the smallpox and monkeypox viruses.
JYNNEOS is supplied with a package of 20 single-dose vials. The dimensions of the pack are: L: 9.8 x W: 12.90 x H: 4.7 cm.
JYNNEOS must be supplied and used ONLY at the direction of the CHO in accordance with this Protocol. The requirements set out in this Protocol are the directions of the CHO for the purposes of the Therapeutic Goods (Medicines – MVA-BN) (Emergency) Exemption) (No.3) 2022 (as amended from time to time).
Vaccination with JYNNEOS may be used for both primary preventative vaccination (PPV) and post-exposure preventative vaccination (PEPV). People at high risk of mpox infection who have received a smallpox vaccine dose more than ten years prior are recommended to receive a booster dose.
JYNNEOS must only be administered by subcutaneous injection. The preferred site is over the deltoid.
If a vaccine course was commenced using the intradermal route for the first dose, it can be completed by subcutaneous injection for the second dose.
For information on JYNNEOS usage please refer to the Australian Immunisation Handbook (appendix D).
JYNNEOS will either be stored frozen or at +2°C to +8°C prior to distribution. It should be stored in its original packaging to protect from light. Once de-frosted it must not be re-frozen.
JYNNEOS will be distributed at the direction of the CHO to locations within NSW.
For distribution, the Vaccine will be transported either frozen or at +2°C to +8°C to designated vaccination providers or the hospital pharmacy.
If received frozen, the vaccine can be stored frozen at -20°C or -50°C. Otherwise the Vaccine must be stored at +2°C to +8°C, it must not be re-frozen. It is stable for 24 weeks if it is brought to this temperature directly from prior storage at -50°C. [Note: storage for 24 weeks at +2°C to +8°C is based on advice from officers of the Commonwealth Department of Health, and it is different to advice in the JYNNEOS® Package Insert FDA (appendix A) which advises that once thawed, the Vaccine may be kept at +2°C to +8°C (+36°F to +46°F) for 12 hours.]
If frozen, before use the Vaccine must be thawed at room temperature for approximately 10 minutes. Vials must not be re-frozen once they have been thawed.
The Vaccine must not be used after the expiration date shown on the vial label, nor beyond 24 weeks after thawing from -50°C.
The Vaccine can only be moved from one provider to another in accordance with the conditions set out in the "Licence to supply by wholesale poisons and restricted substances – Licence No LHD 005" dated 20 December 2022 (as amended from time to time) (Licence). The Licence requires the licensee to comply with the directions regarding the Vaccine as set out in this Protocol (as amended from time to time at the direction of the Chief Health Officer).
Cold chain breaches should be reported to the public health unit (PHU) who must send the details of the breach to MoH-VaccReports@health.nsw.gov.au for further advice.
Vaccine administration must be recorded into the eMR and / or other specific vaccination record for loading the information up to the Australian Immunisation Register (AIR). Patients without a Medicare Card can be registered via the Individual Health Identifier (IHI) process. If Vaccine administration is not recorded on AIR, clinics must be able to provide a record of Vaccine use.
Suspected adverse events following immunisation (AEFI) can be reported by contacting the local PHU on 1300 066 055 or by reporting it directly to the TGA. It is advised to report all uncommon, serious or unexpected AEFI. The form can be found in Appendix H. More information about AEFI.
The CHO will keep records relating to the quantity, location, storage, transportation, supply, use and disposal of the Vaccine. Providers will keep a record of Vaccine received, used and disposed and these will be provided to the CHO upon request.
Unusable Vaccine and Vaccine waste products will be disposed of in designated clinical waste bins for destruction. The CHO will direct unused vaccine to another designated vaccination provider of increased need.
Primary preventative vaccination (PPV) against mpox is recommended for groups at risk of exposure. This includes:
Post-exposure preventative vaccination (PEPV) is recommended for anyone categorised by public health authorities as a high-risk mpox contact within the past 14 days. Risk assessment for people exposed to mpox (contacts) who are being assessed for PEPV is stratified by high, medium or low risk.
This is applicable as at the date of this Protocol; however, it is subject to revision.
Vaccination (including for PEPV) can occur at any of the following locations:
PEPV can also occur at any Public Hospital. The PHU of the LHD is responsible for determining how PEPV can be delivered safely in the Public Hospital, in consultation with the LHD Director of Clinical Governance, and the relevant facility general manager. These pathways must be developed in advance and may include the direction of the person to an Emergency Department.
For additional guidance on the provision of PEPV refer to the Post exposure prophylaxis (PEPV for mpox in NSW protocol at Appendix F)
Providers should maintain familiarity on any new advice from the Australian Technical Advisory Group on Immunisation (ATAGI), Australian Immunisation Handbook or Therapeutic Goods Administration (TGA) regarding JYNNEOS vaccine.
Anaphylaxis must be managed as per the Anaphylaxis after vaccination guidance, found in Appendix F.
In addition, advice in the Australian Immunisation Handbook (Appendix D) must be followed.
Below is the protocol for administration of the JYNNEOS smallpox/mpox vaccine for people 16 years of age and over, in authorised settings.
If the vaccine is received frozen, it must be allowed to thaw at room temperature before administration. Once thawed, it should not be frozen again.
Store vials at +2 to +8 oC. (Refrigerate. Do not freeze. Discard after 24 weeks if defrosted from -50°C)
One vial provides one dose subcutaneously of 0.5 mL. Once thawed, JYNNEOS is a milky, light yellow to pale white coloured suspension. It should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.
Always maintain cold chain storage and protect from light.
see section 4.1
Hypersensitivity to the active substance or to any of the excipients (tromentalmol, sodium chloride, water for injections) or trace residues (chicken protein, benzonase, gentamicin and ciprofloxacin).
0.5 mL suspension administered subcutaneously for patients 16 years and older.
Post-exposure preventative vaccinatio: a single dose
Primary preventative vaccination: two doses - a second dose should be administered at least 4 weeks after a first dose.
Swirl the vial gently before use for at least 30 seconds.
Subcutaneous injection:
Withdraw a dose of 0.5 mL into a sterile syringe for injection.
Administer JYNNEOS by subcutaneous injection, preferably into the upper arm (in the region of the deltoid muscle).
No interaction studies with other vaccines or medicinal products have been performed.
JYNNEOS has a good safety profile. The main adverse events seen in clinical trials include local injection site irritation (increased frequency in people with atopic dermatitis), myalgia, fatigue, fever, chills, nausea and headache.
For further information on adverse effects, please refer to the product information.
If expert advice is needed, the health practitioner can contact the NSW Immunisation Specialist Service (NSWISS) on 1800 679 477.
This Protocol allows for administration of the Vaccine where the patient does not have a relevant precaution or contraindication to treatment. Where a relevant precaution or contraindication exists, treatment (JYNNEOS® vaccination) can only proceed under the direct authority of a medical practitioner.
The following steps must be followed when preparing for vaccine administration.
All assessments and details relating to the administration of the vaccine must be documented.
