At a glance
- ACIP recommends persons who are at continued risk* for occupational exposure to replication competent orthopoxviruses like vaccinia or cowpox receive booster doses of JYNNEOS after the primary JYNNEOS series.
Summary
Question: Should persons who are at continued risk* for occupational exposure to replication competent orthopoxviruses like vaccinia or cowpox receive booster doses of JYNNEOS after the primary JYNNEOS series
Population: Persons who are at risk for occupational exposure to replication competent orthopoxviruses like vaccinia or cowpox.
Intervention: Booster with JYNNEOS
Comparison(s): No booster
Outcome: 1) Prevention of disease 2) Severity of disease 3) Severe adverse events 4) Myo-/peri-carditis
*Continued risk refers to “real” risk due to occupational work performed
Background
The ACIP recommends booster doses of ACAM 2000 every 3 years for persons at occupational risk for virulent replicating orthopoxviruses (e.g., variola virus and monkeypox) and at least every 10 years for persons at occupational risk for less virulent non-replicating orthopoxviruses (e.g., cowpox and variola). Because ACAM2000 was licensed only for prevention of smallpox disease, the package insert only makes recommendations for persons at continued risk for smallpox disease (i.e., booster doses every 3 years).
JYNNEOS is licensed for prevention of both smallpox and monkeypox disease. The package insert describes dosage and administration of the primary vaccination series but does not indicate whether a booster dose should be given or how frequently, possibly because this vaccine has only recently been licensed. ACAM2000 and JYNNEOS are not the same vaccine so recommendations about booster frequency for one may not be appliable to the other. However, there is no indication that JYNNEOS is different from ACAM2000 in not needing boosters. Boosters for persons working with non-replicating orthopoxviruses are expected to be less frequent than those for persons working with smallpox and monkeypox.
Problem
Criteria | Work Group Judgements | Evidence | Additional Information |
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Is the problem of public health importance? | Yes |
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Benefits and Harms
Criteria | Work Group Judgements | Evidence | Additional Information |
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How substantial are the desirable anticipated effects? | Moderate |
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How substantial are the undesirable anticipated effects? | Minimal |
No known harms |
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Do the desirable effects outweigh the undesirable effects? | Favors interventional |
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What is the overall certainty of this evidence for the critical outcomes? | Effectiveness of the intervention: Very low |
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Values
Criteria | Work Group Judgements | Evidence | Additional Information |
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Does the target population feel that the desirable effects are large relative to undesirable effects? | Probably yes |
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Is there important uncertainty about or variability in how much people value the main outcomes? | Probably not important uncertainty or variability |
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Acceptability
Criteria | Work Group Judgements | Evidence | Additional Information |
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Is the intervention acceptable to key stakeholders? | Yes |
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Resource Use
Criteria | Work Group Judgements | Evidence | Additional Information |
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Is the intervention a reasonable and efficient allocation of resources? | Probably yes |
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Equity
Criteria | Work Group Judgements | Evidence | Additional Information |
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What would be the impact on health equity? | Probably no impact |
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Feasibility
Criteria | Work Group Judgements | Evidence | Additional Information |
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Is the intervention feasible to implement? | Probably yes |
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Balance of consequences
Desirable consequences probably outweigh undesirable consequences in most settings
Is there sufficient information to move forward with a recommendation? Yes.