Spain reserves the second dose of “monkeypox” vaccine for immunosuppressed

SHARE TWEET WHATSAPP Email The vaccination plan against monkeypox (“monkeypox”) contemplates the administration of a single dose until there is greater availability of drugs, except for people with immunosuppression, who will receive the second puncture at 28 days of the first to complete the guideline. These people, as well as pregnant women and children, will be given the normal amount of 0.5 ml of serum for each injection, while the rest of those over 18 years of age will be injected with the reduced dose of 0.1 ml , in accordance with the recommendations approved yesterday by the Public Health Commission. In the update of the Strategy that the Ministry of Health has made public this Tuesday, the general directors of Public Health argue that “the availability of doses of vaccines for prevention, both currently and in the short term, is limited, due to the high global demand and the difficulties in their manufacture”, since they are only developed by a single laboratory. While the acquisition of a greater number of vaccines is being negotiated, a little more than 12,000 have arrived in our country, which has reported 6,284 cases today, to which another 5,000 will be added; Given the progress of the outbreak, it was necessary to review the recommendations, both for pre-exposure and post-exposure prophylaxis. Prioritization of groups The strategy continues to prioritize people who engage in high-risk sexual practices, fundamentally but not exclusively GBMSH (gays, bisexuals and men who have sex with men) included within the indications for HIV pre-exposure prophylaxis (PrEP) or with HIV infection under follow-up in hospital consultations. As a novelty, this update establishes that those who are not already vaccinated and who meet any of the following criteria: have a high exchange of sexual partners (10 or more in the last year or more than three in the last 3 months), go to specific places to practice group sex, or have had a sexually transmitted infection in the last month. In addition, people with occupational risk prevail -such as health personnel in specialized consultations in STI/HIV care who attend people with high-risk practices and laboratory personnel who handle potentially contaminated samples- or who are in charge of disinfecting surfaces in premises where risky sexual relations are held, provided that other means of protection cannot be guaranteed. Meanwhile, in post-exposure vaccination, close contacts of confirmed cases prevail, especially those with a high risk of severe disease (child population, pregnant women and people with immunosuppression), as well as health and laboratory personnel with contact with confirmed cases and that have had some incidence in the use of PPE. Second doses From now on, a fifth of the amount that has been given subcutaneously until now will be injected intradermally, with the exception of pregnant women, those under 18 years of age and the immunosuppressed, to whom the traditional model will continue to be applied. The recommended vaccination schedule is two doses with an interval of at least 28 days but, “due to existing limitations”, the first will be administered and “the schedule will be completed until a greater number of vaccines are available” , except for people with immunosuppression, who will receive the second injection at the recommended interval. In people with a history of vaccination against smallpox “it can be considered not to administer the second dose.” If the vaccine was given after the risk contact, a single dose will be administered in the first 4 days after the first close contact, although it may be offered up to 14 days. The second “will only be offered if they meet the criteria for pre-exposure vaccination” described above and “the same recommendations established for this vaccination will be followed.” How the new strategy will be applied The vaccine vials are formulated as a single dose of 0.5 ml, from which a maximum of 5 doses of 0.1 ml can be extracted; if the last dose extracted is less than 0.1 ml, it must be discarded and it will not be completed “in any case with product from another vial”. Once thawed, the containers can be kept for 2 months between 2 and 8ºC (in a refrigerator). To minimize possible contamination by microorganisms, once the first puncture has been made in the stopper, the vial should be at room temperature for as little time as possible and in the refrigerator for a maximum of 8 hours. If people are not vaccinated consecutively, it should also be kept in a refrigerator. According to the protocol, “it is important that intradermal administration is performed by nursing staff with experience or training in this administration technique.” To optimize the use of the vaccine, the use of syringes and needles that minimize dead volume is recommended; In order to avoid a residual loss of volume in the needle, it may be used to load and administer the medication. The plan recommends reporting the expected possibility of induration and erythema or discoloration of the skin at the injection site. These local adverse reactions are self-limiting and reversible.