US may expand monkeypox vaccine eligibility to men with HIV

U.S. officials are considering broadening recommendations on who gets vaccinated against MPX, possibly to include many men with HIV or those recently diagnosed with other sexually transmitted diseases.

Driving the discussion is a study released Thursday showing that a higher-than-expected share of MPX infections are in people with other sexually transmitted infections.

Dr. John T. Brooks, chief medical officer for the Centers for Disease Control and Prevention’s MPX outbreak response, said the report represents a “call to action.”

Brooks told the Associated Press on Thursday that he expected vaccine recommendations to expand and that “the White House, together with CDC, are working on a plan for what that will look like.”

Currently, the CDC recommends the vaccine to people who are a close contact of someone who has MPX; people who know a sexual partner was diagnosed with the disease in the past two weeks; and gay or bisexual men who had multiple sexual partners in the last two weeks in an area with known virus spread.

Shots are also recommended for healthcare workers at high risk of exposure.

The new CDC report suggested that infections in people with HIV and other STDs may be a bigger issue then previously realized.

The report looked at about 2,000 MPX cases from four states and four cities from mid-May to late July. It found that 38% of those with MPX infections had been diagnosed with HIV, far higher than their share of the population among men who have sex with men.

The study also found that 41% of MPX patients had been diagnosed with an STD in the preceding year. And about 10% of those patients had been diagnosed with three or more different STDs in the prior year.

There were racial differences. More than 60% of Black Americans with MPX had HIV, compared with 41% of Latinos, 28% of whites and 22% of Asian Americans.

Jason Farley, an infectious disease expert at the Johns Hopkins School of Nursing, said men of color who have sex with men should be at the front of the line for MPX vaccine doses. Within those racial and ethnic groups, the next priority should be anyone living with HIV or was recently diagnosed with an STD, he said.

The study has several limitations, including that the data may not be nationally representative, the authors said.

Brooks said the findings could lead to vaccines being recommended for people with recent STD infections, people with HIV, people taking pre-exposure prophylaxis (PrEP) medications to prevent HIV infection and, possibly, prostitutes.

Discussions of expanding eligibility will have to take into account supply of the two-dose vaccine. And any substantial expansion of MPX vaccination recommendations may also be subject to review by CDC’s outside vaccine advisors, health officials say.

Also on Thursday, the CDC sent a letter to state and local health departments that said federal funds for HIV and STD prevention can also now be used against MPX. Cases in the U.S. seem to be declining, officials say.

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