Mpox Vaccination at the Counter: From Outbreak Reaction to Routine Prevention

This article was sponsored by Bavarian Nordic

For many pharmacists, the mpox vaccine may be a memory from the 2022 global outbreak, something to order and stock when cases surge. However, the CDC recommends that mpox vaccination should be included as part of routine sexual health care, alongside the prevention conversations that already happen around HIV PrEP and other sexually transmitted infections.¹

The mpox vaccine appears on the Advisory Committee on Immunization Practices (ACIP) adult immunization schedule, recommended for adults 18 and older who are at risk for mpox.² That placement reflects a shift from outbreak response toward routine, ongoing prevention. For appropriate patients, the relevant moments to discuss mpoxvaccination may already occur during a typical pharmacy day. In fact, the mpox vaccine can be given pre- or post- exposure.³

Why this still matters

The 2022 outbreak in the United States was driven by clade II of the virus, which, according to the CDC, remains ongoing at low levels, indicating that mpox continues to be a public health concern. Another clade of the virus, clade I, has caused outbreaks in several countries and has been identified in some U.S. travelers, as well as individuals linked to travelers to affected areas. The CDC’s travel guidance recommends mpox vaccination for people traveling to areas with ongoing clade I or new clade II outbreaks. The specific locations change over time, and current information is maintained on the CDC’s website. Vaccination is expected to protect against mpox regardless of clade, so the distinction does not change which patients may benefit.⁴

Mpox has not gone away. From the start of the 2022 outbreak through January of 2026, more than 37,000 cumulative cases have been reported in the United States⁵ and over 179,000 worldwide⁶, while new cases continue to occur each year.⁴

At the same time, most people at risk are not fully vaccinated. Based on 2023 data, although more than 1.2 million mpox vaccine doses have been administered in the United States, only an estimated 25% of the at-risk population has completed vaccination, meaning roughly three in four people at-risk remain not fully vaccinated.⁷

This gap in vaccination coverage has implications for ongoing transmission risk. The CDC’s forecasting adds local context: the size of a potential outbreak varies with a county’s population immunity from vaccination and prior mpox case rates. Where population immunity is greater than 50%, outbreaks are expected to be smaller. In populations with immunity less than 50%, vaccinating more people against mpox can reduce the risk of an outbreak.¹

Current CDC guidance⁸

Strategies outlined by the CDC

CDC guidance positions mpox vaccination as part of routine sexual health care rather than a stand‑alone intervention. The agency supports offering the vaccine during the same visit as commonly administered immunizations, such as influenza or COVID‑19 vaccines.¹

This approach allows pharmacists and other providers to incorporate mpox vaccination into familiar touchpoints, including seasonal vaccination campaigns and general preventive care visits.

The CDC also advises offering the mpox vaccine when discussing HIV PrEP, HIV PEP, or bacterial STI prophylaxis (doxy-PEP).¹ According to the CDC, mpox vaccination is recommended for all unvaccinated people with HIV that have or anticipate potential exposure to mpox.⁹

Regardless of whether or not immunization is an option for the patient, behavioral strategies can be discussed to minimize risk.¹

* Illustrative patient statements that may signal potential mpox risk assessment and consideration for vaccination.

Questions patients may ask

A few questions may come up at the counter, and information from the CDC can help provide a clear way to answer them.

“Didn’t that end?” The 2022 surge eased, but the virus did not disappear, and vaccination remains recommended for adults at risk for mpox.¹⁰

“Is there a vaccine?” Yes. A vaccine is approved to prevent mpox and is recommended for adults with certain risk factors, and since it’s listed as a routine immunization, it is covered by most insurance plans.^8,11,12

A note on scope of practice

Requirements for administering the mpox vaccine vary by state and may depend on state laws, regulations, protocols, standing orders, and collaborative practice agreements. Current requirements are available from state laws and state board of pharmacy regulations.¹³

More resources
Scan to learn more about mpox and how vaccination can prevent infection and disease.

References

1. Public health guidance for mpox. CDC. Updated February 10, 2026. https://www.cdc.gov/monkeypox/php/public-health-strategy/index.html
2. Adult immunization schedule by age (addendum updated July 2, 2025). CDC. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
3. Vaccine for Monkeypox Prevention in the United States. CDC. Updated Mar. 10, 2026 https://www.cdc.gov/monkeypox/hcp/vaccine-considerations/index.html
4. Mpox in the United States and around the world: current situation. CDC. Updated June 1, 2026 https://www.cdc.gov/monkeypox/situation-summary/index.html
5. U.S. Case Data: Mpox. CDC. https://www.cdc.gov/monkeypox/data-research/cases/index.html
6. Mpox Status Update: American Region Multi-Country Activity. Updated February 27, 2026. https://www.paho.org/en/documents/situation-report-mpox-multi-country-outbreak-region-americas-february-2026
7. Vaccination coverage among persons at risk for mpox — United States, May 22, 2022–January 31, 2023. MMWR Morb Mortal Wkly Rep. https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a4.htm
8. Vaccine for mpox prevention in the United States. CDC. Updated March 10, 2026. https://www.cdc.gov/monkeypox/hcp/vaccine-considerations/index.html
9. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. NIH. updated December 16, 2024. https://www.ncbi.nlm.nih.gov/books/NBK586304/
10. Clade II Monkeypox Outbreaks | Monkeypox | CDC. Updated Jan. 22, 2026 https://www.cdc.gov/monkeypox/outbreaks/2022/index-1.html
11. JYNNEOS Coverage Fact Sheet. CDC. Updated October, 2024. JYNNEOS-Coverage-Fact-Sheet-10-24.pdf
12. Centers for Medicare & Medicaid Services Overview of Vaccine Coverage. CDC. Updated December 2025.CMS-PPT-Template-Baltimore Building
13. Pharmacist and pharmacy technician vaccination authority. NASPA. January 3, 2025. https://naspa.us/resource/2024-pharmacist-immunization-authority/

US-POX-MA 2600001 - August 2026