Monkeypox vaccination

German version / deutsche Fassung

The vaccine against smallpox is also effective against MPX ("monkeypox"). It will initially used primarily after contact with the pathogen in order to prevent the disease and severe symptoms. We have summarized the most important information here.

Last review: 01 July 2022

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The most important facts about monkeypox vaccination

  • There is a generally well-tolerated vaccine.
  • Vaccination is initially carried out primarily after contact with the pathogen.
  • Smallpox vaccination also protects against MPX (“monkey pox”).
  • There is no need for mass vaccination against MPX.
  • People with HIV can also be vaccinated against smallpox.

Is there a vaccine against MPX (monkeypox)?

In Europe, the smallpox vaccine Imvanex is approved for people over the age of 18. According to the STIKO recommendation, it can also be used to protect against MPX ("monkey pox"). It is usually well tolerated, vaccination reactions such as

  • Pain, reddening, swelling and itching at the injection site
  • Muscle pain, headache, fatigue and nausea

are common (in more than one in ten cases), but usually subside after a few days.

smallpox vaccination scar

Vaccination against smallpox was mandatory until 1976 in the FRG and until 1982 in the GDR. Many born up to that time carry this typical smallpox vaccination scar on their upper arm. (Image: Cristian Storto Fotografia | iStockphoto)

Am I protected if I have already been vaccinated against smallpox (variola)?

According to the RKI, vaccination against smallpox (variola), which was mandatory in West Germany until 1976 and in East Germany until 1982, also offers protection against MPX ("monkeypox"). Nevertheless, a subsequent vaccination after contact with the pathogen (post-exposure prophylaxis) or a preventive vaccination for people who are particularly at risk is also recommended for people who have previously been vaccinated against smallpox. For them, however, one vaccine dose is usually sufficient instead of two.

Who is recommended to get vaccinated against MPX (“monkeypox”)?

STIKO distinguishes between two different reasons for vaccination:

  1. Subsequent vaccination (post-exposure prophylaxis after being exposed to the pathogen) preventive vaccination.

1. Subsequent vaccination (post-exposure prophylaxis)

A subsequent vaccination is recommended above all

  • after close physical contact via skin or mucous membranes with a person suffering from MPX (e.g. contact during sex or when living together)
  • after contact in medical care without adequate personal protective equipment
  • after unprotected contact by laboratory personnel with non-inactivated MPX material

2. preventive vaccination

In Germany, MPX cases have so far been found primarily in men who have sex with men (MSM). MSM with frequently changing partners have an increased risk and should therefore be given special protection by vaccination to prevent further spread.

However, the vaccine is scarce at the beginning, so subsequent vaccinations should have priority. A vaccination concept is currently being worked on (status: June 24th, 2022).

Vaccination is also recommended for laboratory personnel who come into contact with infectious samples and are considered at risk of infection.

I would like to be vaccinated against "monkeypox". How do I proceed?

The vaccination concept has not yet been worked out (status: June 24th, 2022). People for whom a vaccination recommendation applies should therefore contact their family doctor or the local health department. It is then checked whether and when the prerequisites for vaccination exist.

What is the schedule for subsequent vaccination against MPX ("monkeypox")?

The first vaccine dose for post-exposure prophylaxis (vaccination after contact with the pathogen) should be given as early as possible within two weeks.

According to the American health authority CDC, an initial vaccination within four days after contact (exposure) can prevent disease. If the first dose is given on days 5 to 14 after exposure, vaccination can prevent a severe course.

Starting four weeks after the first vaccination, the primary immunization is completed with a second dose.

Anyone who has already been vaccinated against smallpox and does not have an immune deficiency usually only needs one dose of vaccine.

Those who have been vaccinated against smallpox and have a weakened immune system should also receive a second dose. This also applies to people with HIV, even if they have a good immune status.

The vaccine is usually injected under the skin in the upper arm.

What is the schedule for preventive vaccination against MPX ("monkeypox")?

Note: Since the vaccine is scarce for the time being, the STIKO recommends giving priority to subsequent vaccinations.

Two vaccine doses with a gap of at least four weeks between them are usually required for the preventive vaccination as well.

Anyone who has already been vaccinated against smallpox and does not have an immune deficiency usually only needs one dose of vaccine as a booster vaccination.

Those who have been vaccinated against smallpox and have a weakened immune system should also receive a second dose. This also applies to people with HIV, even if they have a good immune status.

Can people with HIV also get vaccinated?

People with HIV can also be vaccinated with Imvanex as long as their number of CD4 cells is at least 100. However, it has been observed in people with a weaker or weakened immune system (100 to 750 helper cells per microliter of blood plasma) that the vaccination effect may be reduced.

Should everyone be vaccinated against monkeypox (MPX) now?

The RKI currently assumes that the majority of the population is hardly at risk of becoming infected with the monkeypox virus (MPXV). Vaccination is therefore only recommended for people at increased risk.