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An excellent resource for vaccine contraindications and precautions is the CDC online resource, “General Best Practices for Immunization”. A table in the Contraindications and Precautions chapter has a listing for all routine vaccines in the United States available at www.cdc.gov/vaccines/hcp/imz-best-practices/contraindications-precautions.html. In addition, a table of contraindications and precautions is provided in the appendix of current CDC recommended adult and child/adolescent immunization schedules, available at www.cdc.gov/vaccines/hcp/imz-schedules.
The live smallpox (vaccinia) vaccine, ACAM2000 (Emergent BioSolutions) and the non-replicating, live smallpox and mpox vaccine, Jynneos (Bavarian Nordic) should be brought to room temperature before use, according to the package inserts for these two products.
With the exception of these two vaccines, there is no recommendation to wait until a vaccine reaches room temperature before administration. The vaccine should be administered as soon as it is prepared.
CDC has included in the Vaccine Storage and Handling Toolkit an addendum that contains additional details concerning special considerations for mpox vaccines. The toolkit, mpox addendum, and additional CDC resources are available for download or viewing at www.cdc.gov/vaccines/hcp/storage-handling/index.html.
Routine administration of all age-appropriate doses of vaccines at the same visit, also known as coadministration, is acceptable for children, adolescents, and adults if there are no contraindications at the time of the healthcare visit. COVID-19 vaccine may also be coadministered with nirsevimab or clesrovimab (RSV preventive antibody for infants), given in different syringes and at different anatomical sites. COVID-19 vaccines may also be given at any interval before or after any other vaccination.
There are special considerations for orthopoxvirus vaccination. There is no required minimum interval between receiving a dose of any COVID-19 vaccine and an orthopoxvirus vaccine, either Jynneos or ACAM2000 vaccine (e.g., for mpox prevention), regardless of which vaccine is administered first. However, use of Jynneos vaccine should be prioritized over ACAM2000 when co-administering a COVID-19 vaccine and an orthopoxvirus vaccine.
People, particularly adolescent or young adult males, who are recommended to be vaccinated against both mpox and COVID-19 might consider waiting 4 weeks between vaccines. This is because of the observed risk for myocarditis and pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and COVID-19 vaccines, and the hypothetical risk for myocarditis and pericarditis after Jynneos vaccine. However, if a patient’s risk for mpox or severe disease due to COVID-19 is increased, administration of mpox and COVID-19 vaccines should not be delayed.