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Details

Status:

Action.

Category:

Public health.

Title:

Introduction of routine vaccination programmes for the prevention of mpox and gonorrhoea.

Date of expiry / review:

Not applicable.

For action by:

  • Chief executives, health boards / trusts.
  • Vaccination operational leads, health boards / trusts.
  • Sexual health leads, health boards.
  • Medical directors, health boards / trusts.
  • Directors of primary care, health boards / trusts.
  • Nurse executive directors, health boards / trust.
  • Chief pharmacists, health boards / trusts.
  • Directors of public health, health boards / trusts.
  • Executive Director of Public Health, Public Health Wales.
  • Head Vaccine Preventable Disease Programme, Public Health Wales.
  • Director of Vaccine Delivery, Vaccination Programme Wales, NHS Performance and Improvement.
  • Head of Sexual Health Programme, Public Health Wales
    Community Pharmacy Wales.
  • General Practitioner Committee, Wales.
  • General practitioners.

Sender:

Dr Keith Reid,
Deputy Chief Medical Officer (Public Health),
Health, Social Care and Early Years Group,
Welsh Government.

Contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.
Email: wg.vaccinationsprogrammeteam@gov.wales

Introduction of routine vaccination programmes for the prevention of mpox and gonorrhoea

Dear Colleagues,

The Welsh Government has accepted advice from the Joint Committee on Vaccination and Immunisation (JCVI) to introduce a routine targeted vaccination programme for the prevention of gonorrhoea, alongside a routine vaccination programme against Mpox for those at highest risk.

Gonorrhoea is one of the most common bacterial sexually transmitted infections (STIs), causing significant morbidity, and remains a public health concern globally. The latest report on sexual health trends in Wales shows gonorrhoea diagnoses are at a 10 year high with a 27% increase in cases from the previous year. The majority of cases are in males and in the 15 to 24 age group. Reporting from the Gonococcal Resistance to Antimicrobial Surveillance Programme (GRASP) for England and Wales shows gonorrhoea has developed resistance to all classes of antibiotics used in its treatment.

Mpox is a viral illness caused by MPXV (Monkeypox Virus). There are two known clades of mpox: clade I and clade II. Clade I is split into clade Ia and clade Ib. Clade II is split into clade IIa and clade IIb, with subgroup clusters called lineages. A global outbreak of the disease began in 2022, linked to infections with clade II and a vaccination outbreak response was developed across the UK, using the smallpox vaccine Modified Vaccinia Ankara - Bavarian Nordic (MVA-BN), with this reactive offer continuing in Wales to present day. Over 4,000 cases have been confirmed in the UK since May 2022. There continue to be small numbers of both imported and domestically acquired clade II mpox cased in the UK including Wales. Transmission within Wales has mainly been reported within networks of Gay, Bisexual, and other Men who have Sex withMen (GBMSM) without a documented history of travel to endemic countries, with limited onward transmission outside of sexual networks.

There are also growing outbreaks of clades Ia and Ib in the Central African Region affecting men and women through close, often sexual, contact and children through household transmission. As of August 2024, clade Ib has also been detected beyond the African Region, mainly associated with travel to an affected country, including a small number of cases and household clusters within the UK. Clade I is a more virulent clade of the virus and may lead to an increased risk of severe illness.

I am pleased, therefore, to write to you with instructions to stand-up routine vaccination programmes for the prevention of both mpox and gonorrhoea from summer 2025. Both vaccinations are to be offered on an opportunistic basis through specialist sexual health services, who have experience in assessment and identification of those who are at increased risk of infection with bacterial STIs.

This letter is aimed at health professionals who will deliver both vaccination programmes in Wales. I encourage you to share this guidance with all those involved in delivering the programmes in your area.

Eligibility

Gonorrhoea prevention programme

The programme for gonorrhoea prevention will involve opportunistic vaccination using the 4CMenB vaccine. Eligible individuals are primarily GBMSM who are at increased risk of becoming infected, as well as a small number of individuals who are not GBMSM but who have a similar incidence to the eligible GBMSM group. Individuals should be identified through sexual health services using markers of high risk of infection, as per the guidance in the Green Book.

Mpox

The programme for mpox will be a pre-exposure vaccination primarily offered to GBMSM who are at highest risk of acquiring mpox. GBMSM at highest risk should be identified amongst those who attend sexual health services, using markers of risk to assess eligibility, as per the guidance in the Green Book.

Sexual health services may also vaccinate other individuals who have frequent, close and intimate contact with the GBMSM network at risk of mpox irrespective of their identified gender.

Dosing regime

Both vaccinations require two doses, to be administered in line with the dosing interval schedule set out in the relevant Green Book chapter.

The first dose should be given opportunistically, when eligible individuals attend sexual health clinics for other reasons, such as testing or management of bacterial STIs. Both vaccines can be offered alongside other appropriate vaccines (for example, Hepatitis A and B, Human papillomavirus (HPV)). Further guidance on co-administration of vaccines can be found in the Mpox and gonorrhoea vaccination programme details: 2025 page.

Programme start date

Health boards sexual health services should establish both routine programmes to begin vaccinating once the relevant Green Book chapters have been published and the programme resources and materials are ready. Readiness is anticipated to be from July. Vaccination Programme Wales will advise sexual health clinics nearer to the time, when vaccinations can commence.

NHS oversight and assurance of vaccination programme planning and delivery is through Vaccination Programme Wales. The Vaccination Programme Wales Team will work with health boards and trusts on implementing the new programmes outlined in this circular, whilst Public Health Wales will continue to provide the specialist expert vaccination advice, surveillance and monitoring.

Further detailed information and guidance can be found in the Mpox and gonorrhoea vaccination programme details: 2025 page.

I would like to take this opportunity to thank everyone involved in supporting our vaccination programmes for their continued hard work. I am extremely grateful for the work and commitment shown to making these programmes a success and protecting those most at risk.

Yours sincerely,
Dr Keith Reid.
Deputy Chief Medical Officer (Public Health).