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Control of the 2022 clade IIb mpox (monkeypox) outbreak in the UK, primarily affecting gay, bisexual and other men who have sex with men (GBMSM), was achieved through behavioural change and targeted vaccination, both supported by coproduced health promotion.1 2 In November 2022, the Joint Committee on Vaccination and Immunisation recommended a routine mpox vaccination programme targeted primarily to GBMSM.3 We report mpox vaccination uptake and course completion among a community sample of GBMSM a year following the 2022 mpox outbreak to complement prior findings on mpox vaccination uptake.1
Using data collected from the ‘Reducing inequalities in Sexual Health’ (RiiSH) 2023 survey (November to December 2023), administered online primarily through social networking sites (Facebook, Instagram, X) and dating applications (Grindr), and are part of a series of cross-sectional surveys examining the sexual health and well-being of a GBMSM community sample,4 we performed descriptive analyses of vaccination offer and uptake (ever having ≥1, 2 doses) (%, 95% CI), vaccination course completion (two doses), recency of last dose (June 2022 to survey completion) and method of administration (subcutaneous, intradermal, both) among all participants and those eligible for vaccination. Vaccine eligibility was based on national guidance5 and defined in the analysis using the following proxy criteria (any of the following since August 2023): ≥10 physical male sex partners, meeting a male sex partner(s) in a sex-on-premises venue, sex party or cruising ground; a positive sexually transmitted infection test; and/or in the last year, report of HIV pre-exposure prophylaxis use; or use of recreational drugs associated with chemsex (crystal methamphetamine, mephedrone or gamma-hydroxybutyrate/gamma-butyrolactone).
Of 1106 participants (median age 44 years (IQR: 34–54); 89% white ethnicity; 78% UK born; 78% employed; 62% degree-level education; 24% reporting ≥10 physical male sex partners in the last 3 months), 58% (636/1106) were eligible for mpox vaccination.
Among eligible participants, 66% (419/636) were ever offered an mpox vaccine. Uptake of ≥1 mpox vaccine dose was 94% (393/419) among those offered, or 62% (95% CI 56% to 68%, 393/636) in all eligible participants. A minority of eligible participants reported vaccine offer but declined uptake (6%, 26/419). Nearly one-third of eligible participants reported never having received an mpox vaccination offer (29%, 185/636), of which 65% (121/185) had visited a sexual health service (SHS) in the last year. In those eligible and vaccinated with ≥1 dose, 77% (95% CI 69% to 87%, 304/393) reported course completion (see Supplement).
In all participants, 46% (508/1106) were offered an mpox vaccine. Uptake of ≥1 mpox vaccine dose was 93% (470/508) among those offered, or 42% (95% CI 39% to 47%, 470/1106) in all participants. Most participants reporting ≥1 mpox vaccine dose met proxy eligibility criteria (84%, 393/470). In participants vaccinated with ≥1 dose, 76% (95% CI 68% to 84%, 356/470) reported course completion. Among those with an incomplete vaccination (n=114, only one dose), 90% (103/114) were vaccinated before August 2023. In all those vaccinated, most reported exclusive subcutaneous vaccination (68% (77/114) in those with one dose; 50% (179/356) in those with two doses).
Findings from this community sample indicate vaccination uptake in around two-thirds of participants meeting mpox proxy eligibility criteria with high levels of course completion among all and eligible participants who were ever vaccinated. Vaccine non-offer was a significant barrier to uptake, as nearly a third of those eligible but unvaccinated reported never having received an mpox vaccine offer. Most participants (over 90%) who were ever offered an mpox vaccine reported uptake, but the reasons for not accepting the offer of vaccination were not collected in the survey and may be due to multiple factors such individuals’ assessment of their level of risk.6 Given the cross-sectional design of the RiiSH survey, we cannot determine the temporality of vaccination offer in relation to most sexual risk behaviours comprising our vaccination eligibility proxy; however, we found that most participants who did report vaccination met proxy criteria. While RiiSH participants may represent a sample with higher health literacy and social mobility relative to nationally representative GBMSM survey samples,7 our findings represent key populations that are targeted for mpox vaccination where, like similar convenience samples, participants are more likely to report sexual risk behaviours than the general GBMSM population.8
Lessons learnt from the 2022 mpox outbreak highlight the importance of a community-supported response and rapid deployment of interventions as part of a series of combination prevention tools. Further studies are needed to understand the individual-level and structural-level barriers to mpox vaccination initiation and completion. Continued targeting of vaccination to GBMSM at highest risk of mpox at SHS, with community support, will help facilitate equitable uptake of vaccination.
Supplemental material
Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available upon reasonable request from the UK Health Security Agency (UKHSA). Requests can be directed to riish_survey@ukhsa.gov.uk.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by the UKHSA Research and Ethics Governance Group (REGG; ref: R&D 524). Online informed consent was received from all participants and all methods were performed in accordance with the guidelines and regulations set by the UKHSA REGG. Participants gave informed consent to participate in the study before taking part.
Acknowledgments
The authors thank all the participants involved in this study. We acknowledge the members of the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections (BBSTI) Steering Committee: Professor Caroline Sabin (HPRU Director), Dr John Saunders (UKHSA Lead), Professor Catherine Mercer, Professor Gwenda Hughes, Dr Hamish Mohammed, Professor Greta Rait, Dr Ruth Simmons, Professor William Rosenberg, Dr Tamyo Mbisa, Professor Rosalind Raine, Dr Sema Mandal, Dr Rosamund Yu, Dr Samreen Ijaz, Dr Fabiana Lorencatto, Dr Rachel Hunter, Dr Kirsty Foster and Dr Mamooma Tahir.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Handling editor Anna Maria Geretti
Contributors DM, DP, RW, DR, EB, CML, SM, CHM, JS, HM and DO reviewed and updated the survey instrument. Survey implementation, data collection and data management were carried out by DM, JE, DP, RW, HM and DO. DM, HM and DO conceived secondary analysis design with review and contributions from CHM, JS, KS and SM. DM conducted analyses and, with DO, wrote the first manuscript draft. All authors contributed to successive drafts and reviewed and approved the final manuscript.
Funding DR was funded by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with the UKHSA.
Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or the UKHSA.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.