Health Care Provider Q&A: Monkeypox and Psoriatic Disease

Q: Are patients with psoriatic disease at a higher risk of having a severe monkeypox infection?

A: Patients with psoriasis, including children under the age of 8, and those taking oral or injected medications for psoriasis that may suppress the immune system, could potentially be at higher risk of severe disease with monkeypox, although more data is needed. [9]

Q: Is there a vaccine to protect against a monkeypox infection?

A: Yes, there are 2 vaccines approved by the U.S. Food and Drug Administration (FDA) to prevent monkeypox infections, JYNNEOS (also known as Imvamune or Imvanex) and ACAM2000. Individuals with psoriasis should not use the ACAM2000 vaccine. [7, 10]

Q: Should patients with psoriatic disease get a monkeypox vaccine?

A: The CDC is currently recommending individuals who have been exposed to the monkeypox virus or are at a higher risk of being exposed to get vaccinated. Eligibility for vaccination may change as more vaccines becomes available. For local vaccine availability, contact your local health department.

Q: Is it safe for patients with psoriatic disease to receive a monkeypox vaccine?

A: Based on CDC guidance, the ACAM2000 vaccine is contraindicated for many patients with psoriasis, especially those with severe disease or on any form of immunosuppression. The ACAM2000 vaccine should not be given to individuals who have cardiac disease, an eye disease treated with topical steroids, are pregnant, have a weakened immune system – including those taking a medication that suppresses the immune system, individuals who are living with HIV, or an acute, exfoliative skin condition such as psoriasis. [10]

The JYNNEOS vaccine can be safely administered to individuals who are pregnant, have a weakened immune system, or an exfoliative skin condition such as psoriasis, and children under 18 years of age who have been exposed to monkeypox. [9, 11]  However, individuals with immunocompromising conditions may be less likely to have an effective response after any vaccination, including JYNNEOS. [10] 

Shared decision-making between clinician and patient is recommended. Health care providers should discuss the use of vaccine in a child under 18 years of age with the state or local health departments and CDC.

Q: How can a patient with psoriatic disease get a vaccine for monkeypox?

A: Patients should talk with their health care provider to assess their risk of contracting the monkeypox virus. Current CDC recommendations for vaccination for monkeypox only extends to people who have been exposed to monkeypox and those who may be more likely to contract monkeypox. [12]

People more likely to get monkeypox include:

• People who have been identified by public health officials as a contact of someone with monkeypox
• People who are aware that one of their sexual partners in the past 2 weeks has been diagnosed with monkeypox
• People who had multiple sexual partners in the past 2 weeks in an area with known monkeypox

People whose jobs may expose them to orthopoxviruses, such as:

• Laboratory workers who perform testing for orthopoxviruses
• Laboratory workers who handle cultures or animals with orthopoxviruses
• Some designated healthcare or public health workers

Q: Does the smallpox vaccine prevent monkeypox infections?

A: The smallpox vaccine may reduce your risk of developing a monkeypox infection, however the US stopped vaccinating individuals for smallpox in 1972, so those under the age of 50 are likely to not have received a smallpox vaccine. [8]

Q: What should I do to treat a patient with psoriatic disease who is infected with the monkeypox virus?

A: If you suspect a patient may have a monkeypox infection, contact your state health department or the CDC Emergency Operations Center (770-488-7100). You should advise the patient to isolate at home while a diagnosis is being confirmed. Clinicians should follow CDC Guidance for Infection Prevention and Control of Monkeypox in Healthcare Settings. [5]

Q: Is there a treatment for a monkeypox infection?

A: There is no treatment specifically for monkeypox infections. There is a treatment, tecovirimat (also known as TPOXX or ST-246), that is approved to treat smallpox infections. Because smallpox and monkeypox infections have similarities, this drug may be used to help treat monkeypox infections. Per CDC guidance, it is recommended that this treatment be given to patients who have severe disease or are at risk of severe disease. This includes people with exfoliative skin conditions like psoriasis, immunocompromising conditions, pediatric populations – particularly those under 8 years of age, individuals who are pregnant, or have 1 or more complication. [9, 11, 13]