No Waiting Period Required Between COVID-19 and Mpox Vaccines
COVID-19 and mpox vaccines can be administered simultaneously or at any interval without requiring a waiting period between them. This represents an important update from earlier pandemic guidance when initial concerns about potential cardiac complications led to recommendations for separate vaccination intervals 1.
Current CDC/ACIP Guidance
The Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) have relaxed previous vaccination requirements that initially recommended spacing between COVID-19 and mpox vaccines 1. The evidence demonstrates:
- Both vaccines can be given on the same day or at any time before or after one another
- No minimum interval is required between administrations
- This aligns with standard vaccine administration principles for inactivated vaccines
Clinical Reasoning
The initial concerns during the 2022 mpox outbreak centered on potential additive cardiac risks (myocarditis/pericarditis) from both infections and vaccinations occurring simultaneously 1. However, accumulated safety data has not substantiated these theoretical concerns, leading to the removal of spacing requirements.
Important Context for COVID-19 Vaccines
For COVID-19 vaccines specifically, the general principle is that inactivated vaccines may be administered simultaneously with or at any time before or after other inactivated or live vaccines 2. This includes:
- mRNA COVID-19 vaccines (Pfizer-BioNTech, Moderna)
- Recombinant COVID-19 vaccines
- Mpox vaccines (JYNNEOS/Modified Vaccinia Ankara)
Common Pitfall to Avoid: Do not confuse this guidance with live attenuated vaccines. If a patient were receiving LAIV (live attenuated influenza vaccine) and another non-oral live vaccine (not applicable to mpox), a 4-week interval would be required if not given simultaneously 2. However, mpox vaccines currently used (JYNNEOS) are not live attenuated in the traditional sense.
Practical Implementation
Administer both vaccines during the same visit when indicated, which:
- Improves vaccination coverage
- Reduces missed opportunities
- Simplifies logistics for patients
- Does not compromise safety or efficacy
High-risk individuals should still receive targeted precautions and monitoring as appropriate for their underlying conditions 1, but timing between vaccines is not a concern.