The Defense Health Agency and military services are working to make the mpox vaccine available for those at risk for contracting the virus after the Centers for Disease Control and Prevention recommended travelers to parts of Africa be immunized.

The federal agency issued an advisory last month recommending that travelers to central and east Africa who may be at risk — largely those who have sexual contact with men — get the two-dose vaccine.

During an outbreak in 2022, 146 military health system beneficiaries, including 118 active-duty personnel, had confirmed or suspected cases, according to the Defense Health Agency’s September Medical Surveillance Monthly Report.

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The majority of active-duty members — nearly 90% — who contracted the virus got it in the U.S., with most stationed in California, Virginia or Maryland. The Army and Navy together accounted for nearly 80% of the cases, which largely affected enlisted personnel between the ages of 20 and 34, according to the Armed Forces Health Surveillance Division.

The virus, previously known as monkeypox, is related to smallpox and typically causes symptoms such as fever and headaches, but can result in painful blisters and life-threatening conditions.

To safeguard against additional cases, either at home or while deployed, the Defense Health Agency and the services have made the Ankara-Bavarian Nordic vaccine, a third-generation smallpox vaccine, available at military health facilities and through the Tricare health program.

According to the Navy and the Air Force, the vaccine is not mandatory for troops deploying to Africa but has been made available to those who want it on demand.

The Army did not respond to a request for information by publication.

“When the U.S. declared mpox a national health emergency, the Air Force worked in coordination with DHA to ensure the vaccine was available for airmen and Guardians on demand,” an Air Force official told Military.com in an email.

“Navy personnel traveling overseas are provided a health consultation to assess for risks associated with health threats in the area and can receive medication or a vaccine may be available to help prevent or reduce severity of mpox … infections, particularly for those at high risk of severe infection,” Navy Bureau of Medicine spokeswoman Cmdr. Jessica McNulty said in an email Oct. 24.

Those considered to be at high risk for contracting the virus include people in close contact with an infected individual, with close contact defined as skin-to-skin contact, including kissing. Most of those affected have been gay or bisexual men, and anyone who has sex with multiple partners is considered at high risk, according to the World Health Organization.

The 2022-2023 mpox outbreak in the U.S. sickened more than 34,000 individuals and killed 63, according to the CDC. Armed Forces Health Surveillance Division epidemiologists said the impact may have been lower in the U.S. military as a result of an effective vaccine campaign targeting at-risk service members.

“It has been posited that effective targeting of pre- and post-exposure vaccine prophylaxis campaigns toward the MSM population, along with decreased high-risk sexual activities due to awareness campaigns by Defense Health Agency personnel, may have contributed to the significant decline in military health system beneficiary cases,” they wrote.

They added that they reviewed military health system cases to help military leadership and the medical community to anticipate the illness’ effect on readiness as well as develop prevention and mitigation strategies.

The current surge in Africa and elsewhere has been caused largely by a new strain of the virus, which is bringing the illness to previously unaffected areas. According to the World Health Organization, there have been nearly 45,000 suspected or confirmed cases in 17 countries this year.

The CDC has issued its travel alert for the Democratic Republic of the Congo, where more than 21,000 cases have been reported, as well as Burundi, Central African Republic, Rwanda and Uganda, recommending that physicians discuss prevention and awareness with patients who have plans to travel to these countries.

McNulty noted that, although the vaccine is in short supply, stocks are increasing, and personnel who are at risk or deploying to affected countries should work with their military treatment facility or Navy Environmental Preventive Medicine Unit to assess whether they meet the criteria for getting the immunization.

“Given the evolving nature of monkeypox outbreaks, MTF providers should be reviewing the latest CDC information on monkeypox,” she wrote.

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