Children at risk of mpox in communities experiencing an outbreak should be included in targeted vaccination, WHO’s vaccine advisers have recommended, while retaining tighter conditions for preventive childhood vaccination outside outbreaks.
This guidance holds particular relevance for countries like Nigeria, where past vaccination campaigns focused on adults. The recommendations aim to balance limited vaccine supplies with the need to protect those most vulnerable to severe illness.
Mpox remains a global concern
At an October 13 WHO briefing, Professor Anthony Scott, chair of the Strategic Advisory Group of Experts on Immunization (SAGE), emphasized that mpox persists as a global issue, despite the resolution of major outbreaks. Young children and severely immunocompromised individuals face the highest risk of severe outcomes.
During outbreaks, SAGE advises targeting those at risk of infection in affected communities. This includes children, contacts of mpox cases, individuals exposed through sexual networks, and health and outbreak-response workers with repeated exposure.
Professor Scott clarified that this does not advocate for routine vaccination of all children. Preventive vaccination of children in endemic areas should only occur within research settings. Evidence on vaccine safety and effectiveness remains insufficient for children, pregnant women, and severely immunocompromised individuals.
The most reliable evidence to date pertains to healthy adults. Applying vaccination recommendations to other groups requires careful consideration of the specific vaccine, its authorization, and the outbreak context.
Targeted vaccination in Nigeria
Nigeria has implemented targeted vaccination. A September 2025 campaign report by WHO details a government-led program across 12 high-burden states, using 30,100 MVA-BN vaccine doses supplied with Gavi support.
The campaign targeted adults aged 18 and above who had contact with confirmed cases, frontline health workers, individuals with weakened immune systems, and those with increased sexual exposure risk. Recipients received two doses, administered four weeks apart. States were selected based on epidemiological data and outbreak risk assessments.
Danjuma Chundung Daform, a frontline worker in Plateau, explained her decision to get vaccinated: “As a health worker, I face increased risks. Being vaccinated boosts my confidence to keep serving my community.” Her statement shows the occupational exposure that vaccination programs aim to address.
Vaccine access and global efforts
Vaccine access is improving. In September, WHO and partners announced a global mpox stockpile, launched on August 27. Financed by Gavi and coordinated through the International Coordinating Group on Vaccine Provision, this initiative aims to provide countries with more timely and equitable access to vaccines during outbreaks.
In the announcement, WHO reported 190,683 confirmed cases and 529 deaths across 145 countries and territories between January 2022 and July 31, 2026.
Mpox spreads mainly through close physical contact, which can include sexual contact. Animal-to-human transmission also occurs in parts of Africa. Vaccine deployment therefore needs to reflect local transmission patterns rather than assuming that every affected community faces the same exposures.
WHO recommends PCR testing to confirm infection, preferably using samples from skin lesions, their fluid, or crusts. Mpox can resemble chickenpox and other skin conditions. Accurate identification helps health teams investigate exposure and provide appropriate care.
