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.
The distinction matters for countries such as Nigeria, where an earlier targeted campaign focused on adults, and where decisions about limited vaccine supplies need to account for both exposure and the risk of severe illness.
At an October 13 WHO briefing, Professor Anthony Scott, chair of the Strategic Advisory Group of Experts on Immunization, said mpox remained a global concern despite the resolution of major outbreaks. Young children and severely immunocompromised people face the greatest risk of severe outcomes, he said.
During outbreaks, SAGE recommends targeting people at risk of infection in affected communities. These include children, contacts of people with mpox, people exposed through sexual networks, and health and outbreak-response workers with repeated exposure.
The advice does not amount to a recommendation to vaccinate every child routinely. Scott said preventive vaccination of children in endemic areas should only be considered within research settings. There are still important gaps in evidence on vaccine safety and effectiveness in children, pregnant women and severely immunocompromised people.
The most reassuring evidence available so far concerns healthy adults. Applying vaccination recommendations to other groups requires consideration of the product being used, its authorisation and the particular outbreak setting.
Nigeria has already used targeted vaccination. In its September 2025 campaign report, WHO described a government-led programme across 12 high-burden states, using 30,100 MVA-BN vaccine doses supplied with Gavi support.
That campaign targeted adults aged 18 and above who had contact with confirmed cases, frontline health workers, people with weakened immune systems and people with increased sexual exposure risk. Recipients were scheduled to receive two doses four weeks apart, with states selected using epidemiological data and outbreak risk assessments.
In the published campaign report, Plateau frontline worker Danjuma Chundung Daform described why she accepted vaccination: “As a health worker, I face increased risks. Being vaccinated boosts my confidence to keep serving my community.” Her account reflects the occupational exposure that vaccination programmes are intended to address.
The new SAGE advice provides a basis for reviewing how outbreak programmes identify children who may benefit from vaccination. It also keeps preventive vaccination focused on people whose exposure or medical condition places them at higher risk.
Outside outbreaks, Scott said preventive vaccination could be considered for people at high risk of infection or severe disease. That is a different decision from responding to exposure in a community where cases are already occurring.
Vaccine access is also changing. WHO and partners announced a global mpox stockpile in September, following its launch on August 27. Financed by Gavi and coordinated through the International Coordinating Group on Vaccine Provision, the mechanism is intended to give countries more timely and equitable access during outbreaks.
In that announcement, WHO reported 190,683 confirmed cases and 529 deaths across 145 countries and territories between January 2022 and July 31, 2026. WHO also said two-thirds of reported cases were occurring in the African Region.
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. Identifying the infection helps health teams investigate exposure and arrange appropriate care for affected people.