In the 2022 monkeypox outbreak, this technique is being used to administer the Jynneos smallpox and monkeypox vaccine in order to increase the number of available JYNNEOS vaccine doses.

The standard, FDA-approved regimen involves a subcutaneous injection of 0.5mL of the Jynneos vaccine. The standard regimen continues to be authorized for people under 18 years of age, under an Emergency Use Authorization.

However under an Emergency Use Authorization beginning August 9, 2022, an alternative regimen may be used for people 18 years of age or older. The authorized alternative regimen involves an intradermal route of administration with an injection volume of 0.1mL.

The Jynneos vial in the video contains 0.5ml as a single-dose subcutaneous injection. In this video, we demonstrate how to use one single 0.5ml vial to draw up 5 intradermal doses of 0.1ml.

Important medication information can be found on the vial, including the lot number and manufacturer. The expiration date can be found on the side of the box. Regardless of this expiration date, each vial, once accessed is only good for 8 hours.

To perform the intradermal injection of the vaccine, follow these steps:

1. Locate the injection site on the forearm, 2-3 inches below the antecubital fossa.
2. Clean injection site, and allow to air dry.
3. Hold the skin taut with your hand, either from below or by holding the skin distal to the proposed injection site.
4. With the bevel of the needle UP, insert the needle at a 5-15 degree angle under the skin until the entire bevel is within the skin, the entire needle does not need to be inserted.
5. Flatten the angle to the skin.
6. Inject the vaccine slowly to create a wheal or blister.
7. Withdraw the needle at the same low angle.
8. Do not apply pressure following administration; instruct your patient not to apply pressure to avoid displacement of vaccine into deeper skin tissue. Troubleshooting and injection issues: If no wheal is created, a portion of the vaccine solution leaks back out the injection site, or if bleeding occurs and no wheal or bleb remains, repeat the dose at another site, at least 2 inches away from the first injection site.