Mpox Pop Up PODs

The Florida Department of Health in Broward County (DOH-Broward) is one of 67 Public Health Departments under the governance of the integrated Florida Department of Health (DOH). Although DOH-Broward is a state agency, it maintains a very strong partnership with Broward County Government, which is formalized in a core contract. The main administrative campus is located in Fort Lauderdale, Florida, with additional facilities in geographically accessible locations.  DOH-Broward is responsible for protecting, promoting and improving the health of the county's 1.9 million residents and over 10 million annual visitors. 

According to the U.S. Census population estimates for July 2021, Broward County is the 17th most populous in the United States, with over 1.94 million people and 9% of Florida's residents. Foreign-born individuals constitute approximately 34.1% of the county's population. Among Broward residents, 33.6% identify as (non-Hispanic) White, 31.1% as Hispanic or Latino, and 30.2% as Black or African American. In addition, the county's Black population includes a significant number of immigrants from Haiti, Jamaica, and other parts of the Caribbean, as well as Central and South America. Individuals who speak a language other than English (at home) make up about 37.5% of the county's total population.

On July 23, 2022, the World Health Organization (WHO) Director General declared Mpox a public health emergency of international concern and on August 4, 2022, the U.S. declared Mpox a public health emergency. On May 21, 2022, a presumptive case of Mpox was identified in a Broward County resident with a history of travel outside of the United States and was subsequently confirmed as Mpox (Case 1). As of 10/21/2022, Broward County had 683 cases. Note: In support of the November 28, 2022 recomendación by WHO and Health and Human Services (HHS), the Center for Disease Control and Prevention (CDC) has adopted Mpox” as the term used to refer to monkeypox disease.

Mpox is a disease caused by infection with the Mpox virus, which is closely related to the variola virus (which causes smallpox), the vaccinia virus (used in the smallpox vaccine), and the cowpox virus. Mpox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite having been initially known as "monkeypox," non-primates such as African rodents may also harbor the virus and infect humans. Mpox can spread amongst humans through close, personal, and often skin-to-skin contact, including direct contact with Mpox lesions, or with the saliva, upper respiratory secretions and/or intimate areas of an infected individual. Therefore, one can contract Mpox through oral, anal, or vaginal sex with an infected person; touching the genitals or anal region of an infected person; kissing, hugging, or massaging an infected person; maintaining prolonged face-to-face contact with an infected person.

The goal for the practice was to reduce and contain the transmission of Mpox. The objectives were to: identify and investigate all cases; conduct contact tracing of all cases and monitor contacts; provide vaccination to contacts as prophylaxis when indicated; provide antiviral medication to cases in coordination with healthcare providers; provide timely and accurate information to healthcare providers; provide timely and accurate information to the community; provide mass vaccinations to individuals with likely exposure in the past several weeks; and provide timely and accurate information to the media.

Activities that were implemented included epidemiological identification, investigation, and monitoring of all cases. The first suspected case of Mpox was reported to DOH-Broward's Epidemiology Department on May 21, 2022, by a local infectious disease (ID) physician who received the CDC Health Advisory Notice (HAN) sent out by DOH-Broward. Epidemiology staff collected a specimen, which was then sent to the Bureau of Public Health Laboratories (BPHL). A same-day test by the BPHL and a later test by the CDC confirmed the presence of the Mpox virus. Epidemiology staff conducted the CDC risk assessment to identify contacts that needed to be monitored for 21 days post-exposure. As the outbreak progressed, the Epidemiology Department evaluated and investigated all suspected cases as required. Hospitals and healthcare providers were educated regarding the collection, packaging, storage and shipment of specimens, CDC protocols related to symptoms and treatment options, PPE, risk assessment, and post-exposure prophylaxis. Epidemiology provided data to develop GIS mapping of cases, contacts and possible sites of exposure, which enabled DOH-Broward to rapidly target information and prophylaxis in high impact areas.

In addition, DOH-Broward convened weekly Incident Management Team (IMT) meetings with hospital personnel and elected officials, provided accurate and timely information to individuals at high risk, leveraged relationships with municipalities and community partners to secure vaccine locations in high impact areas including for the use of a mobile vaccination van to rapidly provide vaccine as prophylaxis, and pre-positioned vaccine and antiviral medication at physician practices that serve higher risk individuals. DOH-Broward also co-located vaccine prophylaxis services at its contracted STD clinic. We conducted street outreach to determine any potential reasons for vaccine hesitancy and then utilized our main campus auditorium as one of 10 fixed vaccine locations in response to client requests. We hosted more than 25 successful walk-up events utilizing the mobile vaccination van during evening/late night hours, at locations where higher risk individuals socialize. We also worked with businesses in high impact areas to provide prophylaxis to their staff and entertainers.

The public health impact of this project is important as we continue to respond to this outbreak of Mpox in our county. Increasing the number of individuals vaccinated against Mpox is crucial in stopping its spread. Part of the success of this program was the accessibility and convenience of our service locations. Providing services during unconventional hours (late nights and weekends) and offering additional vaccines as part of an immunization package” greatly improved vaccine uptake. As of November 29^th, 2022, DOH-Broward has provided 35,376 Jynneos, 7,389 Menectra, 4,948 Hepatitis A, and 959 Pfizer MRNA COVID vaccines.

DOH-Broward successfully leveraged relationships, partnerships and experience from COVID response activities to rapidly implement testing, prophylaxis and treatment for a Mpox outbreak. We were able to quickly educate our local elected officials and hospital Chief Medical Officers, Chief Executive Officers, and Infection Control Practitioners about Mpox. DOH-Broward's Epidemiology Department and communicable disease staff generated GIS mapping of cases, contacts, and common social and recreational venues  to target intervention strategies including education on prevention, testing and treatment.

Our GIS-guided vaccination and outreach programs were instrumental in containing the 2022 Mpox outbreak in Broward County. Through detailed investigations, DOH-Broward staff obtained the addresses of our cases' close contacts, preferred recreational/social venues, and recent outings, including potential sites of exposure. Subsequent mapping enabled us to assess the geographic distribution of Mpox in Broward County and quickly identify Wilton Manors as the epicenter of the outbreak. Wilton Manors is home to the majority of Broward County's LGBT population, with approximately 140 out of 1,000 residents identifying as LGBT, according to the 2010 Census. The city also hosts an annual Stonewall Pride Festival and Parade, which typically attracts around 30,000 attendees. In addition, provisional data indicated that approximately 95% of Broward residents who have had Mpox were individuals that identified as men who have sex with men (MSM). DOH-Broward thus focused its efforts against Mpox in Wilton Manors, though other high-impact regions were also targeted.

Many of the large events occurring in Wilton Manors often involve individuals in close contact for extended periods of time. Some of these events provide opportunities for meeting and engaging with new sexual partners. DOH-Broward solicited input from our Black and Hispanic MSM Advisory Groups of the Broward County HIV Prevention Planning Committee regarding perception and barriers to Mpox vaccination. These Advisory Groups were invaluable in helping us to identify venues and events and act as ambassadors to these communities. Utilizing the information obtained by the Advisory Groups, we contacted the business establishments offering to set up our vaccination van in their parking lot. 

DOH-Broward also co-located vaccine prophylaxis services at its contracted STD and HIV providers. We conducted street outreach to identify reasons for vaccine hesitancy and then utilized our main campus auditorium as one of 10 fixed vaccine locations in the county. We also hosted more than 25 walk-up events utilizing the mobile vaccination van during evening/late night hours, at locations where higher risk individuals socialize. We worked with businesses in high impact areas to provide prophylaxis to their staff and entertainers. DOH-Broward maximized access for high-risk populations by allowing them to self-identify for appointments and did not impose screening procedures that are barriers to access. If eligibility for vaccination was unclear, we utilized epidemiologists to interview clients and assess eligibility. DOH-Broward ensured that vaccine points of dispensing (POD) were geographically distributed, patient-friendly, and available during extended hours such as evenings and weekends. We worked with the MSM Advisory Group of the Broward County HIV Prevention Planning Council to make appointments for Black MSM through community leaders and provided de-identified sites as options for vaccination. Additionally, we worked with promoters of dance parties for Black MSM to provide overnight vaccination outreach events. With limited vaccines available, DOH-Broward made the decision to prioritize the highest-impact communities and on July 12^th, 2022, began expanded outreach efforts in areas where our targeted population socialize. Due to the epidemiology of Mpox, we targeted specific venues such as bath houses, nightclubs, lounges and bars. We collaborated with 12 venues and concluded 2^nd dose administration on August 24^th  2022. 

On August 10, 2022, the United States Food and Drug Administration (FDA) authorized the intradermal use of Jynneos for people aged 18 and over, increasing the total vaccine supply by a factor of 5. Armed with a new supply of vaccines, we expanded our outreach efforts and coordinated with businesses to provide vaccine pop-up” opportunities utilizing one of our mobile vaccination vans.

The mobile vaccination van has two tents directly outside of the unit.  The tent with a table on the left side facing the entrance is the registration station. When clients walk up, they are greeted by the clerical support team.  They inform the clients of the vaccines offered and provide them with consent forms and vaccine information statement (VIS) forms.  Clients are then directed to the second tent area on the right side of the door with chairs for the clients to sit.  The clients are instructed once the form is completed to return with the form to the registration station.  The clerical support team then checks Florida SHOTS, Florida's centralized online immunization information system, to determine what vaccines the client has received and what is needed.  They document the vaccine information on the bottom of the form for the vaccines we provide; noting when the vaccine was administered, or no history identified.  We have three nurses set up on the van, one nurse in the front room and the second nurse in the back room.  Each room has the supplies needed to administer vaccine.  The lead nurse is in the center of the mobile vaccination van.  As the clients' numbers are called to enter the van, the client boards the unit, and the Lead nurse will ask the clients what vaccines they would like to receive and direct them to the nurse room 1 or nurse room 2.  The Lead nurse would also pull the vaccines that the client requested and provide them to the nurse assigned to administer the vaccine.  Once the client is in the room with the nurse the nurse would review the vaccine consent form, discuss the contraindication questions with the client.  The nurse would also provide education on the vaccine being administered and the process.  After the client is vaccinated the nurse provides the client with a vaccination card listing the vaccinations administered during the visit.  As the client exit the van, they are instructed to sit in the chairs located outside the van for observation.  During the observation time, one of the clerical support staff will sit next to them and schedule their second dose appointment for Mpox.    

The mobile vaccination van contained supplies for fifteen events.  We resupplied the van with ancillary supplies as needed.  The supplies included consent forms, VIS forms, 30 chairs, three tents, five tables, three laptops, internet access, A- frame (Vaccinations Here), needles, syringes, band aids, alcohol wipes, gauze, biohazard bags, sharps containers, vaccine cards, disinfecting wipes, hand sanitizers, masks, drapes for tables, office supplies, trash cans, ammonia inhalants and epi pen.  The vaccines Jynneos, Menactra, Hep A and COVID-19 were transported to each event in a portable electrical cooler from the DOH-Broward Pharmacy.    The temperature of the cooler is monitored and documented every hour by the Lead Nurse.  The vaccines are returned to the pharmacy at the end of the vaccine event with the completed consent forms.

DOH-Broward scheduled vaccinations events to coincide with participating venues' most popular times, including weekends, evenings, and overnight hours, and published event details on our website. In addition, we coordinated with event promoters and provided vaccinations at events such as Cannonball Week, Pig Week, the South Florida Men's Conference and the Ed Lugo Resort Pool Party. Many of these events attract tourists who had the potential to contract Mpox and transmit the infection when they return home. As of November 2022, DOH-Broward has held 40 events utilizing the mobile vaccination van, averaging three such events per week. Importantly, we offered the Jynneos Mpox vaccine in combination with Hepatitis A, Meningococcal, and COVID-19 vaccines, which greatly helped to reduce stigma and vaccine hesitancy. Through these efforts, 1,569 Jynneos, 467 Menectra, 350 Hepatitis A and 104 Pfizer vaccines were provided. DOH-Broward also provided VIS forms on the above-listed vaccines, informative palm cards on Mpox transmission, and advice on prevention using both PrEP and condoms. In addition, we utilized Florida's vaccine registry to access clients' vaccination histories and scheduled second-dose appointments at the time of the first dose, when possible.

When vaccine supplies were limited, DOH-Broward successfully utilized an online appointment system that was developed during COVID response. As vaccines became more widely available, walk-in vaccination services were offered. DOH-Broward also enlisted its Business Response to AIDS” partners to help distribute accurate and up-to-date information in the communities most impacted. In addition, our contracted HIV providers updated their websites to direct traffic to the DOH-Broward and the Get PrEP Broward” websites for information about Mpox and scheduling appointments (vaccineappointmentbroward.com). As demand for the vaccine ebbed and flowed, the number of vaccination PODs was adjusted appropriately. Finally, DOH-Broward utilized environmental scans throughout the response to proactively plan the number, location, and size of PODs.

Our 2022 Mpox response required the involvement and participation of a number of community partners and external stakeholders, including municipal governments, contracted HIV/STD care providers, community organizations, and private businesses. In addition, by fostering a culture of continuous communication within the department itself, DOH-Broward was able to effectively monitor and manage the Mpox outbreak in Broward County. An essential part of our communication strategy was the bi-weekly IMT meetings, which helped to promote situational awareness and logistical cohesion.

DOH-Broward convened its first IMT meeting on May 22, 2022, utilizing the Federal Emergency Management Agency's (FEMA) Incident Command Structure. DOH-Broward provided numerous briefings, offered subject matter expertise, and attended meetings on a regular basis with groups and organizations across the County. These organizations and groups included but are not limited to: Hospitals, Broward County Healthcare Coalition, County and Municipal Mayors, Broward County Legislative Delegation, Emergency Coordinating Council, EMS subcommittee of the Fire Chief's Association, and School Board.

We also collaborated with the HIV Prevention's Business Responds to AIDS (BRTA), a coalition of 359 Broward County businesses managed by HIV Prevention, to distribute educational materials to residents. We have since enlisted other businesses in our outreach efforts, due to their location in high-impact areas or their popularity with high-risk individuals - connecting with a total of 1,274 businesses in 101 days. Some businesses were visited repetitively, resulting in the distribution of educational materials to 1,967 businesses.

All communication and messaging distributed by DOH-Broward came directly from DOH Communications Office and the CDC. The DOH-Broward website is managed by DOH in Tallahassee and directed the public to DOH website for Mpox-related information. DOH-Broward began community outreach early regarding mpox prevention via the distribution of flyers, palm cards and posters to businesses in neighborhoods with high concentrations of populations at high risk. 

The primary goal of the DOH-Broward public information officer (PIO) was to disseminate messages to the community through multiple mediums. This included utilizing the DOH-Broward Twitter account and multi-media campaigns. The DOH-Broward PIO made sure to post to Twitter at least every couple of days. While it was important that key information was transmitted quickly and efficiently, it was also crucial that the information was presented in relatable and easy-to-read/understand messaging. Additionally, the DOH-Broward PIO made sure to answer questions that were posted on the Twitter page or that were sent via direct message in a timely and private manner. The DOH-Broward PIO used the Twitter page to post information about Mpox resources including vaccination PODs locations/hours in real-time. Between May and October of 2022, the follower count of the DOH-Broward Twitter account increased by approximately 1000 followers. Between May and September of 2022, DOH-Broward worked with a variety of vendors to implement and create a multi-media campaign around vaccination. These vendors were chosen to reach as many different populations as possible in several different platforms. These vendors included South Florida Gay News, OutClique and HotSpots magazines. The information included in these campaigns included the location of vaccination PODs, where residents could sign up for vaccinations, that the vaccinations were free, and that the vaccinations did not require insurance. DOH-Broward ensured that the ads with vendors were thorough, accurate, and conspicuous. The ads also included a link to more information should the public still have questions.

In December 2020 DOH-Broward invested in an in-house print shop for its Special Project's Team, which allowed internal staff to create most of the flyers, signage, consent forms, vaccination information sheets and other materials used at the POD's.

DOH-Broward recognized that providing timely and accurate information to health care providers was extremely important.  DOH-Broward has a robust contact list capability which includes electronic databases of physicians, hospital infection control practitioners, long term care and congregate facilities, etc.  DOH-Broward utilized our email notification process to provide healthcare providers CDC or DOH guidance documents throughout the pandemic.

DOH-Broward educated the call center staff to provide information and referral regarding Mpox. The call center was utilized to provide general information about Mpox, Mpox vaccination sites, and referrals to epidemiology as necessary.

DOH-Broward provided vaccination to contacts as prophylaxis indicated. Contacts were provided appointments by epidemiology staff and vaccinated at a designated closed” vaccination site. Second dose appointments were scheduled during the initial dose appointment. DOH-Broward worked with businesses with employees at higher risk to schedule pop-up” closed PODs to provide employee vaccinations. DOH-Broward utilized relationships developed during the COVID response to secure memoranda of agreements with municipalities to provide POD locations for vaccination sites. The peak number of fixed vaccination PODs that were established by DOH-Broward was 10. DOH-Broward also coordinated with municipalities to provide vaccine more than 40 pop-up” opportunities at local events. In addition to the PODs, DOH-Broward utilized the Region 7 mobile vaccination van to provide vaccination at local businesses. DOH-Broward utilized environmental scans throughout the response to proactively plan the number, location, and size of PODs.

Initially, the number of vaccines and ancillary supplies were based on the estimated number of first- and second-dose appointments scheduled at each POD. The vaccination kits included syringes, mixing diluent, biohazard/sharps containers, vaccination cards, Epi Pens, etc. Once vaccine became more widely available, and appointments were no longer necessary, estimated total number of doses were prepared for the week per site, vaccine and ancillary supply kits were prepared and sent based on the daily estimates. Additional vaccine and ancillary supplies were sent via courier in case demand was higher than estimated. COVID-19, Menactra and Hepatitis A vaccinations were also offered in conjunctions with Mpox vaccine activities.

DOH-Broward worked with infectious disease practitioners, contracted STD and HIV providers, and hospitals to supply, and as cases and antiviral medication supplies increased, pre-position antiviral medication to rapidly provide medication to clients in need. DOH-Broward also served as a hub for vaccines for the region.

In May 2022, person under investigation (PUI) cases were presented to the Regional or State Epidemiologist to request approval for testing as Mpox testing was not yet publicly available and was conducted by BPHL with confirmation conducted by CDC. If approved, epidemiology staff collected the specimen from the client if needed and/or coordinated with hospitals and healthcare providers as to the type of specimen to collect. Epidemiology staff picked up the specimens and packaged for shipment. The Regional Emergency Response Advisor was contacted to transport specimens to the designated BPHL.  Tracking numbers and summary of PUIs were provided to BPHL and regional and/or State epidemiologist. Results were provided from the state of Florida Dept of Health so that epidemiology staff could notify the hospital or healthcare provider and conduct epidemiological investigations. The State Bureau of Epidemiology had established criteria to utilize in determining the need to collect a specimen for testing.

As the outbreak progressed, DOH-Broward epidemiology staff was approved to evaluate all testing through BPHL. Each PUI was entered into Merlin and the Merlin case number was provided to BPHL that the specimen collected had been approved by the Epidemiology Department. In some cases, epidemiology staff arranged for test kits for specimen collection to be delivered and subsequently picked up from hospitals and other acute care facilities (including Urgent Care Centers) with PUIs that met state testing criteria. Epidemiology staff initially provided all local transport, however, as the outbreak progressed, a courier was assigned by general services to assist in this in this operation.

In mid-July, commercial laboratories were approved to conduct testing and public health testing at the BPHL was utilized only for priority testing. Epidemiology staff realigned activities at this point to investigate positive results or provide early treatment based on suspected cases.

DOH-Broward actively monitored the Mpox outbreak across the county, not just in healthcare settings. This surveillance consisted of monitoring and collecting data of all cases, close contacts, and outbreaks throughout county, as well as constant communication with the local hospital medical directors, infection control practitioners and healthcare providers. This communication included giving recommendations, getting information, discussing guidance and changes in guidance, keeping hospitals and healthcare providers updated on what trends they were seeing, and sending regular updates to the hospitals. Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) queries were expanded to assist in early identification of cases and monitor trends. Additionally, DOH-Broward has access to the electronic records of the two largest health systems in the State to assist in obtaining additional information about suspected and/or confirmed cases. Epidemiology provided data to develop GIS mapping of cases, contacts and exposure location/social gatherings.

Epidemiology staff conducted all contact tracing of Mpox cases. A questionnaire was developed in order to determine the risk level based on CDC's Mpox risk assessment. The assessment was utilized to determine the level of monitoring required for each contact. Every identified contact was entered into the Merlin system (Florida's communicable disease reporting system) and into an internal log which included data for each case and their contacts. For the contacts, various data points were included such as demographics, risk levels, whether PEP (Jynneos) had been administered, monitoring timeframe, and disposition.

Epidemiology staff would attempt to get in contact with the individual identified in the Merlin system; this included at least three phone call attempts. If contact could not be made with the individual, staff would conduct a home visit. If the individual was still unable to be reached/located, the contact would be marked with a lost to follow-up” disposition.

Between May 21, 2022, and October 11, 2022, DOH-Broward was able to contain the outbreak and rapidly reduce transmission from its peak number of cases in week 7 (134 new cases week of August 10^th, 2022) with rapidly declining new cases week over week from that point through our rapid and targeted response efforts.

Multiple sources have been used to inform as well as to evaluate the effectiveness of our strategies and practices. One such data source is Florida's Merlin system for reporting communicable diseases. The Merlin system is crucial for disease management in Florida, serving as the state's repository for reportable disease case reports and providing automatic staff notification of high-priority disease cases. Practitioners, hospitals, medical facilities, laboratories, schools, long-term care facilities, state institutions, and other locations offering health services are required to notify DOH-Broward of all reportable diseases or conditions and the associated laboratory test results.

Case investigation and contact tracing were carried out by the Epidemiology Department, sometimes utilizing addresses obtained from the Merlin system. Separate databases were then created with the addresses of close contacts and the locations of preferred social and recreational venues. The addresses were then geocoded or converted from a location description to a position on the earth's surface. Once the addresses were geocoded, DOH-Broward was able to map where the cases resided, where their close contacts resided, and where they frequented for social and recreational activities. The GIS map results helped to determine which areas would be prioritized or targeted by the mobile vaccination and outreach teams. The insights provided by GIS enabled DOH-Broward to appropriately target our initiatives and reduce the number of Mpox cases by 99% since July 2022, when incidence was at an all-year high.

Another data source was the HIV Prevention's BRTA database. DOH-Broward started outreach efforts with existing BRTA members consisting of 359 Broward County businesses, to distribute educational materials to residents. We have since enlisted other businesses in our Mpox outreach efforts, due to their location in high-impact areas or their popularity with high-risk individuals.

Florida's vaccination registry, Florida SHOTS, was also instrumental in our response strategy. Florida SHOTS is a statewide, centralized online immunization information system (IIS) that helps healthcare providers and schools keep track of immunization records to ensure that patients of all ages are properly inoculated against vaccine-preventable diseases. We used Florida SHOTS to establish vaccine histories for recipients of our immunization package”, consisting of vaccines for hepatitis, COVID19, and meningococcal disease. DOH-Broward Mpox mobile vaccination van administered 1,569 Jynneos, 467 Menectra, 350 Hepatitis A and 104 Pfizer vaccines.

Finally, during our Mpox mobile vaccination van response effort, we surveyed unvaccinated individuals to gain insight into residual vaccine hesitancy and other barriers to vaccine uptake in our target communities. Some cited difficulties in obtaining an appointment, while others claimed not to have known about the vaccine prior to their encounter with our outreach teams. These individuals tended to be visitors from other counties or states, who shared that vaccines were not yet available in their municipalities. Some stated that they had severe allergies and were advised not to get the vaccine, while others assumed that they had protection from smallpox vaccines they received as children. Others had concerns about side effects and planned to delay vaccination until they could do more research. Finally, some believed that they weren't at risk for Mpox or that it wasn't a serious illness. It should be noted that these individuals make up a minority of the cohort reached by our response teams.

Our 2022 Mpox response leveraged existing resources that can be readily mobilized in another outbreak. These include vaccination PODs and vans, ARCGIS, various databases, and an online appointment system developed during COVID that allowed us to weather vaccine shortages. We also relied on our relationships with the vast network of policy makers, healthcare practitioners, clinics, and businesses that have historically supported or contributed to our efforts and initiatives. Weekly IMT meetings were held with representatives to exchange information and address any issues or gaps in our strategies.

Street surveying as well as soliciting input from our Black and Hispanic MSM Advisory Groups of the Broward County HIV Prevention Planning Committee regarding perception and barriers were key to our Mpox vaccination efforts. These Advisory Groups were invaluable in helping us identify venues for events and acted as ambassadors to these communities. In addition, by utilizing our in-house printing capabilities, we did not incur additional costs associated with off-site printing of outreach materials. The existing Get PrEP Broward” and DOH-Broward websites also allowed us to disseminate timely and accurate information about Mpox vaccination sites and schedules was also accomplished with no additional costs.

Our response can be scaled up or down by increasing or decreasing the number of sites and the number of personnel needed. DOH-Broward assigned a specific POD manager to oversee the mobile vaccinations, along with 2-3 clerical support staff and 3 nurses to administer vaccines. We were able to utilize existing staffing and reassign program staff and COVID vaccination staff as well as in-school vaccination nurses to support this large effort.