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Liu H, Wang W, Zhang Y, Wang F, Duan J, Huang T, Huang X, Zhang T. Global perspectives on smallpox vaccine against monkeypox: a comprehensive meta-analysis and systematic review of effectiveness, protection, safety and cross-immunogenicity. Emerg Microbes Infect 2024; 13:2387442. [PMID: 39082272 DOI: 10.1080/22221751.2024.2387442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
A large outbreak of monkeypox occurred in 2022, and most people lack immunity to orthopoxvirus. Smallpox vaccination is essential for preventing further smallpox outbreaks. This study evaluated the effectiveness, protection, safety, and cross-immunogenicity of smallpox vaccine in preventing monkeypox infection. PubMed, Embase, Scopus, and Web of Science were searched from database inception to 10 March 2024. We included studies involving "monkeypox virus" and "vaccinations", and excluded reviews, animal studies, and articles with missing or duplicate data. A total of 37 studies with 57,693 participants were included in the final analysis. The effectiveness data showed that monkeypox infection rates were lower in the smallpox-vaccinated group than in the unvaccinated group (risk ratio [RR]: 0.46; 95% confidence interval [CI]: 0.31-0.68). The protection data showed that smallpox vaccination effectively reduced the risk of severe monkeypox infection (RR: 0.61; 95% CI: 0.42-0.87). Third-generation vaccines showed greater efficacy (RR: 0.36, 95% CI: 0.22-0.56) than first-generation vaccines. The number of doses of smallpox vaccine has no significant effect on monkeypox. Safety data showed that adverse reactions after smallpox vaccination were mainly mild and included local erythema, swelling, induration, itching, and pain. Meanwhile, we found that smallpox vaccination could induce the production of neutralizing antibodies against monkeypox. Our findings offer compelling evidence supporting the clinical application of the smallpox vaccine for preventing monkeypox and advocate that high-risk groups should be prioritized for receiving one dose of the smallpox vaccine if the vaccine stockpile is low.
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Affiliation(s)
- Hao Liu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, People's Republic of China
| | - Fuchun Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junyi Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tao Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing, People's Republic of China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, People's Republic of China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing, People's Republic of China
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Ouyang ML, Marusinec R, Bayard PJ, Edmunds M, Johnson M, Lai S, Menker K, Moore C, Moss N, Nguyen M, Peña A, Rajagopal S, Shemsu M, Sheppard I, Slome S, Tang M, Trivedi KK, Yette E, Dunne EF, Ayala G, Chitnis A. Epidemiology of Mpox Cases, and Tecovirimat and JYNNEOS Utilization, Alameda County, California, June-October 2022. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:744-752. [PMID: 39041768 DOI: 10.1097/phh.0000000000002010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
CONTEXT The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men. PROGRAM We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022. IMPLEMENTATION Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox. EVALUATION During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively. DISCUSSION Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities.
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Affiliation(s)
- Megan L Ouyang
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California (Drs Ouyang, Trivedi, Yette, Dunne, and Chitnis, Mss Marusinec, Peña, Shemsu, and Sheppard, and Messrs Johnson, Menker, and Moore); Alameda County Health Care Services Agency, San Leandro, California (Dr Moss); Office of Public Health Director, Alameda County Public Health Department, San Leandro, California (Dr Ayala); La Clínica de La Raza, Oakland, California (Dr Bayard); LifeLong Medical Care, Oakland, California (Dr Edmunds); Alameda Health System, Oakland, California (Dr Lai); Asian Health Services, Oakland, California (Dr Nguyen); Kaiser Permanente Medical Center, Oakland, California (Dr Rajagopal); Bay Area Community Health, Fremont, California (Dr Slome); and East Bay Advanced Care, Alta Bates Summit Medical Center, Sutter Health, Oakland, California (Dr Tang).George Ayala and Amit Chitnis are senior co-authors.Current affiliation of Dr Megan Ouyang is County of Santa Clara Public Health Department, San Jose, California.Current affiliation of Ms April Peña is San Francisco Department of Public Health, San Francisco, California
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Tuan J, Goheen MM, Trebelcock W, Dunne D. Sexually Transmitted Infections in People with Human Immunodeficiency Virus. Infect Dis Clin North Am 2024; 38:559-579. [PMID: 38871569 DOI: 10.1016/j.idc.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Sexually transmitted infections (STIs) are more commonly seen in patients with human immunodeficiency virus (PWH). Routine sexual history taking and appropriate multisite screening practices support prompt identification and treatment of patients, which in turn reduces morbidity and spread of STIs including HIV. Nucleic acid amplification testing has high accuracy for diagnosing many of the major STIs. Diagnosis of syphilis remains complex, requiring 2 stage serologic testing, along with provider awareness of the myriad symptoms that can be attributable to this disease. Prevention through mechanisms such as vaccines and postexposure prophylaxis hold promise to reduce the burden of STIs in PWH.
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Affiliation(s)
- Jessica Tuan
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Morgan M Goheen
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | | | - Dana Dunne
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA.
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Yeganeh N, Yin S, Moir O, Danza P, Kim M, Finn L, Fisher R, Kulkarni S, Perez M, Poortinga K, Garland W, Foo C, Haddix M, Archer R, Frey N, Balter S, Singhal R, Kim A. Effectiveness of JYNNEOS vaccine against symptomatic mpox disease in adult men in Los Angeles County, August 29, 2022 to January 1, 2023. Vaccine 2024; 42:125987. [PMID: 38789368 DOI: 10.1016/j.vaccine.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
We describe real-world estimates of JYNNEOS vaccine effectiveness (VE) against symptomatic mpox in Los Angeles County (LAC). We conducted a retrospective cohort study of men aged ≥18 years residing in LAC who were at risk for mpox and eligible for the JYNNEOS vaccine from 5/19/2022 to 1/1/2023. Case demographics and route of JYNNEOS administration were obtained through vaccine administration data systems. HIV and sexually transmitted infection (STI) status was obtained through disease reporting systems for HIV and STI diagnoses in LAC. To estimate VE, we calculated weekly incidence of confirmed mpox for unvaccinated, partially vaccinated (episode date ≥14 days after first dose), and fully vaccinated (episode date ≥14 days after second dose) cohorts starting on 8/29/2022, when fully vaccinated coverage exceeded 3 %, and ending on 1/1/2023. Overall, 2,171 men had confirmed mpox, and 1,002 (46 %) of those were persons living with diagnosed HIV (PLWDH). 2,019 (93 %) mpox cases were unvaccinated, 114 (5 %) were partially vaccinated and 38 (2 %) were fully vaccinated. VE was 69 % (95 % CI 59-77) for partially vaccinated and 84 % (95 % CI 80-87) for fully vaccinated individuals. Among PLWDH, VE was 72 % (95 % CI 57-82) for fully vaccinated and 28 % (95 % CI -96 to 73) VE for partially vaccinated individuals. Among persons not living with diagnosed HIV, VE was 88 % (95 % CI 86-90) for fully vaccinated and 80 % (95 % CI 76-83) for partially vaccinated individuals. Of 111 individuals hospitalized with mpox, one was partially vaccinated, and the remaining were unvaccinated. Our results align with other published studies that reported that two doses of the JYNNEOS vaccine provided significant protection against symptomatic mpox.
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Affiliation(s)
- Nava Yeganeh
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States.
| | - Sherry Yin
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Olivia Moir
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Phoebe Danza
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Moon Kim
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Lauren Finn
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Rebecca Fisher
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Sonali Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Mario Perez
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Kathleen Poortinga
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Wendy Garland
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chelsea Foo
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Meredith Haddix
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Roxanne Archer
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Natalie Frey
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Sharon Balter
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Rita Singhal
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Andrea Kim
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
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Nakamura H, Yamamoto K. Mpox in people with HIV: A narrative review. HIV Med 2024; 25:910-918. [PMID: 38745559 DOI: 10.1111/hiv.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. RECENT FINDINGS Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. CONCLUSION Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.
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Affiliation(s)
- Hideta Nakamura
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
| | - Kazuko Yamamoto
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
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Dillan MM, Piktel J, Curtis KK, Thomas C, Wilson L. Social determinants and pre-arrest care patterns associated with cardiac arrest and mortality. Resuscitation 2024; 202:110328. [PMID: 39053837 DOI: 10.1016/j.resuscitation.2024.110328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Understanding the impact of social determinants of health (SDOH) on CA, including access to care pre-cardiac arrest (CA) can improve outcomes. Large databases, such as Epic Cosmos, can help identify trends in patient demographics and SDOH that identify gaps in care. The purpose of this study was to determine the incidence of CA and subsequent mortality in a large national database across patient demographics and social determinants and characterize pre-arrest care patterns. METHODS This was a retrospective cohort study using a large national deidentified electronic health database (Epic Cosmos) with 227 million patients. Inclusion criteria was ED encounter for CA (ICD-10-CM: I46). Patient demographics and social determinants included age, sex, race, ethnicity, social vulnerability index (SVI, a composite measure with greater SVI representing more vulnerability). The primary outcome was difference in CA incidence between groups, reported as odds ratios (ORs). The secondary outcomes were 1) incidence of pre-arrest care within 30 days and 2) post-arrest mortality at 7,30, and 180 days. Statistical analysis was performed using Chi-squared analysis (unadjusted OR) and aggregated logistic procedure (adjusted OR). RESULTS There were 201,846 ED visits for CA between April 20, 2020, and April 19, 2023 (0.11% incidence). For all ages, males had a higher incidence of CA (OR 1.76, p < 0.0001). Black, Native Hawaiian or Pacific Islander, and American Indian or Alaska Native had a higher OR of CA while Asian patients were less likely than White patients (adjusted OR 1.85, 1.44,1.51, and 0.81 respectively, all p < 0.0001). Hispanic/Latino patients had a lower OR of CA (adjusted OR 0.72, p < 0.0001). CA was more common in the highest SVI quartile compared to the lowest (adjusted OR 1.71, p < 0.0001). Significant heterogeneities were identified in pre-arrest care across patient demographics and social determinants, where ED visits were more common than office visits among male patients, patients in the highest SVI, Hispanic/Latino, and minority patients, except for Asian patients. Post-arrest mortality after 30 days was highest in females, Black patients, and patients in the highest SVI. CONCLUSIONS SDOH have a significant impact on the risk of CA, pre-arrest care patterns, and post-arrest mortality. Determining the impact that SDOH have on the CA care continuum provides can provide actionable targets to prevent CA and subsequent mortality.
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Affiliation(s)
- Meghan M Dillan
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Joseph Piktel
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA.
| | - Kristen K Curtis
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Charles Thomas
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Lance Wilson
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
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Faherty EAG, Holly T, Ogale YP, Spencer H, Becht AM, Crisler G, Wasz M, Stonehouse P, Barbian HJ, Zelinski C, Kittner A, Foulkes D, Anderson KW, Evans T, Nicolae L, Staton A, Hardnett C, Townsend MB, Carson WC, Satheshkumar PS, Hutson CL, Gigante CM, Quilter LAS, Gorman S, Borah B, Black SR, Pacilli M, Kern D, Kerins J, McCollum AM, Rao AK, Tabidze I. Investigation of an Mpox Outbreak Affecting Many Vaccinated Persons in Chicago, Illinois-March 2023-June 2023. Clin Infect Dis 2024; 79:122-129. [PMID: 38567460 DOI: 10.1093/cid/ciae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After months of few mpox cases, an increase in cases was reported in Chicago during May 2023, predominantly among fully vaccinated (FV) patients. We investigated the outbreak scope, differences between vaccinated and unvaccinated patients, and hypotheses for monkeypox virus (MPXV) infection after vaccination. METHODS We interviewed patients and reviewed medical records to assess demographic, behavioral, and clinical characteristics; mpox vaccine status; and vaccine administration routes. We evaluated serum antibody levels after infection and compared patient viral genomes with MPXV sequences in available databases. We discussed potential vaccine compromise with partners who manufactured, handled, and administered the vaccine associated with breakthrough infections. RESULTS During 18 March-27 June 2023, we identified 49 mpox cases; 57% of these mpox patients were FV. FV patients received both JYNNEOS doses subcutaneously (57%), intradermally (7%), or via heterologous administration (36%). FV patients had more median sex partners (3; interquartile range [IQR] = 1-4) versus not fully vaccinated patients (1; IQR = 1-2). Thirty-six of 37 sequenced specimens belonged to lineage B.1.20 of clade IIb MPXV, which did not demonstrate any amino acid changes relative to B.1, the predominant lineage from May 2022. Vaccinated patients demonstrated expected humoral antibody responses; none were hospitalized. No vaccine storage excursions were identified. Approximately 63% of people at risk for mpox in Chicago were FV during this period. CONCLUSIONS Our investigation indicated that cases were likely due to frequent behaviors associated with mpox transmission, even with relatively high vaccine effectiveness and vaccine coverage. Cases after vaccination might occur in similar populations.
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Affiliation(s)
- Emily A G Faherty
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Taylor Holly
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Yasmin P Ogale
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hillary Spencer
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Ashley M Becht
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Gordon Crisler
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Michael Wasz
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Hannah J Barbian
- Departments of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Alyse Kittner
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - Tiffany Evans
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Lavinia Nicolae
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amber Staton
- Office of the Chief Operating Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carla Hardnett
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael B Townsend
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Carson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Panayampalli S Satheshkumar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Hutson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A S Quilter
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Gorman
- Department of Health and Human Services, Office of Strategic National Stockpile, Atlanta, Georgia, USA
| | - Brian Borah
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - David Kern
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Janna Kerins
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Andrea M McCollum
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irina Tabidze
- Chicago Department of Public Health, Chicago, Illinois, USA
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Swaminathan SS, Medeiros FA. Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis. Am J Ophthalmol 2024; 263:50-60. [PMID: 38395325 PMCID: PMC11162936 DOI: 10.1016/j.ajo.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess disparities in initial disease severity among open-angle glaucoma (OAG) patients. DESIGN Cross-sectional study. METHODS In this analysis of Epic Cosmos, an aggregated electronic health record dataset encompassing >213 million patients, OAG patients examined in ophthalmology or optometry clinics between January 1, 2013, and June 1, 2023, were evaluated. OAG severity at presentation was classified as mild, moderate, or severe using International Classification of Disease-10 codes. Demographics, social vulnerability index (SVI) scores, and rural-urban commuting area codes were evaluated as predictors of disease stage using ordinal logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS Of 245,669 patients, 38.1% had mild, 32.5% moderate, and 29.3% severe disease at presentation. In multivariable analyses, significant determinants of worse severity included older age (OR: 1.23 per decade, 95% CI: 1.22-1.23), male sex (OR: 1.37, 95% CI: 1.35-1.39), Black race (OR: 1.61, 95% CI: 1.58-1.65), Hispanic ethnicity (OR: 1.15, 95% CI: 1.11-1.18), non-commercial insurance or uninsured status (OR: 2.53, 95% CI: 2.33-2.74), secondary OAGs (eg, pseudoexfoliative glaucoma - OR: 1.65, 95% CI: 1.58-1.72), and higher socioeconomic SVI scores (OR: 1.25 for highest versus lowest quartile, 95% CI: 1.22-1.28). Black and Hispanic patients were diagnosed at younger ages compared to White patients (mean ages: 67.8 ± 12.3 and 68.1 ± 12.8 vs 73.3 ± 11.8 years respectively, P < .001). CONCLUSIONS Worse OAG at presentation was associated with older age, male sex, Black race, Hispanic ethnicity, non-commercial insurance or uninsured status, secondary OAGs, and greater socioeconomic vulnerability in this nationwide cohort. These findings can help tailor screening programs towards vulnerable populations.
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Affiliation(s)
- Swarup S Swaminathan
- From the Bascom Palmer Eye Institute (S.S., F.M.), University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Felipe A Medeiros
- From the Bascom Palmer Eye Institute (S.S., F.M.), University of Miami Miller School of Medicine, Miami, Florida, USA
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Kreuter A, Vidakovic M, Wieland U. Causal factors for the rapid decline of the global Mpox outbreak 2022. J Eur Acad Dermatol Venereol 2024; 38:e636-e637. [PMID: 38069519 DOI: 10.1111/jdv.19696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 06/28/2024]
Affiliation(s)
- Alexander Kreuter
- Department of Dermatology, Venerology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Milan Vidakovic
- Department of Dermatology, Venerology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Ulrike Wieland
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Vaughan AM, Afzal M, Nannapaneni P, Leroy M, Andrianou X, Pires J, Funke S, Roman C, Reyes-Uruena J, Aberle S, Aristodimou A, Aspelund G, Bennet KF, Bormane A, Caraglia A, Charles H, Chazelle E, Christova I, Cohen O, Constantinou C, Couvreur S, Diaz A, Fabiánová K, Ferraro F, Grenersen MP, Grilc E, Hannila-Handelberg T, Hvass AK, Igoe D, Jansen K, Janță D, Kaoustou S, Koch A, Kosanovic Licina ML, Krumova S, Labutin A, Lachmann R, Lecompte A, Lefrançois R, Leitena V, Liitsola K, Mlinarić I, Mor Z, Neary M, Novacek A, Øgle MW, Orlíková H, Papadima K, Rehn M, Sadkowska-Todys M, Sîrbu A, Sondén K, Suárez B, Thordardottir M, Vasconcelos P, Vieira Martins J, Zakrzewska K, Widdowson MA, Gossner CM. Continued circulation of mpox: an epidemiological and phylogenetic assessment, European Region, 2023 to 2024. Euro Surveill 2024; 29:2400330. [PMID: 38967012 PMCID: PMC11225264 DOI: 10.2807/1560-7917.es.2024.29.27.2400330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/04/2024] [Indexed: 07/06/2024] Open
Abstract
During the summer of 2023, the European Region experienced a limited resurgence of mpox cases following the substantial outbreak in 2022. This increase was characterised by asynchronous and bimodal increases, with countries experiencing peaks at different times. The demographic profile of cases during the resurgence was largely consistent with those reported previously. All available sequences from the European Region belonged to clade IIb. Sustained efforts are crucial to control and eventually eliminate mpox in the European Region.
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Affiliation(s)
- Aisling M Vaughan
- These authors contributed equally as first authors
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Mohammed Afzal
- These authors contributed equally as first authors
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Mathias Leroy
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Xanthi Andrianou
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jeffrey Pires
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Silvia Funke
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Celine Roman
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | | | - Stephan Aberle
- Medical University of Vienna, Centre for Virology, Vienna, Austria
| | | | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Kirsty F Bennet
- United Kingdom Health Security Agency, London, United Kingdom
| | - Antra Bormane
- Center for Disease Prevention and Control of Latvia, Department of Infectious Diseases Risk Analysis and Prevention, Riga, Latvia
| | | | - Hannah Charles
- United Kingdom Health Security Agency, London, United Kingdom
| | - Emilie Chazelle
- Santé publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Orna Cohen
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | | | - Simon Couvreur
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Asuncion Diaz
- National Centre of Epidemiology, CIBER in Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - Kateřina Fabiánová
- National Institute of Public Health, Centre for Epidemiology and Microbiology, Department of Infectious Disease Epidemiology, Prague, Czechia
| | | | | | - Eva Grilc
- NIJZ (NIPH), Centre for Communicable Diseases, Ljubljana, Slovenia
| | | | - Anne Kathrine Hvass
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Derval Igoe
- HSE Public Health: National Health Protection Office, Dublin, Ireland
| | - Klaus Jansen
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Denisa Janță
- National Institute of Public Health, Bucharest, Romania
| | - Styliani Kaoustou
- Directorate of Epidemiological Surveillance and Intervention for Communicable Diseases, National Public Health Organization, Marousi, Greece
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Stefka Krumova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Anton Labutin
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Raskit Lachmann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Amaryl Lecompte
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Rémi Lefrançois
- Santé publique France, the French National Public Health Agency, Saint-Denis, France
| | - Viktorija Leitena
- Center for Disease Prevention and Control of Latvia, Department of Infectious Diseases Risk Analysis and Prevention, Riga, Latvia
| | - Kirsi Liitsola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ivan Mlinarić
- Croatian Institute of Public Health, Division for Epidemiology of Communicable Diseases, Zagreb, Croatia
| | - Zohar Mor
- School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Martha Neary
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Alina Novacek
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | - Hana Orlíková
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czechia
- National Institute of Public Health, Centre for Epidemiology and Microbiology, Department of Infectious Disease Epidemiology, Prague, Czechia
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Intervention for Communicable Diseases, National Public Health Organization, Marousi, Greece
| | - Moa Rehn
- Public Health Agency of Sweden (PHAS), Solna, Sweden
| | | | - Anca Sîrbu
- National Institute of Public Health, Bucharest, Romania
| | - Klara Sondén
- Public Health Agency of Sweden (PHAS), Solna, Sweden
| | - Berta Suárez
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Marianna Thordardottir
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | - Paula Vasconcelos
- Public Health Emergency Centre, Directorate-General of Health (DGS), Lisbon, Portugal
| | - Joao Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Karolina Zakrzewska
- National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Marc-Alain Widdowson
- These authors contributed equally as last authors
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Céline M Gossner
- These authors contributed equally as last authors
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Pipitò L, Trizzino M, Ferraro D, Calà C, Giammanco G, Cascio A. Do not forget mpox! Travel Med Infect Dis 2024; 60:102728. [PMID: 38825297 DOI: 10.1016/j.tmaid.2024.102728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro,"University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Palermo, Italy; Checkpoint Palermo Fast-Track City, Casa dei Diritti, Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Palermo, Italy; Checkpoint Palermo Fast-Track City, Casa dei Diritti, Palermo, Italy
| | - Donatella Ferraro
- Microbiology and Virology Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy
| | - Cinzia Calà
- Microbiology and Virology Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy
| | - Giovanni Giammanco
- Microbiology and Virology Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro,"University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Palermo, Italy; Checkpoint Palermo Fast-Track City, Casa dei Diritti, Palermo, Italy.
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12
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Yang S, Xia C, Zhang Y, Shen Y, Xia C, Lu Y, Su S, Deng C, Harypursat V, Wang J, Yuan J, Chen Y. Clinical features and viral load variations of Mpox: a retrospective study in Chongqing, China. BMC Infect Dis 2024; 24:641. [PMID: 38926635 PMCID: PMC11202379 DOI: 10.1186/s12879-024-09537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE Since May 2022, Mpox has spread extensively outside of Africa, posing a serious threat to the health of people globally, and particularly to the men who have sex with men (MSM) population. Chongqing, a province in Southwest China, has relatively large MSM and people living with HIV (PLWH) populations, presenting conditions conducive to the wide dissemination of Mpox. In this study, we investigated the clinical characteristics of Mpox patients among MSM and PLWH in Chongqing, aiming to inform the development of targeted prevention, control, and treatment strategies for Mpox. METHOD We evaluated the clinical characteristics, travel history, time of onset, distribution and number of skin lesions of Mpox patients admitted to the Chongqing Public Health Medical Center between September 2022 and October 2023. Meanwhile, a series of clinical samples were collected and the pathogen of interest was identified as Mpox virus using quantitative polymerase chain reaction (qPCR). The results were presented in the form of cycle thresholds (Ct), which help to approximate the quantification of viral load. RESULTS As of October 11, 2023, the Chongqing Public Health Medical Center reported a total of nine Mpox virus infections. All the patients identified were male and belonged to the MSM population, among whom seven (77.8%) were living with HIV, and maintained a preserved immune system while achieving viral suppression via effective ART. We observed no discernible clinical differences between MSM with Mpox with or without HIV, and no fatalities were recorded. Viral loads were observed to be higher in samples taken from the skin than those from the throat, nasopharynx, blood, or semen. CONCLUSION In this retrospective study, the clinical manifestations of MPXV infection appeared consistent among MSM patients, regardless of HIV status. Elevated MPXV viral loads in the skin and mucosal tissues, particularly at genital and anal sites, indicate that transmission is more likely to occur via direct physical contact as opposed to respiratory pathways or through exposure to bodily fluids.
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Affiliation(s)
- Sen Yang
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Chao Xia
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yuxin Zhang
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yan Shen
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Chengshuang Xia
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yanqiu Lu
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Shifang Su
- Department of Disease Prevention, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Changgang Deng
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Vijay Harypursat
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Jing Wang
- Department of Medical Laboratory, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Jing Yuan
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China.
| | - Yemiao Chen
- Biobank, Chongqing Public Health Medical Center, Chongqing, 400036, China.
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Pischel L, Martini BA, Yu N, Cacesse D, Tracy M, Kharbanda K, Ahmed N, Patel KM, Grimshaw AA, Malik AA, Goshua G, Omer SB. Vaccine effectiveness of 3rd generation mpox vaccines against mpox and disease severity: A systematic review and meta-analysis. Vaccine 2024:S0264-410X(24)00694-7. [PMID: 38906763 DOI: 10.1016/j.vaccine.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Before the global mpox outbreak which began in 2022, the real-world vaccine effectiveness (VE) of mpox vaccines was unknown. We quantified the VE in the global population of 3rd generation or later mpox vaccines (MVA-BN, LC16m8, OrthopoxVac) compared with unvaccinated or other vaccinated states for infection, hospitalization and death. VE was stratified by 1-dose and 2-doses and post-exposure prophylaxis (PEP). METHODS Studies were included if they measured vaccine efficacy or effectiveness in humans. Animal studies and immunogenicity studies were excluded. MEDLINE, Web of Science, Google Scholar, Embase, MedRxiv and grey literature were searched from January 1st, 1970, with the last search run on November 3, 2023 (Prospero, CRD42022345240). Risk of publication bias was assessed via funnel plots and Egger's test, and study quality via Newcastle-Ottawa scales. RESULTS A total of 11,892 records were identified via primary search, 3,223 via citation chasing. Thirty-three studies were identified of 3rd generation vaccines, 32 of which were MVA-BN. Two additional studies were re-analysis of existing data. Most of these studies were focused on gay, bisexual, or other men who have sex with men between the ages of 18-49 in May to October of 2022. VE of 1 dose of MVA-BN was 76% (95%CI 64-88%) from twelve studies. VE of 2 doses was 82% (95%CI 72-92%) from six studies. VE of MVA-BN PEP against mpox was 20% (95%CI -24-65%) from seven studies. All VE are calculated from random effects estimates. 18/33(55%) studies were rated as poor, 3/33(9%) as fair and 12/33(36%) as good. Studies included in the meta-analysis had higher quality: 11/16 (69%) were rated as good quality. CONCLUSION Both 1 and 2 doses of MVA-BN are highly effective at preventing mpox. Effectiveness estimates, specifically of PEP are limited by immortal time bias, predominant mode of mpox transmission, and real-world vaccine timing of administration.
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Affiliation(s)
- Lauren Pischel
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | | | - Natalle Yu
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Mahder Tracy
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Kolambi Kharbanda
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Noureen Ahmed
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Kavin M Patel
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Alyssa A Grimshaw
- Yale University, Harvey Cushing/John Hay Whitney Medical Library, New Haven, CT, USA
| | - Amyn A Malik
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - George Goshua
- Yale School of Medicine, Section of Hematology, Department of Internal Medicine and Yale Cancer Center, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Saad B Omer
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
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14
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Back S, Knox B, Coakley C, Deltour N, Jacquot E, Raad H, Garry EM. Effectiveness and Safety of the MVA-BN Vaccine against Mpox in At-Risk Individuals in the United States (USMVAc). Vaccines (Basel) 2024; 12:651. [PMID: 38932380 PMCID: PMC11209565 DOI: 10.3390/vaccines12060651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The mpox 2022 outbreak was declared a public health emergency in July 2022. In August 2022, the MVA-BN vaccine received emergency use authorization in the United States (US) to target at-risk groups. This study (EUPAS104386) used HealthVerity's administrative US healthcare data to generate real-world evidence for MVA-BN vaccine effectiveness and safety to prevent mpox disease in men who have sex with men (MSM) and transgender women, the most affected population during the 2022 mpox outbreak. Fully vaccinated subjects (two doses ≥ 28 days apart) were initially matched with five unvaccinated subjects on calendar date, age, US region, and insurance type. Subjects were followed from index date (14 days after the second dose) until death or data end to ascertain mpox occurrence. After propensity score adjustment, the MVA-BN vaccine effectiveness against mpox disease was 89% (95% CI: 12%, 99%) among those fully vaccinated; attenuated to 64% (95% CI: 40%, 78%) among those with any dose and 70% (95% CI: 44%, 84%) for those with only a single dose. One pericarditis adverse event of special interest was observed when the risk window was extended to 28 days. These results contribute to the totality of evidence supporting the favorable benefit/risk profile of the MVA-BN vaccine.
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15
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Weidenthaler H, Vidojkovic S, Martin BK, De Moerlooze L. Real-world safety data for MVA-BN: Increased frequency of syncope following intradermal administration for immunization against mpox disease. Vaccine 2024:S0264-410X(24)00651-0. [PMID: 38839518 DOI: 10.1016/j.vaccine.2024.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/16/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND MVA-BN vaccine (Jynneos, Imvamune, Imvanex) was used widely in the 2022 mpox outbreak. This experience provides real-world evidence about the vaccine's safety, particularly regarding intradermal use. METHODS Bavarian Nordic's global safety database was searched for all adverse events following immunization (AEFIs) with MVA-BN. AEFI numbers were compared among administration routes. Selected events and administered doses were graphed over the mpox outbreak period. RESULTS A total of 9585 AEFIs have been reported. The rate of myocarditis or pericarditis was <1 per 100,000 doses administered. Eighty-nine cases of syncope, fainting, or loss of consciousness were reported. This number rose after the August 2022 US emergency use authorization for intradermal administration, as did the proportion of all syncope AEFIs reported following intradermal administration (78,7 %). CONCLUSION Real-world data from large-scale administration of MVA-BN has confirmed the vaccine's established safety profile when administered subcutaneously. Intradermal administration is likely associated with increased syncopal event frequency.
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Affiliation(s)
| | - Sanja Vidojkovic
- Bavarian Nordic GmbH, Fraunhoferstrasse 13, 82152 Martinsried, Germany
| | - Barbara K Martin
- Bavarian Nordic Inc, 1005 Slater Road, Suite 101, Durham, NC 27703, United States
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Moss B. Understanding the biology of monkeypox virus to prevent future outbreaks. Nat Microbiol 2024; 9:1408-1416. [PMID: 38724757 DOI: 10.1038/s41564-024-01690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/26/2024] [Indexed: 06/07/2024]
Abstract
Historically, monkeypox (mpox) was a zoonotic disease endemic in Africa. However, in 2022, a global outbreak occurred following a substantial increase in cases in Africa, coupled with spread by international travellers to other continents. Between January 2022 and October 2023, about 91,000 confirmed cases from 115 countries were reported, leading the World Health Organization to declare a public health emergency. The basic biology of monkeypox virus (MPXV) can be inferred from other poxviruses, such as vaccinia virus, and confirmed by genome sequencing. Here the biology of MPXV is reviewed, together with a discussion of adaptive changes during MPXV evolution and implications for transmission. Studying MPXV biology is important to inform specific host interactions, to aid in ongoing outbreaks and to predict those in the future.
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Affiliation(s)
- Bernard Moss
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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17
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Chromy D, Urban N, Bauer WM, Kreuter A, Strassl R, Grabmeier-Pfistershammer K. Scars are frequently found as late sequelae in individuals affected by the 2022 mpox outbreak. HIV Med 2024. [PMID: 38816960 DOI: 10.1111/hiv.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The 2022 mpox outbreak continues, and while progress has been made in prevention strategies and potential treatment options, data on late sequelae following mpox are scarce. OBJECTIVE This analysis aimed to assess the incidence of scar formation in individuals affected by the 2022 mpox outbreak. METHODS All individuals diagnosed with mpox at the Department of Dermatology at the Medical University of Vienna in 2022 were included in this analysis. Follow-up data were collected throughout November 2023. 'Scar formation' was defined as having at least one scar at the former active mpox lesions. RESULTS At our clinic, 28 cases of mpox presented between June 2022 and October 2022 and exclusively occurred in men who have sex with men (100%, 28/28), of whom 46% (13/28) were living with HIV, and 32% (9/28) were using pre-exposure prophylaxis (PrEP). Secondary bacterial infection of mpox lesions was suspected in six individuals, and all received systemic antibiotics. Overall, 26 were followed up in November 2023 after a median time of 15 months, and scar formations were found in 43% of cases. CONCLUSIONS Our data provide insights into the late yet cumulating disease burden caused by the 2022 mpox outbreak. Highly effective prevention strategies are warranted to overcome the mpox epidemic and its potential late sequelae.
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Affiliation(s)
- David Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nikolaus Urban
- Department of Surgery, Klinik Favoriten, Vienna Healthcare Group, Vienna, Austria
| | | | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
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18
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Hsu J, Kim S, Anandasabapathy N. Vaccinia Virus: Mechanisms Supporting Immune Evasion and Successful Long-Term Protective Immunity. Viruses 2024; 16:870. [PMID: 38932162 PMCID: PMC11209207 DOI: 10.3390/v16060870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Vaccinia virus is the most successful vaccine in human history and functions as a protective vaccine against smallpox and monkeypox, highlighting the importance of ongoing research into vaccinia due to its genetic similarity to other emergent poxviruses. Moreover, vaccinia's ability to accommodate large genetic insertions makes it promising for vaccine development and potential therapeutic applications, such as oncolytic agents. Thus, understanding how superior immunity is generated by vaccinia is crucial for designing other effective and safe vaccine strategies. During vaccinia inoculation by scarification, the skin serves as a primary site for the virus-host interaction, with various cell types playing distinct roles. During this process, hematopoietic cells undergo abortive infections, while non-hematopoietic cells support the full viral life cycle. This differential permissiveness to viral replication influences subsequent innate and adaptive immune responses. Dendritic cells (DCs), key immune sentinels in peripheral tissues such as skin, are pivotal in generating T cell memory during vaccinia immunization. DCs residing in the skin capture viral antigens and migrate to the draining lymph nodes (dLN), where they undergo maturation and present processed antigens to T cells. Notably, CD8+ T cells are particularly significant in viral clearance and the establishment of long-term protective immunity. Here, we will discuss vaccinia virus, its continued relevance to public health, and viral strategies permissive to immune escape. We will also discuss key events and populations leading to long-term protective immunity and remaining key gaps.
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Affiliation(s)
- Joy Hsu
- Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10021, USA
- Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Suyon Kim
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Niroshana Anandasabapathy
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10021, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10021, USA
- Englander Institute of Precision Medicine, Weill Cornell Medicine, New York, NY 10021, USA
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19
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Guagliardo SAJ, Kracalik I, Carter RJ, Braden C, Free R, Hamal M, Tuttle A, McCollum AM, Rao AK. Monkeypox Virus Infections After 2 Preexposure Doses of JYNNEOS Vaccine - United States, May 2022-May 2024. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:460-466. [PMID: 38781111 PMCID: PMC11115437 DOI: 10.15585/mmwr.mm7320a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Two doses of JYNNEOS vaccine are effective in preventing many mpox cases and can reduce the severity of symptoms in infected persons. However, infections among fully vaccinated persons can occur. During May 2022-May 2024, a total of 271 mpox cases among fully vaccinated persons were reported to CDC from 27 U.S. jurisdictions. These reported infections are estimated to have occurred in <1% of fully vaccinated persons. Compared with cases among unvaccinated persons, infections among fully vaccinated persons were more likely to occur among non-Hispanic White men aged 30-39 years, were associated with increased numbers of sexual partners, and resulted in less severe disease (p<0.001). Among infections in fully vaccinated persons with complete data, infections after vaccination were reported more commonly after receipt of heterologous (subcutaneous and intradermal) (46%) or homologous subcutaneous (32%) JYNNEOS vaccination than after homologous intradermal (22%) vaccination. Disparate time intervals from vaccination to infection among fully vaccinated persons suggest that immunity is not waning. The median interval between the second vaccine dose and illness onset was longer for cases among persons who had received 2 intradermal doses (median = 363 days; IQR = 221-444 days) compared with cases in persons who had received 2 subcutaneous doses (median = 263 days; IQR = 47-334 days) (p<0.001). The implications of this finding are not known; however, these data should increase confidence in the effectiveness of vaccine doses that were administered intradermally, the preferred method of administration during the peak of the outbreak when vaccine supply was limited. Persons recommended to receive the JYNNEOS vaccine should receive 2 doses, irrespective of the route of administration, and at this time, additional doses are not recommended for the affected population.
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Liu BM, Rakhmanina NY, Yang Z, Bukrinsky MI. Mpox (Monkeypox) Virus and Its Co-Infection with HIV, Sexually Transmitted Infections, or Bacterial Superinfections: Double Whammy or a New Prime Culprit? Viruses 2024; 16:784. [PMID: 38793665 PMCID: PMC11125633 DOI: 10.3390/v16050784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Epidemiologic studies have established that mpox (formerly known as monkeypox) outbreaks worldwide in 2022-2023, due to Clade IIb mpox virus (MPXV), disproportionately affected gay, bisexual, and other men who have sex with men. More than 35% and 40% of the mpox cases suffer from co-infection with HIV and sexually transmitted infections (STIs) (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, and herpes simplex virus), respectively. Bacterial superinfection can also occur. Co-infection of MPXV and other infectious agents may enhance disease severity, deteriorate outcomes, elongate the recovery process, and potentially contribute to the morbidity and mortality of the ensuing diseases. However, the interplays between MPXV and HIV, bacteria, other STI pathogens and host cells are poorly studied. There are many open questions regarding the impact of co-infections with HIV, STIs, or bacterial superinfections on the diagnosis and treatment of MPXV infections, including clinical and laboratory-confirmed mpox diagnosis, suboptimal treatment effectiveness, and induction of antiviral drug resistance. In this review article, we will discuss the progress and knowledge gaps in MPXV biology, antiviral therapy, pathogenesis of human MPXV and its co-infection with HIV, STIs, or bacterial superinfections, and the impact of the co-infections on the diagnosis and treatment of mpox disease. This review not only sheds light on the MPXV infection and co-infection of other etiologies but also calls for more research on MPXV life cycles and the molecular mechanisms of pathogenesis of co-infection of MPXV and other infectious agents, as well as research and development of a novel multiplex molecular testing panel for the detection of MPXV and other STI co-infections.
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Affiliation(s)
- Benjamin M. Liu
- Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA;
- Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA;
- Children’s National Research Institute, Washington, DC 20012, USA
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
| | - Natella Y. Rakhmanina
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA;
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC 20010, USA
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC 20005, USA
| | - Zhilong Yang
- Department of Veterinary Pathobiology, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Michael I. Bukrinsky
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA;
- The District of Columbia Center for AIDS Research, Washington, DC 20052, USA
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21
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Pathela P, Townsend MB, Kopping EJ, Tang J, Navarra T, Priyamvada L, Carson WC, Panayampalli SS, Fowler RC, Kyaw N, Hughes S, Jamison K. Serological Evidence of Mpox Virus Infection During Peak Mpox Transmission in New York City, July to August 2022. J Infect Dis 2024:jiae181. [PMID: 38736232 DOI: 10.1093/infdis/jiae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The extent to which infections may have been undetected in an epicenter of the 2022 mpox outbreak is unknown. METHODS A serosurvey (July and August 2022) assessed the seroprevalence and correlates of mpox infection among a diverse sample of asymptomatic patients with no prior mpox diagnoses and no known histories of smallpox or mpox vaccination. We present seropositivity stratified by participant characteristics collected via survey. RESULTS Two-thirds of 419 participants were cismen (281 of 419), of whom 59.1% (166 of 281) reported sex with men (MSM). The sample also included 109 ciswomen and 28 transgender/gender nonconforming/nonbinary individuals. Overall seroprevalence was 6.4% (95% confidence interval [CI], 4.1%-8.8%); 3.7% among ciswomen (95% CI, 1.0%-9.1%), 7.0% among cismen with only ciswomen partners (95% CI, 2.0%-11.9%), and 7.8% among MSM (95% CI, 3.7%-11.9%). There was little variation in seroprevalence by race/ethnicity, age group, HIV status, or number of recent sex partners. No participants who reported close contact with mpox cases were seropositive. Among participants without recent mpox-like symptoms, 6.3% were seropositive (95% CI, 3.6%-9.0%). CONCLUSIONS Approximately 1 in 15 vaccine-naive people in our study had antibodies to mpox during the height of the NYC outbreak, indicating the presence of asymptomatic infections that could contribute to ongoing transmission.
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Affiliation(s)
- Preeti Pathela
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Michael B Townsend
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erik J Kopping
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Jennifer Tang
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Terese Navarra
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalita Priyamvada
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Carson
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Randal C Fowler
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Nang Kyaw
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Bureau of Healthcare and Community Readiness, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Scott Hughes
- Bureau of the Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Kelly Jamison
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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22
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Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomed J 2024:100746. [PMID: 38734408 DOI: 10.1016/j.bj.2024.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
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Affiliation(s)
- Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Narendra Kumar
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kamal Singh
- Department of Veterinary Pathobiology, College of Veterinary Medicine, and Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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23
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Berry MT, Khan SR, Schlub TE, Notaras A, Kunasekaran M, Grulich AE, MacIntyre CR, Davenport MP, Khoury DS. Predicting vaccine effectiveness for mpox. Nat Commun 2024; 15:3856. [PMID: 38719852 PMCID: PMC11078999 DOI: 10.1038/s41467-024-48180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
The Modified Vaccinia Ankara vaccine developed by Bavarian Nordic (MVA-BN) was widely deployed to prevent mpox during the 2022 global outbreak. This vaccine was initially approved for mpox based on its reported immunogenicity (from phase I/II trials) and effectiveness in animal models, rather than evidence of clinical efficacy. However, no validated correlate of protection after vaccination has been identified. Here we performed a systematic search and meta-analysis of the available data to test whether vaccinia-binding ELISA endpoint titer is predictive of vaccine effectiveness against mpox. We observe a significant correlation between vaccine effectiveness and vaccinia-binding antibody titers, consistent with the existing assumption that antibody levels may be a correlate of protection. Combining this data with analysis of antibody kinetics after vaccination, we predict the durability of protection after vaccination and the impact of dose spacing. We find that delaying the second dose of MVA-BN vaccination will provide more durable protection and may be optimal in an outbreak with limited vaccine stock. Although further work is required to validate this correlate, this study provides a quantitative evidence-based approach for using antibody measurements to predict the effectiveness of mpox vaccination.
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Affiliation(s)
- Matthew T Berry
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Shanchita R Khan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Timothy E Schlub
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Adriana Notaras
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Raina MacIntyre
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, and College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Miles P Davenport
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - David S Khoury
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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24
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Rahim F, Sabet C, Holenn S, Hertz J. Democratic Republic of the Congo: a strengthened response to mpox could help revitalise the country's healthcare system. BMJ 2024; 385:q1004. [PMID: 38697640 DOI: 10.1136/bmj.q1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Faraan Rahim
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Cameron Sabet
- Georgetown University Medical Center, Washington, DC, USA
| | - Serge Holenn
- Ministry of Public Health of the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Julian Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
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25
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Pang Y, Cao D, Zhu X, Long Q, Tian F, Long X, Li Y. Safety and Efficacy of the Modified Vaccinia Ankara-Bavaria Nordic Vaccine Against Mpox in the Real World: Systematic Review and Meta-Analysis. Viral Immunol 2024; 37:216-219. [PMID: 38717823 DOI: 10.1089/vim.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
In May 2022, mpox began to spread worldwide, posing a serious threat to human public health. Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN) is a live attenuated orthopoxvirus vaccine that has been authorized by the U.S. Food and Drug Administration as the vaccine of choice for the prevention of mpox. In this study, we conducted a meta-analysis of all currently published literature on the efficacy and safety of the MVA-BN vaccine in the real world, showing that the MVA-BN vaccine is effective and safe, with efficacy of up to 75% with a single dose and up to 80% with a two-dose vaccine. Meanwhile, we found that subcutaneous injection has lower local and systemic adverse events than intradermal injection, regardless of single- or two-dose vaccination, and subcutaneous injection is better tolerated in children, the elderly, or people with underlying medical conditions. These results have important reference value for clinical practice.
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Affiliation(s)
- Yi Pang
- Science and Technology Department, Youjiang Medical University for Nationalities, Baise, China
| | - Demin Cao
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Xiaoying Zhu
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Qinqin Long
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Fengqin Tian
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Xidai Long
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
| | - Yulei Li
- Clinicopathological Diagnosis & Research Center, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Guangxi Higher Education Institutes, Baise, China
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26
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Haverkate MR, Willemstein IJ, van Ewijk CE, Adam PC, Lanooij SJ, Jonker-Jorna P, van Bokhoven C, van Rijckevorsel GG, Hoornenborg E, David S, Mollema L, Te Wierik MJ, Lange J, Franz E, de Melker HE, Op de Coul EL, Hahné SJ. Factors potentially contributing to the decline of the mpox outbreak in the Netherlands, 2022 and 2023. Euro Surveill 2024; 29:2300608. [PMID: 38785092 PMCID: PMC11128738 DOI: 10.2807/1560-7917.es.2024.29.21.2300608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
BackgroundIn 2022 and 2023, a global outbreak of mpox affected mostly gay, bisexual and other men having sex with men (GBMSM). Outbreak control in the Netherlands included isolation, quarantine, post-exposure prophylaxis vaccination and primary preventive vaccination (PPV).AimWe describe the course of the outbreak, the vaccination programme, vaccine effectiveness (VE) of full vaccination against symptomatic disease, and trends in behaviour to generate hypotheses about factors that influenced the outbreak's decline.MethodsIn this observational study, we collected data from public health services on notified cases, number of PPV invitations and PPV doses administered. We calculated PPV uptake and coverage. Trends in behavioural data of GBMSM visiting sexual health centres were analysed for all consultations in 2022. We estimated VE using the screening method.ResultsUntil 31 December 2023, 1,294 mpox cases were reported. The outbreak peaked in early July 2022 and then declined sharply. PPV started on 25 July 2022; in total 29,851 doses were administered, 45.8% received at least one dose, 35.4% were fully vaccinated. The estimated VE was 68.2% (95% CI 4.3-89.5%). We did not observe an evident decrease in high-risk behaviour.DiscussionIt is unlikely that PPV was a driver of the outbreak's decline, as incidence started to decline well before the start of the PPV programme. The possible impact of behavioural change could not be demonstrated with the available indicators, however, the data had limitations, hampering interpretation. We hypothesise that infection-induced immunity in high-risk groups was an important factor explaining the decline.
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Affiliation(s)
- Manon R Haverkate
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Inge Jm Willemstein
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Catharina E van Ewijk
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Philippe Cg Adam
- Institute for Prevention and Social Research, Utrecht, the Netherlands
- University of New South Wales Sydney, Sydney, Australia
| | - Susan J Lanooij
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | - Gini Gc van Rijckevorsel
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Public Health Service Amsterdam, Amsterdam, the Netherlands
| | | | - Silke David
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Liesbeth Mollema
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Margreet J Te Wierik
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jente Lange
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eelco Franz
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E de Melker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eline Lm Op de Coul
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Susan Jm Hahné
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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27
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Dudášová J, Valenta Z, Sachs JR. Elucidating vaccine efficacy using a correlate of protection, demographics, and logistic regression. BMC Med Res Methodol 2024; 24:101. [PMID: 38689224 PMCID: PMC11059665 DOI: 10.1186/s12874-024-02197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 03/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Vaccine efficacy (VE) assessed in a randomized controlled clinical trial can be affected by demographic, clinical, and other subject-specific characteristics evaluated as baseline covariates. Understanding the effect of covariates on efficacy is key to decisions by vaccine developers and public health authorities. METHODS This work evaluates the impact of including correlate of protection (CoP) data in logistic regression on its performance in identifying statistically and clinically significant covariates in settings typical for a vaccine phase 3 trial. The proposed approach uses CoP data and covariate data as predictors of clinical outcome (diseased versus non-diseased) and is compared to logistic regression (without CoP data) to relate vaccination status and covariate data to clinical outcome. RESULTS Clinical trial simulations, in which the true relationship between CoP data and clinical outcome probability is a sigmoid function, show that use of CoP data increases the positive predictive value for detection of a covariate effect. If the true relationship is characterized by a decreasing convex function, use of CoP data does not substantially change positive or negative predictive value. In either scenario, vaccine efficacy is estimated more precisely (i.e., confidence intervals are narrower) in covariate-defined subgroups if CoP data are used, implying that using CoP data increases the ability to determine clinical significance of baseline covariate effects on efficacy. CONCLUSIONS This study proposes and evaluates a novel approach for assessing baseline demographic covariates potentially affecting VE. Results show that the proposed approach can sensitively and specifically identify potentially important covariates and provides a method for evaluating their likely clinical significance in terms of predicted impact on vaccine efficacy. It shows further that inclusion of CoP data can enable more precise VE estimation, thus enhancing study power and/or efficiency and providing even better information to support health policy and development decisions.
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Affiliation(s)
- Julie Dudášová
- Quantitative Pharmacology and Pharmacometrics, MSD Czech Republic, Svornosti 3321/2, 150 00 Prague 5, Prague, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Zdeněk Valenta
- Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jeffrey R Sachs
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Rahway, NJ, USA
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28
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Fierro C, Weidenthaler H, Vidojkovic S, Schmidt D, Gafoor Z, Stroukova D, Zwiers S, Müller J, Volkmann A. Safety and immunogenicity of a novel trivalent recombinant MVA-based equine encephalitis virus vaccine: A Phase 1 clinical trial. Vaccine 2024; 42:2695-2706. [PMID: 38494412 DOI: 10.1016/j.vaccine.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Three encephalitic alphaviruses-western, eastern, and Venezuelan equine encephalitis virus (WEEV, EEEV and VEEV)-can cause severe disease and have the potential to be used as biological weapons. There are no approved vaccines for human use. A novel multivalent MVA-BN-WEV vaccine encodes the envelope surface proteins of the 3 viruses and is thereby potentially able to protect against them all, as previously demonstrated in animal models. This first-in-human study assessed the safety, tolerability, and immunogenicity of MVA-BN-WEV vaccine in healthy adult participants. METHODS Forty-five participants were enrolled into 3 dose groups (1 × 10E7 Inf.U, 1 × 10E8 Inf.U, and 2 × 10E8 Inf.U), received 2 doses 4 weeks apart, and were then monitored for 6 months. RESULTS The safety profile of MVA-BN-WEV was acceptable at all administered doses, with incidence of local solicited AEs increased with increasing dose and no other clinically meaningful differences between dose groups. One SAE (Grade 2 pleural effusion) was reported in the lowest dose group and assessed as possibly related. No AEs resulted in death or led to withdrawal from the second vaccination or from the trial. The most common local solicited AE was injection site pain, and general solicited AEs were headache, fatigue, and myalgia. MVA-BN-WEV induced humoral immune responses; WEEV-, EEEV- and VEEV-specific neutralizing antibody responses peaked 2 weeks following the second vaccination, and the magnitude of these responses increased with dose escalation. The highest dose resulted in seroconversion of all (100 %) participants for WEEV and VEEV and 92.9 % for EEEV, 2 weeks following second vaccination, and durability was observed for 6 months. MVA-BN-WEV induced cellular immune responses to VEEV E1 and E2 (EEEV and WEEV not tested) and a dose effect for peptide pool E2. CONCLUSION The study demonstrated that MVA-BN-WEV is well tolerated, induces immune responses, and is suitable for further development. CLINICAL TRIAL REGISTRY NUMBER NCT04131595.
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Affiliation(s)
- Carlos Fierro
- Johnson County Clin-Trials (JCCT), 16400 College Blvd., Lenexa, KS 66219, USA
| | | | - Sanja Vidojkovic
- Bavarian Nordic GmbH, Fraunhoferstrasse 13, 82152 Martinsried, Germany
| | - Darja Schmidt
- Bavarian Nordic GmbH, Fraunhoferstrasse 13, 82152 Martinsried, Germany
| | - Zarina Gafoor
- Bavarian Nordic Inc, 1005 Slater Road, Suite 101, Durham, NC 27703, USA
| | - Daria Stroukova
- Bavarian Nordic GmbH, Fraunhoferstrasse 13, 82152 Martinsried, Germany
| | - Susan Zwiers
- Bavarian Nordic Inc, 1005 Slater Road, Suite 101, Durham, NC 27703, USA
| | - Jutta Müller
- Immunic AG, Lochhamer Schlag 21, 82166 Gräfelfing, Germany
| | - Ariane Volkmann
- Bavarian Nordic GmbH, Fraunhoferstrasse 13, 82152 Martinsried, Germany.
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29
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Mazumder A, Lim L, White CM, Van Gerwen OT. A Case of Varicella Zoster and Mpox Coinfection in a Patient Living With HIV. Sex Transm Dis 2024; 51:e14-e16. [PMID: 38301635 DOI: 10.1097/olq.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT We present a case of recurrent, cutaneous mpox with coinfection of disseminated varicella zoster in an immunocompromised patient with poorly controlled HIV. This case demonstrates the importance of maintaining a high index of suspicion for mpox despite prior infection and vaccination, as suboptimal immune response is possible in immunocompromised patients, and also noting the potential for coinfection necessitating timely diagnosis and appropriate testing.
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Affiliation(s)
- Archisman Mazumder
- From the Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Thomassen SE, von Schreeb S, Kirkby NS, Pinholt M, Lebech AM, Kronborg G, Engsig FN. Prospective screening for monkeypox infection among users of HIV pre-exposure prophylaxis in Denmark. Int J STD AIDS 2024; 35:374-378. [PMID: 38164933 DOI: 10.1177/09564624231223764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION During the 2022 outbreak of mpox (previously called monkeypox), which primarily affected Gay, Bisexual, and other Men who have Sex with Men (GBMSM), testing was mainly limited to individuals with symptoms of infection. Although sporadic cases of mpox continue to be diagnosed in Denmark, the feasibility of screening asymptomatic high-risk populations, such as those using HIV pre-exposure prophylaxis (PrEP), is still unknown. METHODS During the autumn of 2022, a rectal swab test for mpox PCR was included in the routine sexually transmitted infections (STI) screening for PrEP users. RESULTS The screening included 224 asymptomatic men with a median age of 36.5 years. One patient (0.4%) tested positive for mpox. Ten (4.5%) and nine (4.0%) had chlamydia and gonorrhea, respectively. DISCUSSION Our study demonstrates that screening for mpox is feasible in two Danish PrEP clinics.
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Affiliation(s)
- Sofie Ellen Thomassen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen Denmark
| | - Sebastian von Schreeb
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen Denmark
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Nikolai Søren Kirkby
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mette Pinholt
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Neess Engsig
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen Denmark
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Shamier MC, Zaeck LM, Götz HM, Vieyra B, Verstrepen BE, Wijnans K, Welkers MR, Hoornenborg E, van Cleef BA, van Royen ME, Jonas KJ, Koopmans MP, de Vries RD, van de Vijver DA, GeurtsvanKessel CH. Scenarios of future mpox outbreaks among men who have sex with men: a modelling study based on cross-sectional seroprevalence data from the Netherlands, 2022. Euro Surveill 2024; 29:2300532. [PMID: 38666400 PMCID: PMC11063670 DOI: 10.2807/1560-7917.es.2024.29.17.2300532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/29/2024] [Indexed: 04/30/2024] Open
Abstract
BackgroundFollowing the 2022-2023 mpox outbreak, crucial knowledge gaps exist regarding orthopoxvirus-specific immunity in risk groups and its impact on future outbreaks.AimWe combined cross-sectional seroprevalence studies in two cities in the Netherlands with mathematical modelling to evaluate scenarios of future mpox outbreaks among men who have sex with men (MSM).MethodsSerum samples were obtained from 1,065 MSM attending Centres for Sexual Health (CSH) in Rotterdam or Amsterdam following the peak of the Dutch mpox outbreak and the introduction of vaccination. For MSM visiting the Rotterdam CSH, sera were linked to epidemiological and vaccination data. An in-house developed ELISA was used to detect vaccinia virus (VACV)-specific IgG. These observations were combined with published data on serial interval and vaccine effectiveness to inform a stochastic transmission model that estimates the risk of future mpox outbreaks.ResultsThe seroprevalence of VACV-specific antibodies was 45.4% and 47.1% in Rotterdam and Amsterdam, respectively. Transmission modelling showed that the impact of risk group vaccination on the original outbreak was likely small. However, assuming different scenarios, the number of mpox cases in a future outbreak would be markedly reduced because of vaccination. Simultaneously, the current level of immunity alone may not prevent future outbreaks. Maintaining a short time-to-diagnosis is a key component of any strategy to prevent new outbreaks.ConclusionOur findings indicate a reduced likelihood of large future mpox outbreaks among MSM in the Netherlands under current conditions, but emphasise the importance of maintaining population immunity, diagnostic capacities and disease awareness.
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Affiliation(s)
- Marc C Shamier
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Luca M Zaeck
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hannelore M Götz
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bruno Vieyra
- Department of Public Health, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
| | - Babs E Verstrepen
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Koen Wijnans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matthijs Ra Welkers
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location AMC, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC location AMC, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Brigitte Agl van Cleef
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands
| | - Martin E van Royen
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kai J Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Marion Pg Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rory D de Vries
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
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Patauner F, Gallo R, Durante-Mangoni E, Bertolino L. Monkeypox infection, 18 months later: A vanishing epidemic? Eur J Intern Med 2024; 122:35-37. [PMID: 38369446 DOI: 10.1016/j.ejim.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Affiliation(s)
- F Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
| | - R Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy.
| | - L Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
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Zelencik S, VanDine A, Campos-Bovee M, Goitia K, Cela V, Walblay K, Galanto D, Pacilli M, Kim DY, Black SR. Health Care Personnel Exposure Risk Assessment and Management During a Mpox Outbreak in Chicago, Illinois, 17 May to 8 July 2022. J Infect Dis 2024; 229:S207-S212. [PMID: 38019754 DOI: 10.1093/infdis/jiad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
This report summarizes risk assessment interviews and follow-up with health care personnel (HCP) after exposure to patients with mpox disease during 17 May to 8 July 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four (2.7%) interactions were defined as high risk, 5 (3.3%) intermediate, 107 (71.3%) low, and 31 (20.7%) no risk. High and intermediate exposures were offered postexposure prophylaxis; 4 accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in health care settings during routine patient care is low.
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Affiliation(s)
- Shane Zelencik
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Alison VanDine
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - Valbona Cela
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Kelly Walblay
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Daniel Galanto
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Do Young Kim
- Chicago Department of Public Health, Chicago, Illinois, USA
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de Araújo LP, de Melo Santos NC, Corsetti PP, de Almeida LA. Immunoinformatic Approach for Rational Identification of Immunogenic Peptides Against Host Entry and/or Exit Mpox Proteins and Potential Multiepitope Vaccine Construction. J Infect Dis 2024; 229:S285-S292. [PMID: 37804521 DOI: 10.1093/infdis/jiad443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
COVID-19 has intensified humanity's concern about the emergence of new pandemics. Since 2018, epidemic outbreaks of the mpox virus have become worrisome. In June 2022, the World Health Organization declared the disease a global health emergency, with 14 500 cases reported by the Centers for Disease Control and Prevention in 60 countries. Therefore, the development of a vaccine based on the current virus genome is paramount in combating new cases. In view of this, we hypothesized the obtainment of rational immunogenic peptides predicted from proteins responsible for entry of the mpox virus into the host (A17L, A26L/A30L, A33R, H2R, L1R), exit (A27L, A35R, A36R, C19L), and both (B5R). To achieve this, we aligned the genome sequencing data of mpox virus isolated from an infected individual in the United States in June 2022 (ON674051.1) with the reference genome dated 2001 (NC_003310.1) for conservation analysis. The Immune Epitope Database server was used for the identification and characterization of the epitopes of each protein related to major histocompatibility complex I or II interaction and recognition by B-cell receptors, resulting in 138 epitopes for A17L, 233 for A28L, 48 for A33R, 77 for H2R, 77 for L1R, 270 for A27L, 72 for A35R, A36R, 148 for C19L, and 276 for B5R. These epitopes were tested in silico for antigenicity, physicochemical properties, and allergenicity, resulting in 51, 40, 10, 34, 38, 57, 25, 7, 47, and 53 epitopes, respectively. Additionally, to select an epitope with the highest promiscuity of binding to major histocompatibility complexes and B-cell receptor simultaneously, all epitopes of each protein were aligned, and the most repetitive and antigenic regions were identified. By classifying the results, we obtained 23 epitopes from the entry proteins, 16 from the exit proteins, and 7 from both. Subsequently, 1 epitope from each protein was selected, and all 3 were fused to construct a chimeric protein that has potential as a multiepitope vaccine. The constructed vaccine was then analyzed for its physicochemical, antigenic, and allergenic properties. Protein modeling, molecular dynamics, and molecular docking were performed on Toll-like receptors 2, 4, and 8, followed by in silico immune simulation of the vaccine. Finally, the results indicate an effective, stable, and safe vaccine that can be further tested, especially in vitro and in vivo, to validate the findings demonstrated in silico.
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Affiliation(s)
| | | | - Patrícia Paiva Corsetti
- Departamento de Microbiologia e Imunologia, Universidade Federal de Alfenas, Alfenas, Brazil
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Brooks JT, Reynolds MG, Torrone E, McCollum A, Spicknall IH, Gigante CM, Li Y, Satheshkumar PS, Quilter LAS, Rao AK, O'Shea J, Guagliardo SAJ, Townsend M, Hutson CL. How the Orthodox Features of Orthopoxviruses Led to an Unorthodox Mpox Outbreak: What We've Learned, and What We Still Need to Understand. J Infect Dis 2024; 229:S121-S131. [PMID: 37861379 DOI: 10.1093/infdis/jiad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Orthopoxviruses have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV), originally characterized in the late 1950s during outbreaks among captive primates, has been recognized since the 1970s to cause human disease (mpox) in West and Central Africa, where interhuman transmission has largely been associated with nonsexual, close physical contact. In May 2022, a focus of MPXV transmission was detected, spreading among international networks of gay, bisexual, and other men who have sex with men. The outbreak grew in both size and geographic scope, testing the strength of preparedness tools and public health science alike. In this article we consider what was known about mpox before the 2022 outbreak, what we learned about mpox during the outbreak, and what continued research is needed to ensure that the global public health community can detect, and halt further spread of this disease threat.
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Affiliation(s)
- John T Brooks
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary G Reynolds
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Torrone
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea McCollum
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian H Spicknall
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura A S Quilter
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Townsend
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Hutson
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lucero-Obusan C, Oda G, Schirmer P, Edson C, Trevino C, Elbeik T, Holodniy M. Epidemiology of the 2022 Mpox Outbreak in the US Veterans Health Administration. J Infect Dis 2024; 229:S172-S180. [PMID: 38134309 DOI: 10.1093/infdis/jiad600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND In May 2022, mpox cases were reported in nonendemic countries, including the United States. We examined mpox infections in the Veterans Health Administration (VHA). METHODS Mpox diagnostic and whole genome sequencing (WGS) results, demographics, risk factors, hospitalizations, exposures, deaths, and pharmacy and immunization data were obtained from VHA data sources (23 May 2022-31 May 2023). RESULTS Of 1144 Veterans tested, 251 (21.9%) were presumptive positive for nonvariola orthopoxvirus (NVO) or confirmed positive for NVO and Monkeypox virus (MPXV). Incidence rate was 7.5 per 100 000 Veterans in care, with the highest rate observed in Veterans aged 25-34 years (13.83 cases per 100 000). Higher odds of NVO or NVO/MPXV positivity was associated with male sex; non-Hispanic Black race/ethnicity; syphilis or human immunodeficiency virus (HIV) positivity; or genital/rectal sample site, whereas older age and vaccination with JYNNEOS or vaccinia (smallpox) had lower odds. Among 209 with confirmatory testing, 90.4% reported intimate contact and/or an epidemiological link, 84.5% were men who have sex with men (MSM), 24.2% received tecovirimat, and 8.1% were hospitalized with 1 death. Eighty-six sequenced samples had evaluable WGS results. All were clade IIb, representing 10 different lineages from 20 states and the District of Columbia. CONCLUSIONS Mpox affected younger, MSM, non-Hispanic Black, and HIV/syphilis-positive men among US Veterans. Viral diversity was noted across geographic regions. At-risk Veterans would benefit from vaccination and risk reduction strategies for mpox and other sexually transmitted infections.
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Affiliation(s)
- Cynthia Lucero-Obusan
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Gina Oda
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Patricia Schirmer
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Connor Edson
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Christina Trevino
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Tarek Elbeik
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Mark Holodniy
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
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Zuiani A, Dulberger CL, De Silva NS, Marquette M, Lu YJ, Palowitch GM, Dokic A, Sanchez-Velazquez R, Schlatterer K, Sarkar S, Kar S, Chawla B, Galeev A, Lindemann C, Rothenberg DA, Diao H, Walls AC, Addona TA, Mensa F, Vogel AB, Stuart LM, van der Most R, Srouji JR, Türeci Ö, Gaynor RB, Şahin U, Poran A. A multivalent mRNA monkeypox virus vaccine (BNT166) protects mice and macaques from orthopoxvirus disease. Cell 2024; 187:1363-1373.e12. [PMID: 38366591 DOI: 10.1016/j.cell.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/13/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024]
Abstract
In response to the 2022 outbreak of mpox driven by unprecedented human-to-human monkeypox virus (MPXV) transmission, we designed BNT166, aiming to create a highly immunogenic, safe, accessible, and scalable next-generation vaccine against MPXV and related orthopoxviruses. To address the multiple viral forms and increase the breadth of immune response, two candidate multivalent mRNA vaccines were evaluated pre-clinically: a quadrivalent vaccine (BNT166a; encoding the MPXV antigens A35, B6, M1, H3) and a trivalent vaccine (BNT166c; without H3). Both candidates induced robust T cell responses and IgG antibodies in mice, including neutralizing antibodies to both MPXV and vaccinia virus. In challenge studies, BNT166a and BNT166c provided complete protection from vaccinia, clade I, and clade IIb MPXV. Furthermore, immunization with BNT166a was 100% effective at preventing death and at suppressing lesions in a lethal clade I MPXV challenge in cynomolgus macaques. These findings support the clinical evaluation of BNT166, now underway (NCT05988203).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Özlem Türeci
- BioNTech SE, Mainz, Germany; HI-TRON - Helmholtz Institute for Translational Oncology Mainz by DKFZ, Mainz, Germany
| | | | - Uğur Şahin
- BioNTech SE, Mainz, Germany; TRON gGmbH - Translational Oncology at the University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
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Nitido AN, Balazs AB. mRNA-based monkeypox virus vaccine prevents disease in non-human primates. Cell 2024; 187:1360-1362. [PMID: 38490180 DOI: 10.1016/j.cell.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 03/17/2024]
Abstract
The mpox outbreak in 2022 launched a vaccination campaign employing an existing vaccine with moderate protection, highlighting the lack of scalable Orthopoxvirus vaccines with optimal protection. In this issue of Cell, Zuiani et al. report pre-clinical findings of an mRNA-based mpox vaccine, paving the way for Phase I/II clinical trials.
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Affiliation(s)
- Adam N Nitido
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
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Gan G, Janhavi A, Tong G, Lim JT, Dickens BL. The need for pre-emptive control strategies for mpox in Asia and Oceania. Infect Dis Model 2024; 9:214-223. [PMID: 38293686 PMCID: PMC10825486 DOI: 10.1016/j.idm.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks, of which Asia and Oceania remains particularly susceptible. Here, we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men (MSM) community before the arrival and establishment of the virus. Materials and methods Using data driven heterogeneous sexual contact networks, we simulated outbreaks of mpox in Singapore, Hong Kong, and Sydney. An individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM populations. Results The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks, with infection peaks occurring at day 41 and 23 respectively, compared to Hong Kong which occurs at day 77. Across the simulations with no vaccination, 68.2%-89.7% of the MSM community will become infected with mpox across the different cities, over a simulation period of 1 year. By implementing vaccination strategies, the infection rate across the cities can be reduced to as low as 3.1% of the population (range: 3.1%-82.2%) depending on the implementation and uptake of the vaccine. Vaccination is also extremely effective in slowing the start of the epidemic, delaying the epidemic peak by 36-50 days in Hong Kong, or even preventing the outbreak of mpox. Discussion With extremely dense and well-connected sexual contact networks, where 65.2%-83.2% of the population are connected to a super-spreader in the different contact networks, pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.
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Affiliation(s)
- Gregory Gan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A. Janhavi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Guan Tong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Borame L. Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Dodd LE, Lane HC, Muyembe-Tamfum JJ. Vaccines for Mpox - An Unmet Global Need. NEJM EVIDENCE 2024; 3:EVIDe2300348. [PMID: 38411453 DOI: 10.1056/evide2300348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
In 1970, the first case of mpox (formerly known as monkeypox) was documented in an infant in Equateur Province, Democratic Republic of Congo (DRC).1 Infections with clade I monkeypox virus (MPXV) are endemic in the rainforest regions of central Africa and result from both zoonotic and human-to-human transmission. The cessation of smallpox vaccination in 1980 because of the eradication of smallpox has led to an increase in the number of individuals who are orthopox immune naïve and is felt to be responsible for a recent increase in mpox cases in the DRC. Comparisons of active surveillance in Sankuru Province from 2005 through 2007 revealed a 20-fold increase in the incidence of mpox compared with the 1980s, with a 5-fold-lower incidence among those with a smallpox vaccination scar.2.
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Affiliation(s)
- Lori E Dodd
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - H Clifford Lane
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Ramírez-Olivencia G, Velasco Arribas M, Vera García MM, Casabona J, Martínez MJ, Membrillo De Novales FJ. Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study). Open Forum Infect Dis 2024; 11:ofae105. [PMID: 38524223 PMCID: PMC10960598 DOI: 10.1093/ofid/ofae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Background We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease. Methods This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected. Results Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died. Conclusions Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.
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Affiliation(s)
- G Ramírez-Olivencia
- Hospital Central de la Defensa "Gómez Ulla." Infectious Diseases Unit, Madrid, Spain
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - M Velasco Arribas
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Hospital Fundación Alcorcón, Department of Internal Medicine-Infectious Department, Research Department, Alcorcón, Spain
| | - M M Vera García
- Centro Sanitario Sandoval, HIV/STI Unit, Madrid, Spain
- Grupo de Estudio de ITS, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
| | - J Casabona
- Grupo de Estudio de ITS, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
- Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
| | - M J Martínez
- Hospital Clinic, Microbiology Department, Barcelona, Spain
- Grupo de Estudio de Patología Importada, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), Madrid, Spain
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Goldstein RH. Never Let a Good Outbreak Go to Waste. NEJM EVIDENCE 2024; 3:EVIDe2300357. [PMID: 38411451 DOI: 10.1056/evide2300357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The multinational outbreak of mpox (formerly known as monkeypox) that began in 2022 resulted in more than 90,000 reported cases, over 150 deaths, and - importantly - a coordinated international response to a rapidly spreading infectious disease.1 Because of decades of global preparedness efforts, vaccines and therapeutics for a related orthopox virus (smallpox) were available in many global stockpiles. Few of these medical countermeasures were specifically designed, evaluated, or approved for use against mpox disease, requiring the global scientific community to identify how best to quickly translate what was known into what was needed.
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Karmarkar EN, Golden MR, Kerani RP, Pogosjans S, Chow EJ, Bender Ignacio RA, Ramchandani MS, Kay MK, Cannon CA, Dombrowski JC. Association of Tecovirimat Therapy With Mpox Symptom Improvement: A Cross-sectional Study-King County, Washington, May-October 2022. Open Forum Infect Dis 2024; 11:ofae029. [PMID: 38456195 PMCID: PMC10919389 DOI: 10.1093/ofid/ofae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background Data on tecovirimat effectiveness for human mpox are limited. We conducted a retrospective cross-sectional interview-based study to identify associations between tecovirimat treatment and the mpox clinical course. Methods Using public health surveillance data from King County, Washington, we recruited and interviewed persons diagnosed with mpox during May-October 2022. We calculated descriptive statistics on demographics, vaccination status, comorbidities, and symptoms including 3 self-reported dates (symptom onset, first date of symptom improvement, and illness resolution). We used multivariable linear regression, stratified by illness severity, to evaluate the association of tecovirimat treatment with time to symptom improvement and time to illness resolution. We compared individuals who did not receive tecovirimat to participants who started tecovirimat early (≤5 days from symptom onset) and late (>5 days and ≤28 days from symptom onset) in their illness. Results Of 465 individuals diagnosed with mpox, 115 (25%) participated in this study. Eighty participants (70%) received tecovirimat and 43 (37%) initiated tecovirimat early. Sixty-eight (59%) reported severe symptoms during their illness, including proctitis (n = 38 [33%]), rectal bleeding (n = 27 [24%]), or severe pain (n = 24 [21%]). In the multivariable analysis, early tecovirimat was associated with shorter time to symptom improvement (-5.5 days, P = .04) among participants with severe illness but not among those with nonsevere illness (0.9 day, P = .66). Early tecovirimat was not associated with faster illness resolution, regardless of severity. Conclusions Our small study suggests that early tecovirimat initiation may hasten subjective symptomatic improvement in people with severe mpox. Larger randomized trials are needed to evaluate this finding.
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Affiliation(s)
- Ellora N Karmarkar
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Roxanne P Kerani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sargis Pogosjans
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Rachel A Bender Ignacio
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Meena S Ramchandani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Meagan K Kay
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Chase A Cannon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Julia C Dombrowski
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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Huang ZY, Cornelisse VJ, Burdon RM. Painful proctitis associated with anorectal mpox, syphilis, HSV, LGV, gonorrhoea and Mycoplasma genitalium in a person living with virologically suppressed HIV and vaccinated against mpox. Sex Transm Infect 2024; 100:106-107. [PMID: 38124214 DOI: 10.1136/sextrans-2023-056033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
A gay man with well-controlled HIV and vaccinated against mpox presented with severe proctitis. Testing revealed anorectal mpox, herpes simplex virus, lymphogranuloma venereum, Neisseria gonorrhoeae and Mycoplasma genitalium Serology was indicative of infectious syphilis. This case highlights the need to consider a wide range of concurrent sexually transmitted infections in patients with proctitis, including those vaccinated against mpox.
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Affiliation(s)
- Zoe Y Huang
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rachel M Burdon
- Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia
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Aparício Martins I, João AL, Neves JM, Fernandes C. Mpox after vaccination: a case series. Sex Transm Infect 2024; 100:120. [PMID: 38135495 DOI: 10.1136/sextrans-2023-056055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Inês Aparício Martins
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Luísa João
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - José Miguel Neves
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Cândida Fernandes
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Clay PA, Asher JM, Carnes N, Copen CE, Delaney KP, Payne DC, Pollock ED, Mermin J, Nakazawa Y, Still W, Mangla AT, Spicknall IH. Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak. Sex Transm Infect 2024; 100:70-76. [PMID: 38050171 PMCID: PMC11323315 DOI: 10.1136/sextrans-2023-055922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The 2022 mpox outbreak has infected over 30 000 people in the USA, with cases declining since mid-August. Infections were commonly associated with sexual contact between men. Interventions to mitigate the outbreak included vaccination and a reduction in sexual partnerships. Understanding the contributions of these interventions to decreasing cases can inform future public health efforts. METHODS We fit a dynamic network transmission model to mpox cases reported by Washington DC through 10 January 2023. This model incorporated both vaccine administration data and reported reductions in sexual partner acquisition by gay, bisexual or other men who have sex with men (MSM). The model output consisted of daily cases over time with or without vaccination and/or behavioural adaptation. RESULTS We found that initial declines in cases were likely caused by behavioural adaptations. One year into the outbreak, vaccination and behavioural adaptation together prevented an estimated 84% (IQR 67% to 91%) of cases. Vaccination alone averted 79% (IQR 64% to 88%) of cases and behavioural adaptation alone averted 25% (IQR 10% to 42%) of cases. We further found that in the absence of vaccination, behavioural adaptation would have reduced the number of cases, but would have prolonged the outbreak. CONCLUSIONS We found that initial declines in cases were likely caused by behavioural adaptation, but vaccination averted more cases overall and was key to hastening outbreak conclusion. Overall, this indicates that outreach to encourage individuals to protect themselves from infection was vital in the early stages of the mpox outbreak, but that combination with a robust vaccination programme hastened outbreak conclusion.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason M Asher
- Office of the Director, Center for Forecasting and Outbreak Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey E Copen
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne & Environmental Diseases, National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily D Pollock
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Mermin
- Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori Nakazawa
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William Still
- DC Department of Health, Washington, District of Columbia, USA
| | - Anil T Mangla
- DC Department of Health, Washington, District of Columbia, USA
| | - Ian H Spicknall
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, Lorusso N, Vázquez Torres M, Barbas del Buey JF, Roig-Sena J, Pastor E, Galmés Truyols A, Artigues Serra F, Sancho Martínez RM, Latasa Zamalloa P, Pérez Martínez O, Vázquez Estepa A, García Rojas AJ, Barreno Estévez AI, Sánchez-Migallón Naranjo A, Pérez Martín JJ, Peces Jiménez P, Morales Romero R, Castilla J, García Cenoz M, Huerta Huerta M, Boone ALD, Macías Ortiz MJ, Álvarez Río V, Rodríguez Recio MJ, Merino Díaz M, Berradre Sáenz B, Villegas-Moreno MT, Limia A, Diaz A, Monge S. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study. Clin Infect Dis 2024; 78:476-483. [PMID: 37864849 PMCID: PMC10874271 DOI: 10.1093/cid/ciad645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Community of Madrid, Spain
| | - Victoria Hernando
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Carmen Olmedo
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ermengol Coma
- Primary Healthcare Information Systems, Health Institute of Catalonia, Catalonia, Spain
| | - Montse Martínez
- Preventive Medicine Service, General Sub-directorate for Health Promotion, Health Department, Secretariat of Public Health,Catalonia, Spain
| | - David Moreno-Perez
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - Nicola Lorusso
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - María Vázquez Torres
- Healthcare Department, General Sub-directorate of Health Prevention and Promotion, General Directorate of Public Health, Community of Madrid, Spain
| | - José Francisco Barbas del Buey
- General Sub-directorate of Public Health Surveillance, General Directorate of Public Health, Madrid, Community of Madrid, Spain
| | - Javier Roig-Sena
- Department of Universal Healthcare and Public Health, Epidemiological Surveillance Service, Valencian Community, Spain
| | - Eliseo Pastor
- Universal Healthcare and Public Health Department, Health Promotion and Prevention Programs Service, Valencian Community, Spain
| | - Antònia Galmés Truyols
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Francisca Artigues Serra
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Rosa María Sancho Martínez
- Epidemiology Unit, General Sub-directorate of Public Health and Addictions of Gipuzkoa, Basque Country, Spain
| | - Pello Latasa Zamalloa
- Epidemiology and Vaccination Service, General Directorate of Public Health, Basque Country, Spain
| | - Olaia Pérez Martínez
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Ana Vázquez Estepa
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Amós José García Rojas
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | - Ana Isabel Barreno Estévez
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | | | - Jaime Jesús Pérez Martín
- Vaccination Progamme, Prevention and Health Protection Service, Health Department, General Directorate of Public Health and Addictions, Murcia Region, Spain
| | - Pilar Peces Jiménez
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Raquel Morales Romero
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA – CIBERESP, Pamplona, Spain
| | | | - Marta Huerta Huerta
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - An Lieve Dirk Boone
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - María José Macías Ortiz
- Vaccination Program, General Directorate of PublicHealth, Healthcare Service of Extremadura, Spain
| | - Virginia Álvarez Río
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla y León, Spain
| | | | - María Merino Díaz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | - Belén Berradre Sáenz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | | | - Aurora Limia
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asuncion Diaz
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Susana Monge
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
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Brousseau N, Carazo S, Febriani Y, Padet L, Hegg-Deloye S, Cadieux G, Bergeron G, Fafard J, Charest H, Lambert G, Talbot D, Longtin J, Dumont-Blais A, Bastien S, Dalpé V, Minot PH, De Serres G, Skowronski DM. Single-dose Effectiveness of Mpox Vaccine in Quebec, Canada: Test-negative Design With and Without Adjustment for Self-reported Exposure Risk. Clin Infect Dis 2024; 78:461-469. [PMID: 37769158 PMCID: PMC10874272 DOI: 10.1093/cid/ciad584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION During the 2022 mpox outbreak, the province of Quebec, Canada, prioritized first doses for pre-exposure vaccination of people at high mpox risk, delaying second doses due to limited supply. We estimated single-dose mpox vaccine effectiveness (VE) adjusting for virus exposure risk based only on surrogate indicators available within administrative databases (eg, clinical record of sexually transmitted infections) or supplemented by self-reported risk factor information (eg, sexual contacts). METHODS We conducted a test-negative case-control study between 19 June and 24 September 2022. Information from administrative databases was supplemented by questionnaire collection of self-reported risk factors specific to the 3-week period before testing. Two study populations were assessed: all within the administrative databases (All-Admin) and the subset completing the questionnaire (Sub-Quest). Logistic regression models adjusted for age, calendar-time and exposure-risk, the latter based on administrative indicators only (All-Admin and Sub-Quest) or with questionnaire supplementation (Sub-Quest). RESULTS There were 532 All-Admin participants, of which 199 (37%) belonged to Sub-Quest. With exposure-risk adjustment based only on administrative indicators, single-dose VE estimates were similar among All-Admin and Sub-Quest populations at 35% (95% confidence interval [CI]:-2 to 59) and 30% (95% CI:-38 to 64), respectively. With adjustment supplemented by questionnaire information, the Sub-Quest VE estimate increased to 65% (95% CI:1-87), with overlapping confidence intervals. CONCLUSIONS Using only administrative data, we estimate one vaccine dose reduced the mpox risk by about one-third; whereas, additionally adjusting for self-reported risk factor information revealed greater vaccine benefit, with one dose instead estimated to reduce the mpox risk by about two-thirds. Inadequate exposure-risk adjustment may substantially under-estimate mpox VE.
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Affiliation(s)
- Nicholas Brousseau
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Sara Carazo
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Yossi Febriani
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Lauriane Padet
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Sandrine Hegg-Deloye
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Cadieux
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Geneviève Bergeron
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Judith Fafard
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Jean Longtin
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | | | - Steve Bastien
- Mpox Awareness Team, RÉZO Community Organization, Montreal, QC Canada
| | - Virginie Dalpé
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Pierre-Henri Minot
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Department, Institut national de santé publique du Québec, Quebec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre Hospitalier Universitaire (CHU) de Québec–Université Laval Research Center, Quebec, QC, Canada
| | - Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Chiuppesi F, Zaia JA, Gutierrez-Franco MA, Ortega-Francisco S, Ly M, Kha M, Kim T, Dempsey S, Kar S, Grifoni A, Sette A, Wussow F, Diamond DJ. Synthetic modified vaccinia Ankara vaccines confer cross-reactive and protective immunity against mpox virus. COMMUNICATIONS MEDICINE 2024; 4:19. [PMID: 38366141 PMCID: PMC10873322 DOI: 10.1038/s43856-024-00443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/23/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Although the mpox global health emergency caused by mpox virus (MPXV) clade IIb.1 has ended, mpox cases are still reported due to low vaccination coverage and waning immunity. COH04S1 is a clinically evaluated, multiantigen COVID-19 vaccine candidate built on a fully synthetic platform of the highly attenuated modified vaccinia Ankara (MVA) vector, representing the only FDA-approved smallpox/mpox vaccine JYNNEOS. Given the potential threat of MPXV resurgence and need for vaccine alternatives, we aimed to assess the capacity COH04S1 and its synthetic MVA (sMVA) backbone to confer MPXV-specific immunity. METHODS We evaluated orthopoxvirus-specific and MPXV cross-reactive immune responses in samples collected during a Phase 1 clinical trial of COH04S1 and in non-human primates (NHP) vaccinated with COH04S1 or its sMVA backbone. MPXV cross-reactive immune responses in COH04S1-vaccinated healthy adults were compared to responses measured in healthy subjects vaccinated with JYNNEOS. Additionally, we evaluated the protective efficacy of COH04S1 and sMVA against mpox in mpox-susceptible CAST/EiJ mice. RESULTS COH04S1-vaccinated individuals develop robust orthopoxvirus-specific humoral and cellular responses, including cross-reactive antibodies to MPXV-specific virion proteins as well as MPXV cross-neutralizing antibodies in 45% of the subjects. In addition, NHP vaccinated with COH04S1 or sMVA show similar MPXV cross-reactive antibody responses. Moreover, MPXV cross-reactive humoral responses elicited by COH04S1 are comparable to those measured in JYNNEOS-vaccinated subjects. Finally, we show that mice vaccinated with COH04S1 or sMVA are protected from lung infection following challenge with MPXV clade IIb.1. CONCLUSIONS These results demonstrate the capacity of sMVA vaccines to elicit cross-reactive and protective orthopox-specific immunity against MPXV, suggesting that COH04S1 and sMVA could be developed as bivalent or monovalent mpox vaccine alternatives against MPXV.
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Affiliation(s)
- Flavia Chiuppesi
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA.
| | - John A Zaia
- Center for Gene Therapy, City of Hope National Medical Center, Duarte, CA, USA
| | - Miguel-Angel Gutierrez-Franco
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Sandra Ortega-Francisco
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Minh Ly
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Mindy Kha
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Taehyun Kim
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Shannon Dempsey
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Alba Grifoni
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA
| | - Felix Wussow
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Don J Diamond
- Department of Hematology and HCT and Hematologic Malignancies Research Institute, City of Hope National Medical Center, Duarte, CA, USA
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