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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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2
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Piccolo AJL, Chan J, Cohen GM, Mgbako O, Pitts RA, Postelnicu R, Wallach A, Mukherjee V. Critical Elements of an Mpox Vaccination Model at the Largest Public Health Hospital System in the United States. Vaccines (Basel) 2023; 11:1138. [PMID: 37514954 PMCID: PMC10385008 DOI: 10.3390/vaccines11071138] [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: 04/30/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
In the spring of 2022, mpox spread to non-endemic countries, including the United States. In New York City (NYC), vaccine demand grew as quickly as case counts. With the leadership of the Regional Emerging Special Pathogens Treatment Center (RESPTC) at NYC Health and Hospitals/Bellevue (NYC H+H)-part of the largest public hospital system in the United States-an innovative vaccination model was established that overcame challenges involving health inequities, inadequate access, and lack of vaccine uptake, to successfully administer JYNNEOS vaccines to over 12,000 patients. Transmission has slowed since its peak in August 2022, which has been attributed to successful vaccination campaigns, infection-induced immunity, and behavioral changes among those at highest risk; however, a Centers for Disease Control and Prevention (CDC) assessment released on 4 April 2023 suggests jurisdictions with low vaccination levels (<35%) remain at risk for an mpox resurgence. Here, we summarize the critical aspects of our mpox vaccination model in NYC, which include integration into routine clinical care, prioritization of health equity, and reutilization of COVID-19 vaccination systems, to provide valuable insights for healthcare institutions as we move into the next stage of this ongoing outbreak.
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Affiliation(s)
- Anthony J Lo Piccolo
- Division of Infectious Diseases & Immunology, NYU Langone Health, New York, NY 10016, USA
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
| | - Justin Chan
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Gabriel M Cohen
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Ofole Mgbako
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Robert A Pitts
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Radu Postelnicu
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Andrew Wallach
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Vikramjit Mukherjee
- NYC Health + Hospitals (NYC H+H)/Bellevue, New York, NY 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
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Reina J, Iglesias C. Vaccines against monkeypox. Med Clin (Barc) 2023; 160:305-309. [PMID: 36775782 PMCID: PMC9916470 DOI: 10.1016/j.medcli.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
The monkeypox virus is a virus that has 90% genomic homology with the human (smallpox), but it is naturally transmitted between different wild animal reservoirs and is considered a zoonosis. Throughout the 20th century, different vaccines based on the vaccinia poxvirus were developed and used for vaccination against smallpox. After the eradication of smallpox, these vaccines were no longer used. Current vaccines against monkeypox virus are classified by the WHO as replicative (ACAM2000), minimally replicative (LC16m8) and non-replicative (MVA-BN), the latter being the one currently used. The 2022 extra-African monkeypox virus epidemic has highlighted the lack of vaccines with proven efficacy and low reactogenicity. It is considered that the use of this vaccine in the current outbreak may play a role in the prevention or attenuation of the disease as pre-exposure prophylaxis in close contacts of confirmed cases.
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Affiliation(s)
- Jordi Reina
- Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Facultad de Medicina de la Universidat Illes Balears, Palma de Mallorca, España.
| | - Carla Iglesias
- Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Facultad de Medicina de la Universidat Illes Balears, Palma de Mallorca, España
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Vaccines against monkeypox. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:305-309. [PMID: 37033199 PMCID: PMC10037303 DOI: 10.1016/j.medcle.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/04/2023] [Indexed: 03/26/2023]
Abstract
The monkeypox virus is a virus that has 90% genomic homology with the human (smallpox), but it is naturally transmitted between different wild animal reservoirs and is considered a zoonosis. Throughout the 20th century, different vaccines based on the vaccinia poxvirus were developed and used for vaccination against smallpox. After the eradication of smallpox, these vaccines were no longer used. Current vaccines against monkeypox virus are classified by the WHO as replicative (ACAM2000), minimally replicative (LC16m8) and non-replicative (MVA-BN), the latter being the one currently used. The 2022 extra-African monkeypox virus epidemic has highlighted the lack of vaccines with proven efficacy and low reactogenicity. It is considered that the use of this vaccine in the current outbreak may play a role in the prevention or attenuation of the disease as pre-exposure prophylaxis in close contacts of confirmed cases.
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Malone SM, Mitra AK, Onumah NA, Brown A, Jones LM, Tresvant D, Brown CS, Onyia AU, Iseguede FO. Safety and Efficacy of Post-Eradication Smallpox Vaccine as an Mpox Vaccine: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2963. [PMID: 36833653 PMCID: PMC9957080 DOI: 10.3390/ijerph20042963] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/14/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
According to the World Health Organization, 83,339 laboratory-confirmed cases, including 72 deaths, of mpox (formerly known as monkeypox), have been reported from 110 locations globally as of 20 December 2022, making the disease a public health concern. Most of the cases (56,171, 67.4%) were reported from countries in North America. Limited data on vaccine effectiveness in the current mpox outbreak are available. However, the modified vaccinia virus (smallpox vaccine) has been predicted to prevent or reduce the severity of the mpox infection. The present study of systematic review and meta-analysis aimed to evaluate the modified vaccinia vaccine's safety and efficacy on mpox by using reported randomized clinical trials. Following guidelines from the Cochrane Collaboration and PRISMA, multiple databases including PubMed, PLOS ONE, Google Scholar, British Medical Journal, and the U. S. National Library of Medicine were searched. Out of 13,294 research articles initially identified, 187 were screened after removing duplicates. Following the inclusion and exclusion criteria, the meta-analysis included ten studies with 7430 patients. Three researchers independently assessed the risk of bias in the included study. The pooled results suggest that the vaccinia-exposed group had fewer side effects when compared to the vaccinia naïve group (odds ratio: 1.66; 95% CI: 1.07-2.57; p = 0.03). Overall, the modified vaccinia has proven safe and effective in both vaccinia naïve and previously exposed groups, with higher efficacy in the previously exposed groups.
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Affiliation(s)
- Shelia M. Malone
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39217, USA
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Payne AB, Ray LC, Cole MM, Canning M, Houck K, Shah HJ, Farrar JL, Lewis NM, Fothergill A, White EB, Feldstein LR, Roper LE, Lee F, Kriss JL, Sims E, Spicknall IH, Nakazawa Y, Gundlapalli AV, Shimabukuro T, Cohen AL, Honein MA, Mermin J, Payne DC. Reduced Risk for Mpox After Receipt of 1 or 2 Doses of JYNNEOS Vaccine Compared with Risk Among Unvaccinated Persons - 43 U.S. Jurisdictions, July 31-October 1, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1560-1564. [PMID: 36480479 PMCID: PMC9762900 DOI: 10.15585/mmwr.mm7149a5] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As of October 28, 2022, a total of 28,244* monkeypox (mpox) cases have been reported in the United States during an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), administered subcutaneously as a 2-dose (0.5 mL per dose) series (with doses administered 4 weeks apart), was approved by the Food and Drug Administration (FDA) in 2019 to prevent smallpox and mpox disease (2); an FDA Emergency Use Authorization issued on August 9, 2022, authorized intradermal administration of 0.1 mL per dose, increasing the number of persons who could be vaccinated with the available vaccine supply† (3). A previous comparison of mpox incidence during July 31-September 3, 2022, among unvaccinated, but vaccine-eligible men aged 18-49 years and those who had received ≥1 JYNNEOS vaccine dose in 32 U.S. jurisdictions, found that incidence among unvaccinated persons was 14 times that among vaccinated persons (95% CI = 5.0-41.0) (4). During September 4-October 1, 2022, a total of 205,504 persons received JYNNEOS vaccine dose 2 in the United States.§ To further examine mpox incidence among persons who were unvaccinated and those who had received either 1 or 2 JYNNEOS doses, investigators analyzed data on 9,544 reported mpox cases among men¶ aged 18-49 years during July 31-October 1, 2022, from 43 U.S. jurisdictions,** by vaccination status. During this study period, mpox incidence (cases per 100,000 population at risk) among unvaccinated persons was 7.4 (95% CI = 6.0-9.1) times that among persons who received only 1 dose of JYNNEOS vaccine ≥14 days earlier and 9.6 (95% CI = 6.9-13.2) times that among persons who received dose 2 ≥14 days earlier. The observed distribution of subcutaneous and intradermal routes of administration of dose 1 among vaccinated persons with mpox was not different from the expected distribution. This report provides additional data suggesting JYNNEOS vaccine provides protection against mpox, irrespective of whether the vaccine is administered intradermally or subcutaneously. The degree and durability of such protection remains unclear. Persons eligible for mpox vaccination should receive the complete 2-dose series to optimize strength of protection†† (5).
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Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis, treatment and prevention. Signal Transduct Target Ther 2022; 7:373. [PMID: 36319633 PMCID: PMC9626568 DOI: 10.1038/s41392-022-01215-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
Monkeypox is a zoonotic disease that was once endemic in west and central Africa caused by monkeypox virus. However, cases recently have been confirmed in many nonendemic countries outside of Africa. WHO declared the ongoing monkeypox outbreak to be a public health emergency of international concern on July 23, 2022, in the context of the COVID-19 pandemic. The rapidly increasing number of confirmed cases could pose a threat to the international community. Here, we review the epidemiology of monkeypox, monkeypox virus reservoirs, novel transmission patterns, mutations and mechanisms of viral infection, clinical characteristics, laboratory diagnosis and treatment measures. In addition, strategies for the prevention, such as vaccination of smallpox vaccine, is also included. Current epidemiological data indicate that high frequency of human-to-human transmission could lead to further outbreaks, especially among men who have sex with men. The development of antiviral drugs and vaccines against monkeypox virus is urgently needed, despite some therapeutic effects of currently used drugs in the clinic. We provide useful information to improve the understanding of monkeypox virus and give guidance for the government and relative agency to prevent and control the further spread of monkeypox virus.
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Affiliation(s)
- Yong Huang
- grid.412901.f0000 0004 1770 1022Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Mu
- grid.412901.f0000 0004 1770 1022Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- grid.412901.f0000 0004 1770 1022Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Brooks JT, Marks P, Goldstein RH, Walensky RP. Intradermal Vaccination for Monkeypox - Benefits for Individual and Public Health. N Engl J Med 2022; 387:1151-1153. [PMID: 36044621 DOI: 10.1056/nejmp2211311] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John T Brooks
- From the Multinational Monkeypox Outbreak Response (J.T.B.) and the Office of the Director (R.H.G., R.P.W.), Centers for Disease Control and Prevention, Atlanta; and the Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (P.M.)
| | - Peter Marks
- From the Multinational Monkeypox Outbreak Response (J.T.B.) and the Office of the Director (R.H.G., R.P.W.), Centers for Disease Control and Prevention, Atlanta; and the Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (P.M.)
| | - Robert H Goldstein
- From the Multinational Monkeypox Outbreak Response (J.T.B.) and the Office of the Director (R.H.G., R.P.W.), Centers for Disease Control and Prevention, Atlanta; and the Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (P.M.)
| | - Rochelle P Walensky
- From the Multinational Monkeypox Outbreak Response (J.T.B.) and the Office of the Director (R.H.G., R.P.W.), Centers for Disease Control and Prevention, Atlanta; and the Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD (P.M.)
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