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Rosen JB, Arciuolo RJ, Pathela P, Boyer CB, Baumgartner J, Latash J, Malec L, Lee EH, Reddy V, King R, Edward Real J, Lipsitch M, Zucker JR. JYNNEOS™ effectiveness as post-exposure prophylaxis against mpox: Challenges using real-world outbreak data. Vaccine 2024; 42:548-555. [PMID: 38218669 PMCID: PMC10960631 DOI: 10.1016/j.vaccine.2023.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND JYNNEOSTM vaccine has been used as post-exposure prophylaxis (PEP) during a mpox outbreak in New York City (NYC). Data on effectiveness are limited. METHODS Effectiveness of a single dose of JYNNEOSTM vaccine administered subcutaneously ≤ 14 days as PEP for preventing mpox disease was assessed among individuals exposed to case-patients from May 22, 2022-August 24, 2022. Individuals were evaluated for mpox through 21 days post-exposure. An observational study was conducted emulating a sequence of nested "target" randomized trials starting each day after exposure. Results were adjusted for exposure risk and race/ethnicity. Analyses were conducted separately based on last (PEPL) and first (PEPF) exposure date. We evaluated the potential to overestimate PEP effectiveness when using conventional analytic methods due to exposed individuals developing illness before they can obtain PEP (immortal time bias) compared to the target trial. RESULTS Median time from last exposure to symptom onset (incubation period) among cases that did not receive PEPL was 7 days (range 1-16). Time to PEPL receipt was 7 days (range 0-14). Among 549 individuals, adjusted PEPL and PEPF effectiveness was 19 % (95 % Confidence Interval [CI], -54 % to 57 %) and -7% (95 % CI, -144 % to 53 %) using the target trial emulation, respectively, and 78 % (95 % CI, 50 % to 91 %) and 73 % (95 % CI, 31 % to 91 %) using conventional analysis. CONCLUSIONS Determining PEP effectiveness using real-world data during an outbreak is challenging. Time to PEP in NYC coupled with the observed incubation period resulted in overestimated PEP effectiveness using a conventional method. The target trial emulation, while yielding wide confidence intervals due to small sample size, avoided immortal time bias. While results from these evaluations cannot be used as reliable estimates of PEP effectiveness, we present important methodologic considerations for future evaluations.
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Affiliation(s)
- Jennifer B Rosen
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA.
| | - Robert J Arciuolo
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Preeti Pathela
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Christopher B Boyer
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer Baumgartner
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Julia Latash
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Lenka Malec
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Ellen H Lee
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Vasudha Reddy
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Renee King
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Joseph Edward Real
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane R Zucker
- Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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