Rapid communication Open Access
Like 0


Modified vaccinia virus Ankara vaccine (MVA-BN; Bavarian Nordic) is recommended to contacts of mpox cases up to 14 days post-exposure but the effectiveness of this strategy is unknown. Among 108 adults (≥ 18 years old) who received one dose of MVA-BN after exposure to mpox, 11 (10%) cases of breakthrough mpox were observed. Sexual exposure was associated with the risk of breakthrough mpox (p = 0.0179). Samples taken from vaccinated breakthrough mpox cases had similar rates of infectious virus isolation than unvaccinated mpox cases.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). 2022 Monkeypox Outbreak: Global Trends. Geneva: WHO; 2022. [Accessed 11 Nov 2022]. Available from: https://worldhealthorg.shinyapps.io/mpx_global/#2_Global_situation_update
  2. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. , SHARE-net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387(8):679-91.  https://doi.org/10.1056/NEJMoa2207323  PMID: 35866746 
  3. Centers for Disease Control and Prevention (CDC). Mpox. Vaccination. Atlanta: CDC; 2022 [Accessed 17 Oct 2022]. Available from: https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/overview.html
  4. UK Health Security Agency (UKHSA). Recommendations for the use of pre- and post-exposure vaccination during a monkeypox incident. UKHSA; Updated 26 August 2022 v12. [Accessed 17 Oct 2022]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1100600/recommendations-for-pre-and-post-exposure-vaccination-during-a-monkeypox-incident-26-august-2022.pdf
  5. Haute Autorité de Santé (HAS). Avis n°2022.0034/SESPEV du 20 mai 2022 du collège de la Haute Autorité de santé relatif à la vaccination contre Monkeypox. Saint Denis: HAS; 2022. [Accessed 19 Oct 2022]. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2022-05/avis_n2022.0034_sespev_du_20_mai_2022_du_college_de_la_has_relatif_a_la_vaccination_contre_la_variole_du_singe_monkeypox_vir.pdf
  6. Haute Autorité de Santé (HAS). Avis n°2022.0039/AC/SESPEV du 7 juillet 2022 du collège de la Haute Autorité de santé relatif à la vaccination contre le virus Monkeypox en préexposition des personnes à haut risque d’exposition. Saint Denis: HAS; 2022. [Accessed 19 Oct 2022]. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2022-07/avis_2022.0039.ac.sespev_du_7_juillet_2022_du_college_de_la_has_relatif_a_la_vaccination_contre_le_virus_monkeypox_en_preexp.pdf
  7. Santé Publique France (SPF). Cas de Monkeypox en Europe, définitions et conduite à tenir. 8 septembre 2022 [Mpox cases in Europe, definitions and practice to follow]. Saint-Maurice: SPF; 2022 [Accessed 17 Oct 2022]. Available from: https://www.santepubliquefrance.fr/media/files/maladies-a-declaration-obligatoire/definition-de-cas-cat-monkeypox
  8. Hazra A, Rusie L, Hedberg T, Schneider JA. Human Monkeypox Virus Infection in the Immediate Period After Receiving Modified Vaccinia Ankara Vaccine. JAMA. 2022;328(20):2064-7.  https://doi.org/10.1001/jama.2022.18320  PMID: 36178700 
  9. Thy M, Peiffer-Smadja N, Mailhe M, Kramer L, Ferré VM, Houhou N, et al. Breakthrough Infections after Postexposure Vaccination against Mpox. N Engl J Med. 2022;NEJMc2211944.  https://doi.org/10.1056/NEJMc2211944  PMID: 36477495 
  10. Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26(4):782-5.  https://doi.org/10.3201/eid2604.191164  PMID: 32023204 
  11. Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL, et al. Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci USA. 2010;107(37):16262-7.  https://doi.org/10.1073/pnas.1005769107  PMID: 20805472 
  12. Fine PE, Jezek Z, Grab B, Dixon H. The transmission potential of monkeypox virus in human populations. Int J Epidemiol. 1988;17(3):643-50.  https://doi.org/10.1093/ije/17.3.643  PMID: 2850277 
  13. Hammarlund E, Lewis MW, Carter SV, Amanna I, Hansen SG, Strelow LI, et al. Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox. Nat Med. 2005;11(9):1005-11.  https://doi.org/10.1038/nm1273  PMID: 16086024 
  14. Poland GA, Kennedy RB, Tosh PK. Prevention of monkeypox with vaccines: a rapid review. Lancet Infect Dis. 2022;22(12):e349-58.  https://doi.org/10.1016/S1473-3099(22)00574-6  PMID: 36116460 
  15. Pittman PR, Hahn M, Lee HS, Koca C, Samy N, Schmidt D, et al. Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine against Smallpox. N Engl J Med. 2019;381(20):1897-908.  https://doi.org/10.1056/NEJMoa1817307  PMID: 31722150 
  16. Hatch GJ, Graham VA, Bewley KR, Tree JA, Dennis M, Taylor I, et al. Assessment of the protective effect of Imvamune and Acam2000 vaccines against aerosolized monkeypox virus in cynomolgus macaques. J Virol. 2013;87(14):7805-15.  https://doi.org/10.1128/JVI.03481-12  PMID: 23658452 
  17. Stittelaar KJ, van Amerongen G, Kondova I, Kuiken T, van Lavieren RF, Pistoor FHM, et al. Modified vaccinia virus Ankara protects macaques against respiratory challenge with monkeypox virus. J Virol. 2005;79(12):7845-51.  https://doi.org/10.1128/JVI.79.12.7845-7851.2005  PMID: 15919938 
  18. Earl PL, Americo JL, Wyatt LS, Eller LA, Whitbeck JC, Cohen GH, et al. Immunogenicity of a highly attenuated MVA smallpox vaccine and protection against monkeypox. Nature. 2004;428(6979):182-5.  https://doi.org/10.1038/nature02331  PMID: 15014500 
  19. Bertran M, Andrews N, Davison C, Dugbazah B, Boateng J, Lunt R, et al. Effectiveness of one dose of MVA-BN smallpox vaccine against monkeypox in England using the case-coverage method. Preprint. [Accessed 5 Dec 2022]. Available from: https://khub.net/documents/135939561/673678774/Monkeypox+VE_vf_20221121_preprint+SR.docx/4ef85866-342f-475a-1d2e-0b2c5d3ae8b9?
  20. Santé Publique France (SPF). Cas de variole du singe : point de situation au 29 novembre 2022. [Mpox cases: situation update of 29 November 2022]. Saint-Maurice: SPF; 2022. [Accessed 5 Dec 2022]. Available from: https://www.santepubliquefrance.fr/les-actualites/2022/cas-de-variole-du-singe-point-de-situation-au-29-novembre-2022
  21. Ferré VM, Bachelard A, Zaidi M, Armand-Lefevre L, Descamps D, Charpentier C, et al. Detection of Monkeypox Virus in Anorectal Swabs From Asymptomatic Men Who Have Sex With Men in a Sexually Transmitted Infection Screening Program in Paris, France. Ann Intern Med. 2022;175(10):1491-2.  https://doi.org/10.7326/M22-2183  PMID: 35969863 

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error