1887
Research Open Access
Like 0

Abstract

Background

Appropriate vaccination strategies have been key to controlling the outbreak of mpox outside endemic areas in 2022, yet few studies have provided information on mpox vaccine effectiveness (VE).

Aim

To assess VE after one dose of a third-generation smallpox vaccine against mpox when given as post-exposure prophylaxis (PEP) within 14 days.

Methods

A survival analysis in a prospective cohort of close contacts of laboratory-confirmed mpox cases was conducted from the beginning of the outbreak in the region of Madrid in May 2022. The study included contacts of cases in this region diagnosed between 17 May and 15 August 2022. Follow up was up to 49 days. A multivariate proportional hazard model was used to evaluate VE in the presence of confounding and interaction.

Results

Information was obtained from 484 close contacts, of which 230 were vaccinated within 14 days of exposure. Of the close contacts, 57 became ill during follow-up, eight vaccinated and 49 unvaccinated. The adjusted effectiveness of the vaccine was 88.8% (95% CI: 76.0–94.7). Among sexual contacts, VE was 93.6% (95% CI: 72.1–98.5) for non-cohabitants and 88.6% (95% CI: 66.1–96.2) for cohabitants.

Conclusion

Post-exposure prophylaxis of close contacts of mpox cases is an effective measure that can contribute to reducing the number of cases and eventually the symptoms of breakthrough infections. The continued use of PEP together with pre-exposure prophylaxis by vaccination and other population-targeted prevention measures are key factors in controlling an mpox outbreak.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.24.2200883
2023-06-15
2024-06-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.24.2200883
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/24/eurosurv-28-24-4.html?itemId=/content/10.2807/1560-7917.ES.2023.28.24.2200883&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). 2022-23 Mpox (monkeypox) outbreak: global trends. Geneva: WHO. [Accessed: 29 Mar 2023]. Available from: https://worldhealthorg.shinyapps.io/mpx_global
  2. World Health Organization (WHO). Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox. Geneva: WHO; 2022. Available from: https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox
  3. Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, et al. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill. 2022;27(36):2200620.  https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620  PMID: 36082686 
  4. Instituto Nacional de Estadística. Cifras oficiales de población resultantes de la revisión del Padrón municipal a 1 de enero. Resumen por comunidades autónomas. [Official population figures resulting from the revision of the municipal census as of January 1. Summary by autonomous community]. Madrid: Instituto Nacional de Estadística. [Accessed: 2 Nov 2022]. Spanish. Available from: https://www.ine.es/jaxiT3/Tabla.htm?t=2915
  5. Iñigo Martínez J, Gil Montalbán E, Jiménez Bueno S, Martín Martínez F, Nieto Juliá A, Sánchez Díaz J, et al. Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022. Euro Surveill. 2022;27(27):2200471.  https://doi.org/10.2807/1560-7917.ES.2022.27.27.2200471  PMID: 35801519 
  6. Centro de Coordinación de Alertas y Emergencias Sanitarias. Informe de situación. Alerta sobre infección de viruela del mono en España y otros países no endémicos. [Situation report. Monkeypox infection alert in Spain and other non-endemic countries]. Madrid: Centro de Coordinación de Alertas y Emergencias Sanitarias. [Accessed: 4 Nov 2022]. Spanish. Available from: https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox/docs/Informe_de_situacion_MPX_20221102.pdf
  7. Centers for Disease Control and Prevention (CDC). Interim clinical considerations for use of JYNNEOS and ACAM2000 vaccines during the 2022 U.S. monkeypox outbreak. Atlanta: CDC. [Accessed: 10 Nov 2022]. Available from: https://www.cdc.gov/poxvirus/monkeypox/clinicians/vaccines/vaccine-considerations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fpoxvirus%2Fmonkeypox%2Fclinicians%2Fsmallpox-vaccine.html
  8. UK Health Security Agency (UKHSA). Recommendations for the use of pre-and post-exposure vaccination during a monkeypox incident. London: UKHSA; 26 Aug 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
  9. Killikelly A, Brousseau N. Summary of the National Advisory Committee on immunization (NACI) rapid response—interim guidance on the use of Imvamune in the context of monkeypox outbreaks in Canada. Can Commun Dis Rep. 2022;48(7/8):367-71.  https://doi.org/10.14745/ccdr.v48i78a09 
  10. Comisión de Salud Pública. Recomendaciones de vacunación en el brote actual de viruela del mono. [Vaccination recommendations in the current monkeypox outbreak]. Madrid: Comisión de Salud Pública; 2022. Spanish. Available from: https://www.sanidad.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/MonkeyPox/docs/Propuesta_vacunacion_Monkeypox.pdf
  11. Kupferschmidt K. How effective is the monkeypox vaccine? Scientists scramble for clues as trials ramp up. Washington DC: Science; 2022. Available from: https://www.science.org/content/article/how-effective-monkeypox-vaccine-scientists-scramble-clues-trials-ramp
  12. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment. Monkeypox multi-country outbreak-second update. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-multi-country-outbreak-second-update.pdf
  13. Ministerio de Sanidad. Protocolo para la detección precoz y manejo de casos ante la alerta de viruela de los monos (monkeypox) en España [Protocol for the early detection and management of cases of monkeypox alert in Spain]. Madrid: Ministerio de Sanidad; 2022. Spanish. Available from: https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox/docs/ProtocoloMPX_20220805.pdf
  14. Comisión de Salud Pública. Recomendaciones de vacunación en el brote actual de viruela del mono [Vaccination recommendations in the current monkeypox outbreak]. Madrid: Comisión de Salud Pública; 2022. Spanish. Available from: https://www.sanidad.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/MonkeyPox/docs/Actualizacion_Propuesta_vacunacion_Monkeypox.pdf
  15. European Medicines Agency (EMA). IMVANEX annex. Summary of product characteristics. Amsterdam: EMA. [Accessed: 31 Oct 2022]. Available from: https://www.ema.europa.eu/en/documents/product-information/imvanex-epar-product-information_en.pdf
  16. Food and Drug Administration (FDA). Fact sheet for healthcare providers administering vaccine: emergency use authorization of JYNNEOS (smallpox and monkeypox vaccine, live, non-replicating) for prevention of monkeypox disease in individuals determined to be at high risk for monkeypox infection. Silver Spring: FDA; 2022. Available from: https://www.fda.gov/media/160774/download
  17. Ministerio de Sanidad. Resumen de nuevas indicaciones PrEP. [Summary of new PrEP indications]. Madrid: Ministerio de Sanidad; 1 Dec 2021. Spanish. Available from: https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/PrEP/Resumen_nuevas_indicaciones_de_la_PrEP.pdf
  18. Agencia Estatal Boletín Oficial del Estado. Orden de 26 de octubre de 1979 por la que se deja en suspenso la obligatoriedad de vacunación antivariólica. [Official State Gazette. Order of October 26, 1979, suspending the compulsory antivariate vaccination]. Ministerio de Sanidad y Seguridad Social; 1979. Spanish. Available from: https://www.boe.es/eli/es/o/1979/10/26/(2)
  19. Pan American Health Organization (PAHO) and World Health Organization. (WHO). VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) On vaccine-preventable diseases: technical briefing on the multi-country monkeypox outbreak, 31 May 2022 (virtual). Washington DC: PAHO and WHO; 2022. Available from: https://iris.paho.org/handle/10665.2/56116
  20. Gallagher T, Lipsitch M. Postexposure effects of vaccines on infectious diseases. Epidemiol Rev. 2019;41(1):13-27.  https://doi.org/10.1093/epirev/mxz014  PMID: 31680134 
  21. Bertran M, Andrews N, Davison C, Dugbazah B, Boateng J, Lunt R, et al. Effectiveness of one dose of MVA-BN smallpox vaccine against mpox in England using the case-coverage method: an observational study. Lancet Infect Dis. 2023 Mar 13:S1473-3099(23)00057-9.
  22. Wolff Sagy Y, Zucker R, Hammerman A, Markovits H, Arieh NG, Abu Ahmad W, et al. Real-world effectiveness of a single dose of mpox vaccine in males. Nat Med. 2023;29(3):748-52.  https://doi.org/10.1038/s41591-023-02229-3  PMID: 36720271 
  23. Payne AB, Ray LC, Kugeler KJ, Fothergill A, White EB, Canning M, et al. Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose - 32 U.S. Jurisdictions, July 31-September 3, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(40):1278-82.  https://doi.org/10.15585/mmwr.mm7140e3  PMID: 36201401 
  24. 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;387(26):2477-9.  https://doi.org/10.1056/NEJMc2211944  PMID: 36477495 
  25. Merad Y, Gaymard A, Cotte L, Perpoint T, Alfaiate D, Godinot M, et al. Outcomes of post-exposure vaccination by modified vaccinia Ankara to prevent mpox (formerly monkeypox): a retrospective observational study in Lyon, France, June to August 2022. Euro Surveill. 2022;27(50):2200882.  https://doi.org/10.2807/1560-7917.ES.2022.27.50.2200882  PMID: 36695469 
  26. World Health Organization (WHO). Surveillance, case investigation and contact tracing for mpox (onkeypox): interim guidance. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.3
  27. Reyes-Urueña J, D’Ambrosio A, Croci R, Bluemel B, Cenciarelli O, Pharris A, et al. High monkeypox vaccine acceptance among male users of smartphone-based online gay-dating apps in Europe, 30 July to 12 August 2022. Euro Surveill. 2022;27(42):2200757.  https://doi.org/10.2807/1560-7917.ES.2022.27.42.2200757  PMID: 36268737 
  28. Delaney KP, Sanchez T, Hannah M, Edwards OW, Carpino T, Agnew-Brune C, et al. Strategies adopted by gay, bisexual, and other men who have sex with men to prevent monkeypox virus transmission - United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022;71(35):1126-30.  https://doi.org/10.15585/mmwr.mm7135e1  PMID: 36048582 
/content/10.2807/1560-7917.ES.2023.28.24.2200883
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
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