8 August 2022

Taylor L. Monkeypox: Concerns mount over vaccine inequity. BMJ. 2022 Aug 8;378:o1971. PubMed: https://pubmed.gov/35940615. Full text: https://doi.org/10.1136/bmj.o1971

“Whether vaccine supplies will be sufficient to supply all nations at their time of need is unclear, because of continuing uncertainty over vaccine production capacity and efficacy and the best strategies to contain the outbreak.”

 

4 August 2022

Rubin EJ, Baden LR, Morrissey S. Audio Interview: Updated Covid-19 Vaccines and a Look at Monkeypox. N Engl J Med. 2022 Aug 4;387(5):e16. PubMed: https://pubmed.gov/35921460. Full text: https://doi.org/10.1056/NEJMe2210394

“In this audio interview conducted on August 2, 2022, the editors discuss soon-to-be-released Covid-19 vaccines against BA.4/BA.5 strains, as well as the current state of therapeutics for monkeypox.”

 

1 July 2022

Petersen E, Zumla A, Hui DS, et al. Vaccination for monkeypox prevention in persons with high-risk sexual behaviours to control on-going outbreak of monkeypox virus clade 3. Int J Infect Dis. 2022 Jul 1:S1201-9712(22)00378-2. PubMed: https://pubmed.gov/35788415. Full text: https://doi.org/10.1016/j.ijid.2022.06.047

The authors caution that we do not know if immunization with a smallpox vaccine like IMVANEX® (EU) / JYNNEOS® (US) will provide protective immunity against sexually transmitted monkeypox virus (MPXV). Therefore, the use of a vaccine as pre-exposure prophylaxis (PrEP) against MPXV must be in the form of a randomized, controlled trial with another vaccine used in the control arm. (IMVANEX® (EU) / JYNNEOS® (US)  is a live vaccine produced from the Modified Vaccinia Ankara-Bavarian Nordic [MVA-BN) strain, an attenuated, non-replicating orthopoxvirus manufactured by Bavarian Nordic, Hellerup, Denmark.)

 

18 June 2022

Kozlov M. Monkeypox vaccination begins – can the global outbreaks be contained? Nature. 2022 Jun;606(7914):444-445. PubMed: https://pubmed.gov/35676362. Full text: https://doi.org/10.1038/d41586-022-01587-1

In theory, monkeypox is conducive to a ring vaccination campaign because it spreads slower than most human viruses and has a long incubation period. However, getting people to take vaccines could be difficult. As of 24 May, only 15 of 107 community contacts and 169 of 245 health-care workers in the United Kingdom opted to take an MVA-BN vaccine after possible monkeypox exposure during the current outbreaks.

 

10 June 2022

Kupferschmidt K. Monkeypox vaccination plans take shape amid questions. Science. 2022 Jun 10;376(6598):1142-1143. PubMed: https://pubmed.gov/35679422. Full text: https://doi.org/10.1126/science.add3743

“But what role the vaccine will ultimately play depends on a host of factors: whether those most at risk from infection can be identified and vaccinated, whether the vaccine is as effective as hoped, and whether enough is available to stop the burgeoning outbreak. WHO has so far only backed ring vaccination—MVA is ideally given within 4 days of an exposure but recommended for up to 14 days.”

 

3 June 2022

Rao AK, Petersen BW, Whitehill F, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices – United States, 2022. MMWR Morb Mortal Wkly Rep. 2022 Jun 3;71(22):734-742. PubMed: https://pubmed.gov/35653347. Full text: https://doi.org/10.15585/mmwr.mm7122e1

The CDC recommendation to use JYNNEOS (a replication-deficient live Vaccinia virus vaccine licensed in the United States; EU: Imvanex) for certain persons at risk for occupational exposure to orthopoxviruses. See also the section “Special Populations” (persons with atopic dermatitis, eczema, or other exfoliative skin conditions; persons with immunocompromising conditions; pregnant women; breastfeeding women; children and adolescents aged <18 years; persons with multiple cardiac risk factors).

 

17 October 2020

Volkmann A, Williamson AL, Weidenthaler H, et al. The Brighton Collaboration standardized template for collection of key information for risk/benefit assessment of a Modified Vaccinia Ankara (MVA) vaccine platform. Vaccine. 2021 May 21;39(22):3067-3080. PubMed: https://pubmed.gov/33077299. Full text: https://doi.org/10.1016/j.vaccine.2020.08.050

The Modified Vaccinia Ankara (MVA) vector system is being explored as a platform for development of multiple vaccines. This paper reviews the molecular and biological features specifically of the MVA-BN vector system. MVA-BN  has been approved as smallpox vaccine in Europe and Canada in 2013, and as smallpox and monkeypox vaccine in the US in 2019.

 

14 November 2018

Petersen BW, Kabamba J, McCollum AM, et al. Vaccinating against monkeypox in the Democratic Republic of the Congo. Antiviral Res. 2019 Feb;162:171-177. PubMed: https://pubmed.gov/30445121. Full text: https://doi.org/10.1016/j.antiviral.2018.11.004

A study of vaccination of HCWs at risk of MPX with IMVAMUNE, a third-generation smallpox vaccine.

 

28 February 2018

Albarnaz JD, Torres AA, Smith GL. Modulating Vaccinia Virus Immunomodulators to Improve Immunological Memory. Viruses. 2018 Feb 28;10(3):101. PubMed: https://pubmed.gov/29495547. Full text: https://doi.org/10.3390/v10030101

This article considers the genetic engineering of vaccinia virus (VACV) to enhance vaccine immunogenicity and safety. The authors describe the virulence, immunogenicity and protective efficacy of VACV strains engineered to lack specific immunomodulatory or host range proteins.

 

1 September 2015

Eto A, Saito T, Yokote H, Kurane I, Kanatani Y. Recent advances in the study of live attenuated cell-cultured smallpox vaccine LC16m8. Vaccine. 2015 Nov 9;33(45):6106-11. PubMed: https://pubmed.gov/26319072. Full text: https://doi.org/10.1016/j.vaccine.2015.07.111

Approximately 50,000 children in the 1970s and about 3500 healthy adults in the 2000s were vaccinated with LC16m8 in Japan. The authors suggest that LC16m8 might be a viable alternative to first-generation smallpox vaccines to prevent human monkeypox.

 

25 October 2013

Keckler MS, Reynolds MG, Damon IK, Karem KL. The effects of post-exposure smallpox vaccination on clinical disease presentation: addressing the data gaps between historical epidemiology and modern surrogate model data. Vaccine. 2013 Oct 25;31(45):5192-201. PubMed: https://pubmed.gov/23994378. Full text: https://doi.org/10.1016/j.vaccine.2013.08.039

This review seeks to (1) summarize conclusions about the efficacy of post-exposure smallpox vaccination from historic epidemiological reports and modern animal studies; (2) identify data gaps in these studies; and (3) summarize the clinical features of orthopoxvirus-associated infections in various animal models to identify those models that are most useful for post-exposure vaccination studies.

 

14 June 2013

Smith KA. Smallpox: can we still learn from the journey to eradication? PubMed: https://pubmed.gov/23760373. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734679/

This difference in the pathogenicity of variola vs. vaccinia is thought to be due to the capacity of variola to circumvent innate immunity, which allows it to disseminate widely before the adaptive immune response occurs.

 

15 September 2011

Kennedy JS, Gurwith M, Dekker CL, et al. Safety and immunogenicity of LC16m8, an attenuated smallpox vaccine in vaccinia-naive adults. J Infect Dis. 2011 Nov;204(9):1395-402. PubMed: https://pubmed.gov/21921208. Full text: https://doi.org/10.1093/infdis/jir527

LC16m8 is an attenuated cell culture-adapted Lister vaccinia smallpox vaccine missing the B5R protein and licensed for use in Japan. LC16m8 generated neutralizing antibody titers to multiple poxviruses, including vaccinia, monkeypox, and variola major, and broad T-cell responses.

 

23 June 2009

Handley L, Buller RM, Frey SE, Bellone C, Parker S. The new ACAM2000 vaccine and other therapies to control orthopoxvirus outbreaks and bioterror attacks. Expert Rev Vaccines. 2009 Jul;8(7):841-50. PubMed: https://pubmed.gov/19538111. Full text: https://doi.org/10.1586/erv.09.55

“ACAM2000 is one of the new generation of smallpox vaccines. It is produced in cell culture from a clonally purified master seed stock of vaccinia derived from the New York City Board of Health strain of vaccinia.”

 

13 December 2006

Parrino J, Graham BS. Smallpox vaccines: Past, present, and future. J Allergy Clin Immunol. 2006 Dec;118(6):1320-6. PubMed: https://pubmed.gov/17157663. Full text: https://doi.org/10.1016/j.jaci.2006.09.037

“Although motivated by the threat of bioterrorism, the hope is for new poxvirus vaccines to have their greatest utility against other pathogenic orthopoxviruses such as monkeypox and for the development of recombinant poxvirus-based vectors to treat and prevent other diseases.”

 

1 September 2004

Abrahams BC, Kaufman DM. Anticipating smallpox and monkeypox outbreaks: complications of the smallpox vaccine. Neurologist. 2004 Sep;10(5):265-74. PubMed: https://pubmed.gov/15335444. Full text: https://doi.org/10.1097/01.nrl.0000138998.11209.88

Review of the literature regarding past and current (2004) experiences with smallpox vaccination. According to prior reports, neurologic complications have occurred in 2.5 per million US individuals, with the most common being postvaccinal encephalomyelitis (PVEM). In older children and adults, PVEM causes stupor and coma, seizures, paraparesis, and other neurologic and mental abnormalities, and, in 16% of PVEM cases, permanent neurologic sequelae. The overall mortality rate of neurologic complications is approximately 1.5 per million vaccinees.