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Effectiveness of one dose of MVA–BN smallpox vaccine against mpox in England using the case-coverage method: an observational study - 29/06/23

Doi : 10.1016/S1473-3099(23)00057-9 
Marta Bertran, MSc a, Nick Andrews, PhD a, Chloe Davison, MSc a, Bennet Dugbazah, MSc a, Jacob Boateng, MSc a, Rachel Lunt, MSc a, Joanne Hardstaff, PhD b, Melanie Green, BA b, Paula Blomquist, MSc b, Charlie Turner, PhD b, Hamish Mohammed, PhD c, d, Rebecca Cordery, MD a, Sema Mandal, FFPH a, Colin Campbell, FFPH a, Shamez N Ladhani, ProfPhD a, e, Mary Ramsay, ProfFFPH a, Gayatri Amirthalingam, MFPH a, Jamie Lopez Bernal, FFPH a,
a Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK 
b Monkeypox Data, Epidemiology and Analytics Cell, UK Health Security Agency, London, UK 
c Division of Blood Safety, Hepatitis, STIs and HIV, UK Health Security Agency, London, UK 
d Institute for Global Health, University College London, London, UK 
e Paediatric Infectious Diseases Research Group, St. George’s University of London, London, UK 

* Correspondence to: Dr Jamie Lopez Bernal, Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK Immunisations and Vaccine Preventable Diseases Division UK Health Security Agency London NW9 5EQ UK

Summary

Background

The UK experienced a national outbreak of mpox (formerly known as monkeypox) disease that started in May, 2022, as did many other countries worldwide, with case numbers rising rapidly, mainly among gay, bisexual, and other men who have sex with men (GBMSM). To control the outbreak, Modified Vaccinia Ankara–Bavaria Nordic (MVA–BN), an attenuated smallpox vaccine, was offered to at-risk GBMSM. We aimed to assess the effectiveness of a single MVA–BN dose against symptomatic mpox disease in at-risk GBMSM.

Methods

In this case-coverage study, mpox cases in England were sent questionnaires collecting information on demographics, vaccination history, symptoms, and sexual orientation. Returned questionnaires were linked to laboratory data and a public health case management system (HP Zone) to obtain additional information on symptom onset and specimen date. Cases with a rash onset date (or alternative proxy) between July 4 and Oct 9, 2022, were included. Females, heterosexual men, and those with missing vaccination information were excluded. Vaccine effectiveness was calculated using the case-coverage method in which vaccine coverage among cases is compared with coverage in the eligible population, estimated from doses given to GBMSM and the estimated size of at-risk GBMSM. Sensitivity analyses included an increase and decrease of 20% differences in the estimated high-risk GBMSM population size.

Findings

By Nov 3, 2022, 1102 people had responded to questionnaires, of which 739 were excluded (52 females or self-declared male heterosexuals, 590 with an index date outside of the study period, and 97 missing a vaccination date). 363 cases were included in the analyses. Vaccine uptake among eligible GBMSM increased steadily from July, 2022, reaching 47% by Oct 9, 2022. Of the 363 confirmed cases, eight cases either did occur or were likely to have occurred at least 14 days after vaccination, 32 within 0–13 days after vaccination, and the rest were unvaccinated. The estimated vaccine effectiveness against symptomatic mpox at least 14 days after a single dose was 78% (95% CI 54 to 89) ranging from 71 to 85 in sensitivity analyses. Vaccine effectiveness within 0–13 days after vaccination was –4% (95% CI –50 to 29).

Interpretation

A single MVA–BN dose was highly protective against symptomatic mpox disease among at-risk GBMSM, making it a useful tool for mpox outbreak control when rapid protection is needed. For cases in which numbers at highest risk of infection exceed vaccine supply, there might be benefit in prioritising delivery of first doses.

Funding

UK Health Security Agency.

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Vol 23 - N° 7

P. 828-835 - juillet 2023 Retour au numéro
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