Prevention of monkeypox with vaccines: a rapid review

Gregory A Poland, Richard B Kennedy, Pritish K Tosh, Gregory A Poland, Richard B Kennedy, Pritish K Tosh

Abstract

The largest outbreak of monkeypox in history began in May, 2022, and has rapidly spread across the globe ever since. The purpose of this Review is to briefly describe human immune responses to orthopoxviruses; provide an overview of the vaccines available to combat this outbreak; and discuss the various clinical data and animal studies evaluating protective immunity to monkeypox elicited by vaccinia virus-based smallpox vaccines, address ongoing concerns regarding the outbreak, and provide suggestions for the appropriate use of vaccines as an outbreak control measure. Data showing clinical effectiveness (~85%) of smallpox vaccines against monkeypox come from surveillance studies conducted in central Africa in the 1980s and later during outbreaks in the same area. These data are supported by a large number of animal studies (primarily in non-human primates) with live virus challenge by various inoculation routes. These studies uniformly showed a high degree of protection and immunity against monkeypox virus following vaccination with various smallpox vaccines. Smallpox vaccines represent an effective countermeasure that can be used to control monkeypox outbreaks. However, smallpox vaccines do cause side-effects and the replication-competent, second-generation vaccines have contraindications. Third-generation vaccines, although safer for use in immunocompromised populations, require two doses, which is an impediment to rapid outbreak response. Lessons learned from the COVID-19 pandemic should be used to inform our collective response to this monkeypox outbreak and to future outbreaks.

Conflict of interest statement

Declaration of interests GAP offers consultative advice on vaccine development to Merck, Medicago, GlaxoSmithKline, Sanofi Pasteur, Emergent Biosolutions, Dynavax, Genentech, Eli Lilly, Affinivax, Novavax, Bavarian Nordic, AstraZeneca, Exelixis, Regeneron, Janssen, Vyriad, Moderna, and Genevant Sciences. GAP holds patents related to vaccinia and measles peptide vaccines. RBK and GAP hold a patent related to vaccinia peptide vaccines. GAP and RBK have received grant funding from ICW Ventures for preclinical studies on a peptide-based COVID-19 vaccine. RBK has received funding from Merck Research Laboratories to study waning immunity to mumps vaccine. PKT declares no competing interests.

Copyright © 2022 Elsevier Ltd. All rights reserved.

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