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Abstract

Background

In 2022, a global monkeypox virus (MPXV) clade II epidemic occurred mainly among men who have sex with men. Until early 1980s, European smallpox vaccination programmes were part of worldwide smallpox eradication efforts. Having received smallpox vaccine > 20 years ago may provide some cross-protection against MPXV.

Aim

To assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.

Methods

European countries with sufficient data on case vaccination status and historical smallpox vaccination coverage were included. We selected mpox cases born in these countries during the height of the national smallpox vaccination campaigns (latest 1971), male, with date of onset before 1 August 2022. We estimated vaccine effectiveness (VE) and corresponding 95% CI for each country using logistic regression as per the Farrington screening method. We calculated a pooled estimate using a random effects model.

Results

In Denmark, France, the Netherlands and Spain, historical smallpox vaccination coverage was high (80–90%) until the end of the 1960s. VE estimates varied widely (40–80%, I2 = 82%), possibly reflecting different booster strategies. The pooled VE estimate was 70% (95% CI: 23–89%).

Conclusion

Our findings suggest residual cross-protection by historical smallpox vaccination against mpox caused by MPXV clade II in men with high uncertainty and heterogeneity. Individuals at high-risk of exposure should be offered mpox vaccination, following national recommendations, regardless of prior smallpox vaccine history, until further evidence becomes available. There is an urgent need to conduct similar studies in sub-Saharan countries currently affected by the MPXV clade I outbreak.

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2024-08-22
2024-08-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.34.2400139
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Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Soledad+Colombe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Colombe Soledad</a>, <a href="/search?value1=Silvia+Funke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Funke Silvia</a>, <a href="/search?value1=Anders+Koch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koch Anders</a>, <a href="/search?value1=Manon+Haverkate&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haverkate Manon</a>, <a href="/search?value1=Susana+Monge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monge Susana</a>, <a href="/search?value1=Anne-Sophie+Barret&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Barret Anne-Sophie</a>, <a href="/search?value1=Aisling+Vaughan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vaughan Aisling</a>, <a href="/search?value1=Susan+Hahn%C3%A9&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hahné Susan</a>, <a href="/search?value1=Catharina+van+Ewijk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Ewijk Catharina</a>, <a href="/search?value1=Hanne-Dorthe+Emborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Emborg Hanne-Dorthe</a>, <a href="/search?value1=Sebastian+von+Schreeb&option1=author&noRedirect=true" class="nonDisambigAuthorLink">von Schreeb Sebastian</a>, <a href="/search?value1=Asunci%C3%B3n+D%C3%ADaz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Díaz Asunción</a>, <a href="/search?value1=Carmen+Olmedo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Olmedo Carmen</a>, <a href="/search?value1=Laura+Zanetti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zanetti Laura</a>, <a href="/search?value1=Daniel+Levy-Bruhl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Levy-Bruhl Daniel</a>, <a href="/search?value1=Luis+Alves+de+Sousa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Sousa Luis Alves</a>, <a href="/search?value1=Jos%C3%A9+Hagan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hagan José</a>, <a href="/search?value1=Nathalie+Nicolay&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nicolay Nathalie</a>, <a href="/search?value1=Richard+Pebody&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pebody Richard</a></span>. Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(34):pii=2400139. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.34.2400139" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.34.2400139</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 29 Feb 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 07 Jun 2024 </span> </p>
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