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Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022
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Soledad Colombe1,2
, Silvia Funke3 , Anders Koch4,5
, Manon Haverkate6 , Susana Monge7
, Anne-Sophie Barret8
, Aisling Vaughan1
, Susan Hahné6 , Catharina van Ewijk6,9
, Hanne-Dorthe Emborg4
, Sebastian von Schreeb4,9,10
, Asunción Díaz7
, Carmen Olmedo11 , Laura Zanetti8 , Daniel Levy-Bruhl8
, Luis Alves de Sousa3 , José Hagan1 , Nathalie Nicolay3,*
, Richard Pebody1,*
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View Affiliations Hide AffiliationsAffiliations: 1 World Health Organization Regional Office for Europe, Copenhagen, Denmark 2 Institute of Tropical Medicine, Antwerp, Belgium 3 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 4 Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark 5 Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark 6 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands 7 National Centre of Epidemiology, Carlos III Institute of Health, CIBERINFEC, Madrid, Spain 8 Santé Publique France, St-Maurice, France 9 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 10 Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre Hospital, Copenhagen, Denmark 11 Vaccination Programme, Ministry of Health, Madrid, Spain* These authors contributed equally to this work and share last authorship.Correspondence:Nathalie NicolayNathalie.Nicolay ecdc.europa.eu
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Citation style for this article: Colombe Soledad, Funke Silvia, Koch Anders, Haverkate Manon, Monge Susana, Barret Anne-Sophie, Vaughan Aisling, Hahné Susan, van Ewijk Catharina, Emborg Hanne-Dorthe, von Schreeb Sebastian, Díaz Asunción, Olmedo Carmen, Zanetti Laura, Levy-Bruhl Daniel, de Sousa Luis Alves, Hagan José, Nicolay Nathalie, Pebody Richard. Effectiveness of historical smallpox vaccination against mpox clade II in men in Denmark, France, the Netherlands and Spain, 2022. Euro Surveill. 2024;29(34):pii=2400139. https://doi.org/10.2807/1560-7917.ES.2024.29.34.2400139 Received: 29 Feb 2024; Accepted: 07 Jun 2024
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Abstract
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.
To assess the effectiveness of historical smallpox vaccination against laboratory-confirmed mpox in 2022 in Europe.
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.
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%).
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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