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. 2024 Feb 17;78(2):476-483.
doi: 10.1093/cid/ciad645.

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Mario Fontán-Vela  1   2 , Victoria Hernando  1   3 , Carmen Olmedo  4 , Ermengol Coma  5 , Montse Martínez  6 , David Moreno-Perez  7 , Nicola Lorusso  7 , María Vázquez Torres  8 , José Francisco Barbas Del Buey  9 , Javier Roig-Sena  10 , Eliseo Pastor  11 , Antònia Galmés Truyols  12 , Francisca Artigues Serra  12 , Rosa María Sancho Martínez  13 , Pello Latasa Zamalloa  14 , Olaia Pérez Martínez  15 , Ana Vázquez Estepa  15 , Amós José García Rojas  16 , Ana Isabel Barreno Estévez  16 , Alonso Sánchez-Migallón Naranjo  17 , Jaime Jesús Pérez Martín  18 , Pilar Peces Jiménez  19 , Raquel Morales Romero  19 , Jesús Castilla  20 , Manuel García Cenoz  20 , Marta Huerta Huerta  21 , An Lieve Dirk Boone  21 , María José Macías Ortiz  22 , Virginia Álvarez Río  23 , María Jesús Rodríguez Recio  23 , María Merino Díaz  24 , Belén Berradre Sáenz  24 , María Teresa Villegas-Moreno  1 , Aurora Limia  4 , Asuncion Diaz  1   3 , Susana Monge  1   3 ; Spanish MPOX Vaccine Effectiveness Study Group
Collaborators, Affiliations

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Mario Fontán-Vela et al. Clin Infect Dis. .

Abstract

Background: With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP.

Methods: National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100).

Results: We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination.

Conclusions: One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.

Keywords: MVA-BN vaccine; monkeypox; mpox; pre-exposure prophylaxis; vaccine effectiveness.

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Conflict of interest statement

Potential conflicts of interest. A. G. T. reports financial support for expert testimony from Moderna and GSK and for attending meetings and/or travel from Pfizer and MSD. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Sample selection flowchart. Abbreviations: HIV-PrEP, HIV pre-exposure prophylaxis; MVA-BN, modified vaccinia Ankara-Bavaria Nordic.
Figure 2.
Figure 2.
Estimated mpox virus infection risk in the sample of individuals vaccinated with at least 1 dose of Modified Vaccinia Ankara-Bavaria Nordic vaccine and matched unvaccinated controls overall (A) and in individuals aged <50 years (B).
See this image and copyright information in PMC

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