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JYNNEOS™ effectiveness as post-exposure prophylaxis against mpox: Challenges using real-world outbreak data.

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Summary
This summary is machine-generated.

Evaluating JYNNEOS vaccine as post-exposure prophylaxis (PEP) for mpox in NYC revealed conventional methods overestimated effectiveness. Target trial emulation avoided bias but yielded wide confidence intervals, highlighting challenges in real-world data analysis.

Keywords:
EffectivenessJynneosProphylaxisVaccinempox

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Area of Science:

  • Epidemiology
  • Vaccinology
  • Public Health

Background:

  • JYNNEOS vaccine utilized for mpox post-exposure prophylaxis (PEP) during the New York City (NYC) outbreak.
  • Limited data available on the real-world effectiveness of JYNNEOS as PEP.

Purpose of the Study:

  • To assess the effectiveness of a single JYNNEOS vaccine dose as PEP for preventing mpox disease.
  • To compare the target trial emulation method with conventional analysis for PEP effectiveness, addressing potential immortal time bias.

Main Methods:

  • Observational study emulating a sequence of nested target randomized trials.
  • Assessed effectiveness of JYNNEOS administered ≤14 days post-exposure during the NYC mpox outbreak (May-August 2022).
  • Adjusted for exposure risk and race/ethnicity; analyzed based on last (PEP_L) and first (PEP_F) exposure dates.

Main Results:

  • Conventional analysis suggested high PEP_L (78%) and PEP_F (73%) effectiveness.
  • Target trial emulation showed significantly lower adjusted effectiveness: PEP_L 19% and PEP_F -7%.
  • Median incubation period was 7 days; median time to PEP_L receipt was also 7 days.

Conclusions:

  • Real-world PEP effectiveness determination is challenging due to factors like timing relative to incubation.
  • Conventional methods can overestimate effectiveness by not accounting for immortal time bias.
  • Target trial emulation is a more robust method, though small sample sizes can limit precision.