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Vaccines for Mpox - An Unmet Global Need

Lori E Dodd1, H Clifford Lane1, Jean-Jacques Muyembe-Tamfum2

  • 1National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.

NEJM Evidence
|February 27, 2024
PubMed

Insights

Mpox (formerly monkeypox) cases have increased in the DRC due to waning smallpox immunity. Surveillance shows a 20-fold rise in mpox incidence since the 1980s, with vaccinated individuals showing lower infection rates.

Area of Science:

  • Epidemiology
  • Virology
  • Public Health

Background:

  • Mpox (formerly monkeypox) is endemic in central African rainforests, transmitted via zoonotic and human-to-human routes.
  • Clade I monkeypox virus (MPXV) infections are a significant concern in the Democratic Republic of Congo (DRC).
  • The cessation of smallpox vaccination globally in 1980 has led to a growing population susceptible to orthopoxviral infections.

Discussion:

  • The decline in smallpox vaccination has resulted in a rise of orthopox immune-naïve individuals, contributing to increased mpox outbreaks.
  • Active surveillance in Sankuru Province, DRC, documented a significant increase in mpox incidence between 2005–2007 compared to the 1980s.
  • Individuals with a smallpox vaccination scar exhibited a substantially lower incidence of mpox, indicating lasting vaccine-induced immunity.

Key Insights:

  • Waning immunity from smallpox vaccination is a critical factor driving the resurgence of mpox in the DRC.
  • A 20-fold increase in mpox incidence highlights the vulnerability of populations without prior smallpox vaccination.
  • Evidence suggests that smallpox vaccination provides significant protection against mpox infection.

Outlook:

  • Re-evaluation of vaccination strategies may be necessary to control mpox outbreaks in endemic regions.
  • Further research into the long-term efficacy of smallpox vaccination against mpox is warranted.
  • Understanding the impact of immune naivety on mpox epidemiology is crucial for public health interventions.

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