As of September 16, 2022, the latest number of global monkeypox cases is now 60,332 in 107 countries.
The CDC published a case report about a man who contracted monkeypox even though he was vaccinated with the ACAM2000 smallpox vaccine eight years ago.
The ACAM2000 is approved to help protect against smallpox and has been made available to prevent monkeypox. ACAM2000 is an alternative to the JYNNEOS vaccine.
ACAM2000 contains a live virus called the Vaccinia virus. Vaccinia virus is in the same family of viruses as the viruses that cause monkeypox or smallpox, which is why it can help protect against monkeypox.
The patient was a previously healthy 34-year-old man who served in the US military. He was vaccinated against smallpox with the ACAM2000 smallpox vaccine in March 2014.
Ninety days before his symptoms, he had penetrative anal and receptive oral sexual intercourse with 13–14 new partners. He did not use any condoms.
His last sexual intercourse was 11 days before he sought care when he engaged in unprotected anal-insertive sex with a single anonymous partner at a local Pride event.
He presented to a walk-in sexually transmitted infections clinic for a 4-day history of malaise, fatigue, and headache and a 2-day history of 4 painless penile lesions.
The patient had sought evaluation at a local emergency department two days before he visited the clinic. Results for testing performed in the emergency department were negative for Neisseria gonorrhea, Chlamydia trachomatis, and herpes simplex virus.
His constitutional symptoms improved over the next two days. However, his penile ulcers progressed into white papular lesions, prompting him to seek reevaluation.
The image below shows the evolution of penile lesions in the monkeypox patient.
A) Two days after constitutional symptoms developed; B) evolution of rash showing coalescence and development of a pustular appearance six days after onset of constitutional symptoms; C) ulceration of lesion on day 16; D) dissipation of lesion without residual scarring.
Clinically the patient did well, only requiring supportive care with oral acetaminophen (Tylenol) for constitutional symptoms, which resolved ten days after symptom onset.
The penile lesions dissipated without scarring, as seen in image D above.
According to the authors,
the JYNNEOS and ACAM2000 vaccines present disparate challenges.
Specifically, the JYNNEOS vaccine is administered as a 2-dose regimen that shows a mild side effect profile, and the ACAM2000 vaccine is a single inoculation that can induce severe adverse effects.
However, because of persistent JYNNEOS shortages hampering preexposure and postexposure prophylaxis efforts, vaccination with ACAM2000 might be an option in locales that urgently need immunizations protective against monkeypox.
The efficacy of either vaccine in the current outbreak remains unknown.
Although vaccination is foundational for prevention of infectious disease, this case highlights that vaccination alone does not guarantee immunity from monkeypox.
Public health leaders should taper expectations that vaccination alone will end the outbreak.
Vaccine should complement, not replace, public health campaigns that aim to minimize high-risk health behaviors.
I agree with that.
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Reference:
Turner W, Mandia J, Keltner C, Haynes R, Faestel P, Mease L. Monkeypox in patient immunized with ACAM2000 smallpox vaccine during 2022 outbreak. Emerg Infect Dis. Year month September 15, 2022.
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