When I started writing about monkeypox on May 19, there were only 35 cases. As of this writing, there are now 228 confirmed and 90 suspected cases as tabulated by BNO News. 35 to 237 confirmed cases in five days. That is almost a 700% increase.
At this rate, the monkeypox cases may be in the thousands by next week. Currently, healthcare providers taking care of monkeypox cases and close contacts with infected patients are getting vaccinated with smallpox vaccines to prevent the spread.
I like to be ahead of the curve and do the same thing for my readers. This article aims to familiarize the readers with the options available once the need for vaccination against monkeypox comes.
Smallpox vaccination was discontinued in the 1970s. However, experience in Africa has shown that smallpox vaccination provides 85% protection against monkeypox, according to the CDC. Smallpox and monkeypox viruses belong to the same Poxviridae family. That is why there is cross-protection.
As a side note, chickenpox is caused by a different virus, the varicella-zoster virus. It is not a pox virus. Therefore previous chickenpox infection nor vaccination will not give any protection.
The following smallpox vaccines are n the Strategic National Stockpile and ready to be mobilized when needed.
JYNNEOSTM (aka Imvamune or Imvanex)
Jynneos is the US brand name, and Imvanex is for the German market. Bavarian Nordic produces it. Germany ordered 40,000 doses yesterday.
Jynneos is an attenuated live vaccinia virus vaccine and cannot multiply inside the body. That makes it helpful in vaccinating people 18 years and older with certain immune deficiencies or conditions, such as HIV or atopic dermatitis.
JYNNEOSTM is administered subcutaneously as two doses separated by four weeks (one dose at week 0 and a second dose at week 4) for individuals who have never been vaccinated against smallpox or do not recall receiving a smallpox vaccination in the past. Individuals previously vaccinated against smallpox receive one dose.
ACAM2000®
The U.S. Food and Drug Administration (FDA) has licensed ACAM2000®. It is a live replication-competent vaccine for active immunization against smallpox disease in persons determined to be at high risk for smallpox infection.
The vaccinia virus, a member of the poxvirus family, is used to make ACAM2000. There is no smallpox (variola) virus in it.
Since there is a live and replication-competent virus in ACAM2000, it can multiply if given to an immune-compromised person and produce symptoms. The vaccinia virus may cause rash, fever, and head and body aches.
The area where the ACAM2000 is injected should be covered to prevent the live virus from being transmitted to other parts of the body and those body parts can develop a vaccinia rash.
If the vaccine fluid from the injected area is scratched and contaminates another person, they can develop vaccinia symptoms. If they are immune-compromised, their symptoms can be worse.
Immune compromised people include those with HIV, those taking steroids chronically, and organ transplant, recipients.
ACAM2000® is given as a single dose by the percutaneous route using the multiple puncture technique.
Aventis Pasteur Smallpox Vaccine (APSV)
APSV is another replication-competent vaccinia virus vaccine in the Strategic National Stockpile, with a safety profile similar to ACAM2000®.
It is an investigational vaccine. In a smallpox emergency, APSV would be made available under an Investigational New Drug or Emergency Use Authorization for use in circumstances where ACAM2000® is depleted, not readily available, or on a case-by-case basis where ACAM2000® is contraindicated.
It will probably be the same if the monkeypox outbreak becomes uncontrolled and we run out of the ACAM2000.
The same multiple puncture technique is also used when administering APSV.
Take away message
If the time comes when you may need to have a smallpox vaccine because of monkeypox exposure, be ready to give your medical history to let the doctor know if you are immune-compromised or not.
Another consideration when getting a replication-competent vaccine like the ACAM200 will be the people in your household. Tell your doctor if you live with someone who is immune-compromised, and they can give you tips to prevent your family from getting symptoms of the vaccinia virus.
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References:
- CDC Monkeypox Treatment webpage
- CDC Smallpox Vaccines webpage
- JYNNEOSTM Package Insert
- ACAM2000® Package Insert
- Medication Guide, ACAM2000®
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