Anticipating Smallpox and Monkeypox Outbreaks

Abrahams, Brian C.; Kaufman, David

doi:10.1097/01.nrl.0000138998.11209.88

Cited by 20 publications

(9 citation statements)

References 33 publications

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“…Most of the vaccines stockpiled are first-generation vaccines, as were used during the World Health Organization (WHO) smallpox-eradication campaign. Considering the large number of unvaccinated people in present societies, the question arises about how many people would be expected to have serious adverse events, such as postvaccinal encephalitis (PVE [ 1 , 2 ]) or death, after smallpox vaccination. Because PVE had a case-fatality rate of approximately 25%–30%, with 16%–30% of survivors having permanent neurological damage [ 1 , 2 ], the WHO promoted the switch to the Lister strain of vaccinia virus for vaccine production in the 1950s.…”

Section: Introductionmentioning

confidence: 99%

“…Considering the large number of unvaccinated people in present societies, the question arises about how many people would be expected to have serious adverse events, such as postvaccinal encephalitis (PVE [ 1 , 2 ]) or death, after smallpox vaccination. Because PVE had a case-fatality rate of approximately 25%–30%, with 16%–30% of survivors having permanent neurological damage [ 1 , 2 ], the WHO promoted the switch to the Lister strain of vaccinia virus for vaccine production in the 1950s. It has been shown that vaccinia strains differ in their pathogenicity in animals [ 3 ] and that vaccinia strains that are more pathogenic in animals may cause a higher rate of postvaccinal complications in humans after vaccination [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Frequency of Adverse Events after Vaccination with Different Vaccinia Strains

et al. 2006

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BackgroundLarge quantities of smallpox vaccine have been stockpiled to protect entire nations against a possible reintroduction of smallpox. Planning for an appropriate use of these stockpiled vaccines in response to a smallpox outbreak requires a rational assessment of the risks of vaccination-related adverse events, compared to the risk of contracting an infection. Although considerable effort has been made to understand the dynamics of smallpox transmission in modern societies, little attention has been paid to estimating the frequency of adverse events due to smallpox vaccination. Studies exploring the consequences of smallpox vaccination strategies have commonly used a frequency of approximately one death per million vaccinations, which is based on a study of vaccination with the New York City Board of Health (NYCBH) strain of vaccinia virus. However, a multitude of historical studies of smallpox vaccination with other vaccinia strains suggest that there are strain-related differences in the frequency of adverse events after vaccination. Because many countries have stockpiled vaccine based on the Lister strain of vaccinia virus, a quantitative evaluation of the adverse effects of such vaccines is essential for emergency response planning. We conducted a systematic review and statistical analysis of historical data concerning vaccination against smallpox with different strains of vaccinia virus.Methods and FindingsWe analyzed historical vaccination data extracted from the literature. We extracted data on the frequency of postvaccinal encephalitis and death with respect to vaccinia strain and age of vaccinees. Using a hierarchical Bayesian approach for meta-analysis, we estimated the expected frequencies of postvaccinal encephalitis and death with respect to age at vaccination for smallpox vaccines based on the NYCBH and Lister vaccinia strains. We found large heterogeneity between findings from different studies and a time-period effect that showed decreasing incidences of adverse events over several decades. To estimate death rates, we then restricted our analysis to more-recent studies. We estimated that vaccination with the NYCBH strain leads to an average of 1.4 deaths per million vaccinations (95% credible interval, 0–6) and that vaccination with Lister vaccine leads to an average of 8.4 deaths per million vaccinations (95% credible interval, 0–31). We combined age-dependent estimates of the frequency of death after vaccination and revaccination with demographic data to obtain estimates of the expected number of deaths in present societies due to vaccination with the NYCBH and Lister vaccinia strains.ConclusionsPrevious analyses of smallpox vaccination policies, which rely on the commonly assumed value of one death per million vaccinations, may give serious underestimates of the number of deaths resulting from vaccination. Moreover, because there are large, strain-dependent differences in the frequency of adverse events due to smallpox vaccination, it is difficult to extrapolate from predictions for the ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frequency of Adverse Events after Vaccination with Different Vaccinia Strains

et al. 2006

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“…There are many studies on the connection between smallpox vaccines and the monkeypox virus. As early as 2004, studies pointed out that vaccination against smallpox affects the manifestation and severity of monkeypox, and it is feasible to treat monkeypox with a subunit vaccine method of smallpox-monkeypox immunization [15,29]. Studies have shown that the smallpox vaccine could achieve an 85% effectiveness rate in preventing monkeypox.…”

Section: Discussionmentioning

confidence: 99%

Bibliometric Analysis and Key Messages of Monkeypox Research (2003–2022)

Zhang

et al. 2023

Sustainability

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Objective: At the global level, a multi-country outbreak of monkeypox has attracted global attention. The purpose of this study is to explore the growing contribution of global research on monkeypox. Methods: Publications related to monkeypox were retrieved from PubMed and Web of Science. Bibliometric analyses were conducted by VOSviewer and CiteSpace software to generate network maps, evaluate hot topics in the field, and identify cooperation patterns between different authors and countries. Results: A total of 1822 publications were retrieved to reflect the global overall monkeypox research output, including clinical trials, systematic reviews, case reports, and laboratory studies. The most productive country and institution were respectively the United States and Centers for Disease Control and Prevention—USA (CDC). The top three authors with the highest number of publications were all from the CDC. Research hotspots included some monkeypox-related diseases, such as smallpox and vaccinia, and the prevention and treatment of monkeypox diseases, such as antiviral drugs and smallpox vaccines. Research fronts included real-time PCR, immune evasion, animal models, and monkeypox outbreak countries (Democratic Republic of Congo and others). Conclusions: Research on monkeypox is mainly carried out from the aspects of its source, transmission route, virus prevalence, and prevention and control measures. Controlling monkeypox is a global responsibility, and the future research into monkeypox control methods is suggested to focus on more than vaccines.

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“…PVEM presents as stupor, coma, seizure, and paraparesis, especially in older children and adults. Around 16% of cases have reported long‐term neurologic effects, while mortality rates amount to 1.5 per million per vaccination recipient (Abrahams & Kaufman, 2004 ). Similar neuropsychiatric complications have been reported for MPX as well (Jezek et al., 1987 ; Sejvar et al., 2004 ).…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric manifestations of monkeypox: A clinically oriented comprehensive review

et al. 2023

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Monkeypox (MPX) has emerged as a threatening outbreak in recent months. The understanding of disease pathogenesis and its systemic involvement has evolved with time. Both the virus and its vaccine, like other members of the Orthopoxvirus family, were always expected to have neuropsychiatric consequences. Several neurological complications have been reported with MPX and its vaccines that include but not limited to headaches, myalgia, encephalitis, and coma. Psychiatric complications like anxiety and depression have also been reported; however, we lack evidence to present a direct causality. We conducted a literature review to compile recent evidence on neuropsychiatric manifestations and underline the importance of evolving aspects and complications of MPX. We advocate for better reporting of cases and adverse events, to enhance our understanding of the disease, aiding physicians to make more informed decisions, thus facilitating timely diagnosis and treatment.

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Anticipating Smallpox and Monkeypox Outbreaks

Cited by 20 publications

References 33 publications

Frequency of Adverse Events after Vaccination with Different Vaccinia Strains

Frequency of Adverse Events after Vaccination with Different Vaccinia Strains

Bibliometric Analysis and Key Messages of Monkeypox Research (2003–2022)

Neuropsychiatric manifestations of monkeypox: A clinically oriented comprehensive review

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