Breakthrough monkeypox infection among individuals previously immunized with smallpox or monkeypox vaccination

Raccagni, Angelo Roberto; Candela, Caterina; Mileto, Davide; Bruzzesi, Elena; Canetti, Diana; Bertoni, Costanza; Castagna, Antonella; Nozza, Silvia

doi:10.1016/j.jinf.2022.12.001

Cited by 29 publications

(40 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We should also consider that among the cohort more than three-quarters were living with HIV and others were taking immunosuppressive agents for co-morbidities. According to this hypothesis, immunosuppression and HIV-related immune-senescence may play a role in contracting mpox, despite vaccination [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics

Candela

Raccagni

Bruzzesi

et al. 2023

Viruses

Self Cite

View full text Add to dashboard Cite

Background: Monkeypox virus (mpxv) started to spread to Europe and North America at the beginning of the current outbreak in May 2022, and the World Health Organization (WHO) declared Human Monkeypox (mpox) as a public health emergency of international concern (PHEIC) in July 2022. The aim of this observational analysis is to describe demographical data, symptoms presentation and clinical course till outcome of individuals diagnosed with mpox, between May and October 2022, at our open-access Sexual Health Clinic in IRCCS San Raffaele Hospital in Milan, Italy. Methods: Among people who accessed our Sexual Health Clinic, we considered, as suspected diagnosis of mpox, individuals with consistent symptoms and epidemiological criteria. Following the physical examination, oropharyngeal, anal, genital and cutaneous swabs, plus plasma, urine and seminal fluid were collected as biological materials to detect mpxv DNA. We also performed a screening for sexually transmitted infections (STIs). Results: Overall, 140 individuals with mpox were included in this study. Median age was 37 (interquartile, IQR 33, 43) years old. Males were 137 (98%) and men who have sex with men (MSM) were 134 (96%). As risk factors, we detected travels abroad in 35 (25%) individuals and close contact with mpox cases in 49 (35%). There were 66 (47%) people living with HIV (PLWH). Most frequent symptoms were fever (59%), lymphadenopathy (57%), cutaneous (77%), genital (42%), anal (34%) and oral (26%) lesions, proctitis (39%), sore throat (22%) and generalized rash (5%). At mpox diagnosis, we also observed N. gonorrhoeae in 18 (13%) cases, syphilis in 14 (10%) and C. trachomatis in 12 (9%). Two (1%) people received a concomitant diagnosis of HIV infection. We attended to 21 (15%) complications, with nine (6%) cases of hospitalization including six (IQR 3,7) median hospital days. Forty-five (32%) patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs), 37 (26%) with antibiotics and eight (6%) with antiviral drugs. Conclusions: Similarly to other international cohorts, sexual transmission was most frequently present, and concomitant STIs were common. Symptoms were heterogenous, self-resolving and responsive to therapy. Hospitalization was necessary in few patients. There is uncertainty about the future development of mpox and further studies (e.g., potential disease reservoirs, other possible means of transmission, predictors of severe disease) are still needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics

Candela

Raccagni

Bruzzesi

et al. 2023

Viruses

Self Cite

View full text Add to dashboard Cite

show abstract

“…95,96 Monkeypox in immunosuppressed patients According to studies, there is a greater chance of severe manifestation of MPXV infection in immunosuppressed patients. 50,[97][98][99][100][101][102][103][104][105][106] Immunosuppressed patients include patients who have undertaken cancer treatment, organ transplant, HIV infection, primary immune deficiency disorders, some severe autoimmune disorders, and medications to treat autoimmune diseases and other illnesses that can weaken the immune system. The disease appears to have a lethal prognosis, especially in children who have not been vaccinated against smallpox.…”

Section: Immunosuppressionmentioning

confidence: 99%

Monkeypox (mpox) in immunosuppressed patients

et al. 2023

View full text Add to dashboard Cite

The World Health Organization (WHO) proclaimed a public health emergency in July 2022 due to the emergence of Mpox (formerly monkeypox) while the globe was still dealing with the COVID-19 epidemic. The characteristics of mpox in immunocompetent individuals are well-characterized, despite difficulties in diagnostics, immunization, and access to treatment that persist in low-income countries. Patients with weakened immune systems are more likely to spread an illness and die from it than healthy people because they cannot mount a protective immune response against it, such as a neutralizing IgG and poxvirus-specific Th1 response. A health warning on severe mpox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advice does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as “having autoimmune disease with immunodeficiency as a clinical component”. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, “of the people with severe mpox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression”. However, new cases are still expected to be discovered, especially in low-income countries with limited access to diagnosis, treatment, and prevention, and where a large percentage of the mpox-infected population also has advanced HIV infection. Thus, further research is always needed to determine the best way to treat mpox in immunocompromised people. In this context, we discussed /reviewed the mpox clinical presentation, available treatment options and current preventive guidelines in immunocompromised patients.

show abstract

“…81,82 Monkeypox in immunosuppressed patients According to studies, there is a greater chance of severe manifestation of MPXV infection in immunosuppressed patients. 42,83,92,[84][85][86][87][88][89][90][91] Immunosuppressed patients include patients who have undertaken cancer treatment, organ transplant, HIV infection, primary immune deficiency disorders, some severe autoimmune disorders, and medications to treat autoimmune diseases and other illnesses that can weaken the immune system. The disease appears to have a lethal prognosis, especially in children who have not been vaccinated against smallpox.…”

Section: Immunosuppressionmentioning

confidence: 99%

Monkeypox (mpox) in immunosuppressed patients

et al. 2023

View full text Add to dashboard Cite

The World Health Assembly declared that smallpox had been completely eradicated from the human population in 1980. Monkeypox, a zoonosis native to damp forested regions in West and Central Africa, is the illness that is most comparable to smallpox clinically and immunologically. Both illnesses could be prevented by the smallpox vaccine. Although the monkeypox virus is a less effective human disease than the smallpox virus, it could now spread among human populations if smallpox had not been eradicated and population-wide immunity had not been developed. A health warning on severe monkeypox in people who are immunocompromised due to Human Immunodeficiency virus (HIV) and other illnesses was released by the U.S. Centers for Disease Control and Prevention (CDC) on September 29, 2022. The advise does not specifically include primary immunodeficiency, but it does define other immunocompromising disorders as “having autoimmune disease with immunodeficiency as a clinical component”. The documented severe signs of monkeypox include widespread rashes with secondary fungal or bacterial skin infections or tissue death (necrosis), intestine obstruction, and difficulties with the heart, lungs, urinary system, and nervous system. Both those with healthy immune systems and those with weakened immune systems, such as those who are immunosuppressed, older people, children, etc., have encountered serious health issues, but the latter group is more likely to do so. According to the advisory, “of the people with severe monkeypox manifestations for whom CDC has been consulted, the majority have had HIV with CD4 counts 200 cells/ml, indicating substantial immunosuppression”. The current article goes into great detail about monkeypox disease occurring in immunocompromised patients and preventive guidelines.

show abstract

Breakthrough monkeypox infection among individuals previously immunized with smallpox or monkeypox vaccination

Cited by 29 publications

References 10 publications

Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics

Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics

Monkeypox (mpox) in immunosuppressed patients

Monkeypox (mpox) in immunosuppressed patients

Contact Info

Product

Resources

About