Guidance on the use of mpox vaccines. Revised edition
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Guidance on the use of mpox vaccines. Revised edition. (2024). [Technical reports]. PAHO. https://iris.paho.org/handle/10665.2/59558
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English; 51 pages
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2024
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PAHO/CIM/23-0010
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On 23 July 2022, the WHO Director-General declared the mpox outbreak a public health emergency of international concern (PHEIC). A coordinated response was launched, aimed at interrupting transmission and protecting vulnerable groups, and a number of recommendations were made, including vaccination. These temporary recommendations apply to different groups of countries, based on their epidemiological situation, patterns of transmission, and capacities. These recommendations include different aspects such as: the implementation of a coordinated response, community engagement and protection, surveillance and public health measures, clinical management, and infection control, among others. WHO recommends use of the vaccine for countries that have imported cases of mpox in the population and/or human-to-human transmission of monkeypox virus, including in key population groups and communities at high risk of exposure. The overall goal of the global response to mpox as a PHEIC, is to stop human-to-human transmission and minimize zoonotic transmission of the monkeypox virus wherever it occurs. The use of vaccines can contribute to this response. However, vaccination should be considered a measure to complement primary public health interventions that include surveillance, early case detection, diagnosis and care, isolation and contact tracing and follow-up, and self-monitoring to reduce contacts. This document aims to provide useful accessible, and understandable information about mpox vaccines in order to facilitate deployment of vaccination strategies in the context of the current epidemiological scenario and based on the recommendations of the VIII Ad Hoc Meeting of the PAHO Technical Advisory Group (TAG) on Vaccine-Preventable Diseases.
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Item VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) On Vaccine-Preventable Diseases: Technical Briefing on the Multi-Country Monkeypox Outbreak, 31 May 2022 (virtual)(PAHO, 2022)Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of Central and West Africa. Two distinct clades are identified: the West African clade and the Congo Basin clade. Monkeypox is a zoonosis. Cases are often found close to tropical rainforests where various animals carry the virus including squirrels, rodents, dormice, and monkeys. Most human monkeypox infections in endemic countries result from a primary animal-to-human transmission. Human-to-human transmission does occur, with the longest documented chain of transmission being six generations. Transmission occurs through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects. Close contact with infected people or contaminated materials should be avoided. While human-to-animal transmission is rare, it should be considered as a possible link in the transmission chain. Monkeypox has been endemic in central and west Africa since its first detection in 1958 in the Democratic Republic of the Congo (1). However, since 13 May 2022 multiple countries in Europe have reported the sudden and unexpected appearance of monkeypox. To date, 27 non-endemic countries across four WHO regions have reported cases. Of these, four are countries in the Americas. Multiple suspected cases in these and other countries are currently under investigation. PAHO's Technical Advisory Group (TAG) on Vaccine-Preventable Diseases met for an ad hoc meeting on 31 May 2022 to discuss the implications for monkeypox in the Region of the Americas. The following report summarizes the epidemiological data to date, reviews available information on monkeypox vaccines, and provides recommendations to Member States of the Americas on how to minimize viral transmission and approach vaccination operations.Item Final Statement. Advisory Meeting: Integrating and strengthening responses to mpox, syphilis, and other STIs on the road to elimination. São Paulo, 3–4 April 2024(PAHO, 2024-10-30)Despite country-level initiatives and efforts, syphilis and other sexually transmitted infections (STIs) continue to pose a serious public health problem in the Americas. Although there are many activities aimed at eliminating vertical transmission of syphilis, adult syphilis infection rates have risen in many countries. This rise has been recorded in several population groups, as shown by data from different countries, but mainly in pregnant women. In addition to syphilis, other STIs such as gonorrhea—as well as antimicrobial resistance to treatment—pose challenges to the sustainability of the public health response and the elimination of STIs. An estimated 11 million new cases of STIs occur every year in the Americas, and many countries have only limited resources for etiological diagnosis and surveillance of treatment resistance. The purpose of the meeting was to assess the situation and formulate consensus recommendations for innovative, effective, and integrated strategic lines of action for the response to syphilis and other STIs and the elimination of mpox in Latin America and the Caribbean, based on WHO guidance.Item VIII Ad Hoc Meeting of PAHO’s Technical Advisory Group (TAG) on Vaccine-Preventable Diseases. Technical Briefing on the Multi-Country Monkeypox Outbreak: Recommendations on Monkeypox Vaccines and Vaccination(PAHO, 2022)Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of Central and West Africa. Two distinct clades are identified: the West African clade and the Congo Basin clade. Monkeypox is a zoonosis and cases are often found close to tropical rainforests where various animals carry the virus including squirrels, rodents, dormice, and monkeys. Most human monkeypox infections in endemic countries result from a primary animal-to-human transmission. Human-to-human transmission does occur, with the longest documented chain of transmission being six generations. Transmission occurs through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets, and contaminated objects. Close contact with infected people or contaminated materials should be avoided. While human-to-animal transmission is rare, it should be considered as a possible link in the transmission chain. Monkeypox has been endemic in central and west Africa since its first detection in 1958 in the Democratic Republic of Congo. However, since 13 May 2022 multiple countries in Europe have reported the sudden and unexpected appearance of monkeypox. To date, 27 non-endemic countries across four WHO regions have reported cases. Of these, four are countries in the Americas. Multiple suspected cases in these and other countries are currently under investigation. PAHO's Technical Advisory Group (TAG) on Vaccine-Preventable Diseases met for an ad hoc meeting on 31 May 2022 to discuss the implications for monkeypox in the Region of the Americas. This executive summary summarizes the contents of the final report generated from this meeting.Item Diagnostic accuracy of polymerase chain reaction for detection of mpox in humans(2024-12-04)[ABSTRACT]. Objective. To evaluate diagnostic accuracy of polymerase chain reaction (PCR) in detecting mpox infection in humans by pooling the estimates of sensitivity and specificity across different study settings. Methods. A systematic search was conducted in PubMed, Cochrane database, Scopus, and Google Scholar. Studies that evaluated the diagnostic accuracy of PCR test for the detection of monkeypox virus providing the sensitivity and specificity values and the total number of samples were included. The sensitivity and specificity values of PCR test were pooled for all the included studies. The meta-analysis was conducted in accordance with PRISMA guidelines using the metadta package in STATA software. A summary receiver operating characteristic (SROC) curve and forest plot were generated. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024590183. Results. Twelve studies were included for meta-analysis. The pooled sensitivity and specificity estimate across all the studies using a random effects model was 0.99 (95% CI [0.95, 1.00]) and 1 (95% CI [0.96, 1.00]), respectively. The SROC curve confirmed high diagnostic accuracy of PCR. The quality assessment of diagnostic accuracy studies (QUADAS) tool depicted low risk of bias. Conclusions. This systematic review and meta-analysis is the first study in the scientific literature to provide a pooling for diagnostic accuracy for PCR test for mpox and confirms it as an accurate tool in detecting the infection in humans.Item Foot-and-Mouth Disease: Comparative Analysis of Disease-Free Status with and Without Vaccination, 11 May 2023(PAHO, 2023)The techinical note of the Pan American Center for foot-and-mouth disease and veterinary public health: Comparative analysis between with and without vaccination statuses is aimed at conducting a comparative analysis between the statuses established by WOAH for foot-and-mouth disease, free with vaccination and free without vaccination, with special focus on the use of systematic vaccination in South American countries. The foot-and-mouth disease vaccine has been a major cornerstone in the fight against the disease since the onset of the PHEFA. At present, the risk of disease is mainly concentrated in the Andean region, particularly in the Bolivarian Republic of Venezuela and the bordering region with the Republic of Colombia, which questions the need of maintaining systematic vaccination in the other disease-free countries of South America. The foot-and-mouth disease vaccine is a control tool, but it is not necessary to maintain in the foot-and-mouth disease-free zones as a prevention strategy. Besides, it should be remembered that it only provides protection against vaccine serotypes, while animals remain susceptible to other serotypes. Countries with robust surveillance systems and no cases for a long period of time can progress towards eradication, suspending vaccination and gaining the foot-and-mouth disease-free status without vaccination, as outlined in the PHEFA. Several differences exist between the two statuses, which are translated into two different epidemiological contexts, with different health requirements for trade, as showed in Chart 1. Thus, foot-and-mouth disease-free zones with vaccination require improved surveillance efforts since they should demonstrate the absence of both infection and transmission. Besides, these vaccinated populations are not the end of the eradication process, which is completed by eliminating control measures. These factors result in significant differences in the maintenance costs of the two statuses (Perry et al., 2020). Decision-makers in each country, both of the public and private sectors, should take into account available scientific and technical information to start a planned transition process and achieve disease eradication in their territories. The key to eradicating foot-and-mouth disease in South America has been the collaboration and coordination of countries, orchestrated under the umbrella of the PHEFA. Joint work is essential to achieve eradication in the entire continent. The countries should address the transition to the status of foot-and-mouth disease-free without vaccination in a responsible manner, grounded on available scientific and technical evidence, with transparency in all the involved sectors to seek alternatives that foster progress and ensure sustainability of the progress achieved so far.