Letter to the editor
The impact of vaccination against monkeypox on risk of mpox reinfection
a Department of Internal Medicine, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
b Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
c Department of Pediatrics, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
d Department of Medical Microbiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Vacunas. 2023;24:400-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the editor</span>" "titulo" => "Autoimmune diseases related to post-SARS-CoV-2 vaccination: A rheumatology perspective" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "401" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Farhad Dadgar, Jorge Casseb, Masoud Keikha" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Farhad" "apellidos" => "Dadgar" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Casseb" ] 2 => array:2 [ "nombre" => "Masoud" "apellidos" => "Keikha" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146023000699?idApp=UINPBA00004N" "url" => "/24451460/0000002400000004/v2_202401230726/S2445146023000699/v2_202401230726/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the editor</span>" "titulo" => "The impact of vaccination against monkeypox on risk of mpox reinfection" "tieneTextoCompleto" => true "saludo" => "Dear Editor;" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "403" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Farhad Dadgar, Jalil Rouhani, Fatemeh Dehghani, Masoud Keikha" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Farhad" "apellidos" => "Dadgar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] ] ] 1 => array:3 [ "nombre" => "Jalil" "apellidos" => "Rouhani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Fatemeh" "apellidos" => "Dehghani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "af0015" ] ] ] 3 => array:4 [ "nombre" => "Masoud" "apellidos" => "Keikha" "email" => array:1 [ 0 => "masoud.keykha90@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "af0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Internal Medicine, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran" "etiqueta" => "b" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Department of Pediatrics, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran" "etiqueta" => "c" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Department of Medical Microbiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran" "etiqueta" => "d" "identificador" => "af0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">In May 2022, the first monkeypox multicounty outbreak occurred beyond Africa, in non-endemic regions. At the time of the writing of this letter, there were 87,545 laboratory confirmed mpox (formerly known as monkeypox) cases (85,962 outside the African continent) including 141 deaths from May 2022 to June 2023. Initial investigations suggested that about 85% of the individuals fully-vaccinated against small pox were less likely to develop severe mpox outcomes.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> According to available literature, 9–18% of mpox infected-individuals in the 2022 multicounty outbreak had a history of vaccination against mpox.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> In this scenario, it has been suggested that smallpox vaccination cessation is responsible for the reduction of cross-reactive immunity against mpox infection particularly in individuals with immunosuppression.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> There are limitations regarding the impact mucosal immunity can have against mpox. During this outbreak, there were, so far, seven cases of mpox reinfection until June 2023. We aimed to discuss the clinical relevance of mpox vaccination on the prevention of mpox reinfection.</p><p id="p0010" class="elsevierStylePara elsevierViewall">Golden et al. recently reported an mpox reinfection case in the United Kingdom. The patient presented first clinical manifestations on July 2022, He reported inguinal lymphadenopathy, rectal pain, as well as rectal discharge at first attendance. Laboratory results rendered a positive RT-PCR to mpox from rectal swab sample and a negative Human Immnodeficiency virus (HIV) serology. The case had received two doses of Jynneos® smallpox vaccination 1week after the first attendance and 10 weeks after that. On November 2022, a second manifestation of infection revealed aphthous ulcers and inflammation of cervical lymph nodes. The patient described several condomless sexual intercourse with multiple male partners. He also had clinical history of previous, neuro-syphilis <span class="elsevierStyleItalic">C. trachomatis</span>, as well as <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> infections in the past<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a>. The patient fully-recovered from mpox infection without severe complication.</p><p id="p0015" class="elsevierStylePara elsevierViewall">In another report, Lopez et al reported another mpox reinfection in a 51-year-old man with positive history of childhood smallpox vaccination. On July 2022, he presented typical mpox clinical symptoms e.g., pseudopustules on his anogenital regions as well as groin lymphadenopathy. He also complained of having a genital lesion and painful lymphadenopathy similar to the first episode on November 2022. The case reported having had unprotected multiple sexual-intercourse with men prior to this second clinical manifestatios. Nevertheless, he was discharged with healing cutaneous lesion without further serious complications.<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">Both cases reviewed in these articles on mpox reinfection in individuals that received complete smallpox vaccination, were neither HIV positive nor had any other immunosuppressive condition. Previous evidences suggested smallpox vaccination or natural infections lead to complete protection against mpox.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> However, there is evidence of at least two cases of mpox reinfection in healthy individuals without comorbidities that had received full smallpox vaccination.</p><p id="p0025" class="elsevierStylePara elsevierViewall">Raccagni et al. suggested mpox reinfection with high RT-PCR cycle threshold (Tc) value following virus clearance after the first attendance.<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> In this relation, it has been postulated that persistent virus shedding or relapse from tissue reservoirs. In this report, both individuals informed of unprotected sexual-intercourse with multiple partners. However, genomic sequencing analysis was not performed to determined reinfection or relapse. A recent investigation showed that 83% and 71% of both vaccinated and mpox-infected individuals produce MPXV-neutralizing antibodies in serum.<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> However, sterilizing immunity may not be established without systemic infection. In this scenario, the virus adaptation such as a mutation-driven immune escape should not be ruled out regarding reinfection after smallpox vaccination. Overall, mpox-reinfection cases were fully-recovered without serious outcomes. Therefore, the broad awareness regarding possibility of mpox reinfection even in individuals who have received full mpox vaccination should be noted. In addition, further investigations are need to highlight the impact of smallpox vaccination regarding protection from mpox reinfections.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-06-05" "fechaAceptado" => "2023-06-09" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The transmission potential of monkeypox virus in human populations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Fine" 1 => "Z. Jezek" 2 => "B. Grab" 3 => "H. 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