背景:英国经历了全国性的水痘(以前称为猴痘)疾病爆发,始于5月,2022年,与世界上许多其他国家一样,随着病例数量的快速增长,主要是同性恋,双性恋,和其他与男性发生性关系的男性(GBMSM)。为了控制疫情,改良的安卡拉-巴伐利亚北欧牛痘(MVA-BN),一种减毒的天花疫苗,被提供给有风险的GBMSM。我们旨在评估单一MVA-BN剂量对有风险的GBMSM中症状性痘疾病的有效性。
方法:在本案例覆盖研究中,英格兰的水痘病例被发送问卷,收集人口统计信息,疫苗接种史,症状,和性取向。将返回的问卷与实验室数据和公共卫生病例管理系统(HPZone)相关联,以获取有关症状发作和标本日期的其他信息。包括2022年7月4日至10月9日皮疹发病日期(或替代替代)的病例。雌性,异性恋男人,那些缺少疫苗接种信息的人被排除在外.使用病例覆盖率方法计算疫苗有效性,该方法将病例之间的疫苗覆盖率与合格人群的覆盖率进行比较,根据给予GBMSM的剂量和高危GBMSM的估计大小进行估计。敏感性分析包括估计的高风险GBMSM人口规模的增加和减少20%的差异。
结果:到2022年11月3日,1102人回答了问卷,其中739人被排除在外(52名女性或自称男性异性恋者,590,索引日期在研究期间之外,和97缺少疫苗接种日期)。363例病例纳入分析。从7月开始,合格的GBMSM疫苗接种率稳步上升,2022年,到2022年10月9日达到47%。在363例确诊病例中,接种疫苗后至少14天,有8例病例确实发生或可能发生,32在接种疫苗后0-13天内,其余的都没有接种疫苗。在敏感性分析中,单剂量后至少14天估计的疫苗对有症状的水痘的有效性为78%(95%CI54至89),范围为71至85。疫苗接种后0-13天内的疫苗有效性为-4%(95%CI-50至29)。
结论:单剂量MVA-BN在高危GBMSM中对症状性痘疾病具有高度保护作用,当需要快速保护时,使其成为控制水痘爆发的有用工具。对于感染风险最高的人数超过疫苗供应量的病例,优先服用第一剂可能会有好处.
背景:英国卫生安全局。
The UK experienced a national outbreak of mpox (formerly known as monkeypox) disease that started in May, 2022, as did many other countries worldwide, with
case numbers rising rapidly, mainly among gay, bisexual, and other men who have sex with men (GBMSM). To control the outbreak, Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN), an attenuated smallpox vaccine, was offered to at-risk GBMSM. We aimed to assess the effectiveness of a single MVA-BN dose against symptomatic mpox disease in at-risk GBMSM.
In this
case-coverage study, mpox cases in England were sent questionnaires collecting information on demographics, vaccination history, symptoms, and sexual orientation. Returned questionnaires were linked to laboratory data and a public health
case management system (HP Zone) to obtain additional information on symptom onset and specimen date. Cases with a rash onset date (or alternative proxy) between July 4 and Oct 9, 2022, were included. Females, heterosexual men, and those with missing vaccination information were excluded. Vaccine effectiveness was calculated using the
case-coverage method in which vaccine coverage among cases is compared with coverage in the eligible population, estimated from doses given to GBMSM and the estimated size of at-risk GBMSM. Sensitivity analyses included an increase and decrease of 20% differences in the estimated high-risk GBMSM population size.
By Nov 3, 2022, 1102 people had responded to questionnaires, of which 739 were excluded (52 females or self-declared male heterosexuals, 590 with an index date outside of the study period, and 97 missing a vaccination date). 363 cases were included in the analyses. Vaccine uptake among eligible GBMSM increased steadily from July, 2022, reaching 47% by Oct 9, 2022. Of the 363 confirmed cases, eight cases either did occur or were likely to have occurred at least 14 days after vaccination, 32 within 0-13 days after vaccination, and the rest were unvaccinated. The estimated vaccine effectiveness against symptomatic mpox at least 14 days after a single dose was 78% (95% CI 54 to 89) ranging from 71 to 85 in sensitivity analyses. Vaccine effectiveness within 0-13 days after vaccination was -4% (95% CI -50 to 29).
A single MVA-BN dose was highly protective against symptomatic mpox disease among at-risk GBMSM, making it a useful tool for mpox outbreak control when rapid protection is needed. For cases in which numbers at highest risk of infection exceed vaccine supply, there might be benefit in prioritising delivery of first doses.
UK Health Security Agency.