Vaccinations against monkey pox: what you need to know

Science and politics emphasize that the cases of monkey pox in Europe do not herald a new pandemic. Nevertheless, the pathogen can be dangerous and you need to be prepared, stresses Federal Health Minister Karl Lauterbach. One possible measure: vaccination. The most important questions and answers.

Will my old smallpox vaccine help fight monkey pox?

Yes. Vaccination against smallpox also protects against the closely related monkey pox virus, the keyword of which is cross-resistance. Much more uncertain is how clear the protection is provided by the smallpox vaccination, which in Germany generally goes back decades. In the Federal Republic of Germany, compulsory initial vaccination against smallpox was abolished in 1976, in East Germany in 1980. The disease is believed to have been eradicated and younger people have generally not been vaccinated anymore.

But even for older adults who were vaccinated decades ago, it is unclear to what extent immune protection through vaccination is still effective. Health Minister Karl Lauterbach (SPD) said in Bremen on Tuesday: “We don’t know exactly how strong the resistance is. It’s probably complete immunity, but we don’t know exactly yet. ‘

Many experts assume that immune protection may not be as good as it was right after vaccination – but at least it’s less likely to be severe than in unvaccinated people. “Partial protection can certainly be expected here. We know from individual observations that even decades after the WHO mass vaccination program, immune memory still persists, ‘says Gerd Sutter, virologist and vaccine researcher at LMU, for example.

A report published in Vaccine in 2020 describes monkey pox as a “resurgent disease” after the immune protection provided by smallpox vaccines has declined steadily over the past few decades. The authors estimated that by 2020, more than 70 percent of the world’s population will no longer be protected against smallpox – and also because of cross-immunity to monkey pox.

Is there already a vaccine against monkey pox?

There is currently no vaccine specifically approved for vaccination against monkey pox in Germany. However, the Imvanex smallpox vaccine from the Danish-German company Bavarian Nordic has been approved in Germany since 2013. The pharmaceutical company also has a headquarters with around 125 employees in Martinsried near Munich. The vaccine is effective against monkey pox and is approved for vaccination against the disease, for example, in the United States. According to Health Minister Karl Lauterbach (SPD), Imvanex can be used “immediately” in Germany for a vaccine against monkey pox.

Incidentally, the fact that a modern vaccine even exists is to the credit of the US – they originally commissioned the development. After the terrorist attacks of September 11, the then Bush administration was afraid of attacks with the use of biochemical weapons – including smallpox viruses. At the time, the idea was to vaccinate the entire US population against him.

Are there vaccines against smallpox in Germany?

Yes. According to a report for the Bundestag’s Health Committee, the federal government has stored around 100 million doses of the smallpox vaccine – for safety reasons, said Health Minister Lauterbach. Because theoretically, on the one hand, a smallpox outbreak may occur again, and on the other hand, it is also possible to produce smallpox viruses in controversial laboratory tests – a key biochemical weapon.

However, this stored vaccine is not suitable for vaccination against monkey pox, Lauterbach said. Why: The vaccine likely has side effects that are too severe to treat monkey pox. Regensburg virologist Ralf Wagner also described the 100 million dose vaccination in the BR interview as “absolute overkill.” The benefit and risk calculation does not add up.

To be on the safe side, the federal government purchases up to 40,000 doses of Imvanex. “This vaccine can be used to prevent infection, but also to prevent an outbreak in people who are already infected,” said Health Minister Lauterbach. The vaccine was also tested in Germany for vaccination against monkey pox and the documents were available. “I expect we will have a reserve delivered soon,” said Lauterbach.

Do we all need to be vaccinated against monkey pox?

This cannot be assumed in any way at the moment. There are currently no vaccinations against monkey pox in Germany. The government is working on a concept called ring vaccinations, but it’s …

  1. still not sure if it will be used at all i
  2. it is intended only for close contacts with infected people and not for the general population.

Lauterbach cites as an example scenario an infected person who is surrounded by vulnerable people, such as immunocompromised people. According to the minister, they can then be vaccinated so that they do not develop diseases or at least become seriously ill.

The fact that vaccination may still make sense for someone who is already infected is due to the long incubation period of smallpox and monkey pox, explains Sebastian Ulbert of the Institute of Cell Therapy and Immunology Fraunhofer in an interview with Bavarian Radio. Because protective immune mechanisms develop rapidly after vaccination. “They may actually work before the disease really breaks out.” The condition is vaccination a few days after possible infection.

Lauterbach stressed on Tuesday that while a concept is being developed to use the ordered vaccine, its use is not currently planned. You want to be prepared, emphasizes Lauterbach, and not be left without a vaccine when the worst comes to the worst. Vaccination expert Ulbert also talks about a purely preventive measure. “But ring vaccination can be a very effective way to control smallpox outbreaks at an early stage.” Similar models have been around for years. This can also be applied to monkey pox. “So, it makes sense to prepare for an emergency with a reasonable amount of vaccine.”

In Great Britain, close contacts of an infected person can already be vaccinated. Susan Hopkins, Senior Medical Adviser to the British Health Security Agency, told the BBC a few days ago.

Also in Germany, neither science nor politics speak about vaccination offerings for everyone, vaccination recommendations for everyone, and even compulsory vaccinations. The head of the Standing Committee on Immunization (Stiko), Thomas Mertens, told the Rheinische Post (Wednesday) about the possible vaccination of the entire population: “This is very unlikely at present.” For the time being, Mertens says, only vaccination against monkey pox for the at-risk groups may make sense.

Does the chickenpox vaccine help against monkey pox?

no Chickenpox has the same name as smallpox or monkey pox, possibly because the symptoms on the skin look similar. However, the actual pathogens are quite different: chickenpox belongs to herpes viruses and not to the classic pox viruses, to which monkey pox belongs. “The two are so different that it is impossible to obtain protective immunity by vaccination against the second virus. Antibodies to one do not work against the other, ”explains Sebastian Ulbert.

Is monkey pox vaccination compatible with corona vaccination?

“Both vaccinations would not have affected their effectiveness,” says Ulbert. Because these are very different preparations. Imvanex is made up of an attenuated virus (see next question), “currently used corona vaccines are RNA, vector or protein vaccines, each of which only administers a specific component of SARS-CoV2”.

Another question is whether the vaccines can be administered at the same time – for this, careful research is needed. “In the current situation, however, it is a secondary issue, it is only a question – if at all – of very few preventive vaccinations” – says the expert.

What type of vaccine is Imvanex?

Imvanex contains live and modified vaccinia viruses. “It is a classic vaccine virus that stimulates effective humoral immune responses – ie antibodies – and at the same time cellular responses – ie T lymphocytes,” explains virologist Gerd Sutter. According to the EMA, the virus does not cause any disease in humans and cannot reproduce. However, the body still produces antibodies, and because the virus is very similar to the smallpox and simian pox viruses, the antibodies produced also protect against these viruses.

The vaccine was approved in 2013 under ‘extraordinary circumstances’. The background is that, unlike, for example, corona vaccination, it has not been possible to obtain complete information about Imvanex due to the ‘rarity of the disease’. Since smallpox has been eradicated and people are not infected with smallpox after vaccination for ethical reasons, no definitive assurance can be given on efficacy in the studies. However, how many antibodies and defense cells are produced, and what side effects vaccination has.

EMA reviews any new information about the vaccine every year. Overall, the agency assumes that side effects are less likely than with other smallpox vaccines because vaccinia virus injected with the vaccine cannot replicate in human cells as already described.

Is monkey pox a new epidemic or even a pandemic?

This cannot be assumed, if only because the monkey pox virus is much more difficult to transmit from person to person than, for example, corona viruses. “Monkey pox transmissions are therefore relatively ineffective compared to Covid-19 or influenza virus infections and, with the right measures to diagnose and establish contact, usually only lead to short chains of infection,” says virologist Gerd Sutter. Therefore, it assesses the risk of a major epidemic in Germany or Europe as low.

However, it is still true that zoonoses, which are infectious diseases that can spread naturally from animals to humans, are becoming increasingly common. One of the reasons is that people are increasingly delving into areas they haven’t been to before. Climate change and the number of trips around the world also play an important role.

More information on this topic and how well we are prepared for the next pandemic can also be found in BR Podcast “Man vs Virus” To listen.

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