The intention of Egyptian healthcare workers to take the monkeypox vaccine: is urgent action required?

BACKGROUND: In light of the ongoing monkeypox (MPOX) epidemic, healthcare workers (HCWs) have been in contact with various diseases. Therefore, they should take appropriate preventive and control measures to maintain their health. This study assessed Egyptian HCWs' intentions to take MPOX vaccines. METHODS: A cross-sectional survey was conducted using social media platforms between September 27 and November 4, 2022. An anonymous online survey using the 5C scale was conducted using convenience and snowball sampling methods to assess the five psychological antecedents of vaccination (i.e., confidence, constraints, complacency, calculation, and collective responsibility). RESULTS: A total of 399 HCWs with a mean age of 32.6 ± 5.7 participated in this study. Of them, 89.7% were female. The five C psychological antecedents of vaccination were as follows: 55.9% were confident about vaccination, 50.6% were complacent, 56.6% experienced constraints, 60.7% calculated the risk and benefit, and 58.4% had collective responsibility. Multivariate analysis showed that high income level and having information about MPOX were significant predictors of confidence in the MPOX vaccines (adjusted odds ratio ((AOR) = 4.19, 95% CI (1.12- 15.59), P = 0.032). Participants aged 31-45 years and 19-30 years showed significant association (AOR = 2.46, 95% CI (0.85-7.15), P = 0.096) and (AOR = 4.19, 95% CI (1.39-12.64), P = 0.011), respectively. Having an idea about the MPOX vaccines significantly predicted the complacency domain (AOR = 3.77, 95%CI (1.47-9.65, P = 0.006). Moreover, precollege/undergraduate education and having an idea about MPOX vaccination were significant predictors of the constraint domain (AOR = 1.81.95% CI (1.09-2.99, P = 0.020), (AOR = 2.70, 95% CI (1.05-6.95, P = 0.038), respectively). Female sex, having a diploma, postgraduate studies, and having an idea about MPOX vaccine significantly predicted calculation domain (AOR = 2.06, 95% CI (1.05-4.04, P = 0.035), (AOR = 3.98,95% CI (1.33-11.87, P = 0.013), (AOR = 2.02, 95% CI (1.25-3.26, P = 0.004) & (AOR = 2.75. 95% CI (1.05-7.18, P = 0.039), respectively. The only significant predictor of collective responsibility was having a diploma and postgraduate studies (AOR = 3.44, 95% CI (1.21-9.78, P = 0.020), (AOR = 1.90,95% CI (1.17-3.09, P = 0.009). CONCLUSIONS: Efforts to control MPOX should focus on promoting protective measures such as the vaccination of HCWs as well as raising their awareness about the updated information regarding the virus and the approved vaccines.

Africa aims to avert an mpox pandemic.

Last month, when the world's most populus country, India, reported its first case of the new, highly transmissible clade Ib mpox variant, the challenge of containing the virus was once again evident. Only a few weeks before that in August, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a public health emergency in response to its spread in Africa. Since then, cases of clade Ib mpox have been reported in Sweden, Thailand, and Pakistan. Although mpox is not yet a global pandemic, the new variant may tip the scales in that direction if the world does not act quickly to mitigate its spread in Africa.

Mpox global health emergency: Insights into the virus, immune responses, and advancements in vaccines PART I: Insights into the virus and immune responses.

Mpox, the zoonotic disease caused by Monkeypox virus (MPXV), is currently a global health emergency. This review (Part I) aims to provide insights into the virus life cycle, epidemiology, host immune responses, and immune evasion mechanisms. Mpox symptoms is similar to smallpox but with lower mortality rates and lower transmissibility. In the past, the virus has been endemic in Central (Clade I) and West (Clade II) African countries. The first outbreak in outside Africa is reported in the United States in 2003. A multi-country outbreak across all continents occurred in 2022, predominantly driven by Clade II. Recently, the emergence of Clade Ib with sustained person-to-person transmission characteristic in the 2023-2024 outbreaks has raised significant public health concerns. Its apparent capacity for rapid spread and potential for causing severe disease highlight the need for enhanced surveillance, especially in regions not traditionally affected by Mpox. Immune responses induced by MPXV infection in humans and animal models provide the insights into the key step in which the host immune response recognizes and responds to the infection. The sophisticated immune evasion strategy by MPXV at both innate and adaptive arms also emerges that are useful for vaccine-based control measures. Taken together, understanding MPXV life cycle, epidemiology and immune response will facilitate better control, limit viral spread, and provide important insights for vaccine development.

Development and validation of the mpox stigma scale (MSS) and mpox knowledge scale (MKS).

BACKGROUND: Few validated brief scales are available to measure constructs that may hinder mpox-related prevention and care engagement, such as knowledge and stigma. Both are highly salient barriers to infectious disease care and disease understanding, precursors to evaluating one's risk and need to, for example, accept vaccination. To address this gap, we developed and validated the Mpox Stigma Scale (MSS) and Mpox Knowledge Scale (MKS). METHODS: As part of a full-scale clinical trial, we offered an optional mpox survey to participants who self-identified as African American or Black, were 18-29 years old, and lived in Alabama, Georgia, or North Carolina (2023, N = 330). We calculated psychometric properties through confirmatory factor analyses (CFA) and applied Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Tucker-Lewis Index (TLI) values equal to or exceeding 0.90 and Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) values less than 0.08 to determine adequate model fit. We computed internal reliability using Cronbach's alpha and calculated Pearson or Spearman correlation coefficients between the MSS and MKS and related variables. RESULTS: For the MSS, CFA results showed that the one-factor model fit the data well (χ2(df = 5, N = 330) = 34.962, CFI = 0.97, GFI = 0.99, TLI = 0.94, RMSEA = 0.13, SRMR = 0.03). For the MKS, the one-factor model provided a good fit to the data (χ2(df = 6, N = 330) = 8.44, CFI = 0.99, GFI = 0.99, TLI = 0.95, RMSEA = 0.15, SRMR = 0.02). Cronbach's alphas were MSS = 0.91 and MKS = 0.83, suggesting good to excellent reliability. The MSS was correlated with the MKS (r = .55, p < .001), stigmatizing attitudes (r = .24, p < .001), attitudes towards mpox vaccination (r=-.12, p = .030), and worry about contracting mpox (r = .44, p < .001). The MKS was correlated with worry about contracting mpox (r = .30, p < .001) and mpox disclosure (r=-.16, p = .003). CONCLUSIONS: The MSS and MKS are reliable and valid tools for public health practice, treatment and prevention research, and behavioral science. Further validation is warranted across populations and geographic locations. TRIAL REGISTRATION: ClinicalTrials.gov NCT05490329.

Public health response to Mpox: Safeguarding vulnerable Key Populations and People Living with HIV in Zanzibar.

Mpox, caused by the Monkeypox virus (MPXV), has emerged as a significant global public health concern, particularly affecting vulnerable populations. The recent outbreak in the Democratic Republic of the Congo (DRC) is the largest recorded, driven by the highly virulent clade 1 strain. Transmission has shifted from animal contact to primarily sexual contact among Key Populations (KPs) such as Sex Workers (SW) and Men who have Sex with Men (MSM). In Zanzibar, where HIV prevalence is significantly higher among Key Populations, People Living with Human Immunodeficiency Virus (PLHIV) are at increased risk of Mpox infection due to socioeconomic challenges and immunosuppression. Despite no reported cases in Zanzibar, the spread of Mpox in non-endemic areas highlights the need for proactive measures. Leveraging Zanzibar's strengthened public health infrastructure, key strategies include tailored awareness campaigns, improved vaccine access through existing COVID-19 vaccination models, healthcare infrastructure enhancement, and mental health support. These targeted actions aim to protect Zanzibar's most vulnerable populations and bolster preparedness against Mpox, emphasizing the importance of resource-appropriate interventions to mitigate potential outbreaks.

Understanding Barriers to Establishing Public JYNNEOS Mpox Vaccination Clinics in New Hampshire: Mpox vaccine clinic NH.

OBJECTIVE: 2022 - 2023 mpox outbreak necessitated rapid distribution of JYNNEOS vaccines from US Strategic National Stockpile to state and local public health agencies. New Hampshire's centralized public health structure required partnering with healthcare facilities to reach at-risk persons. Among the 67 organizations contacted to partner with, only 7 established public JYNNEOS vaccine clinics. The study objective was to identify barriers and resources needed for emergency public vaccination. METHODS: In March 2023, mixed-method surveys were developed and sent to 20 non-participating organizations and 7 participating organizations ("vaccine-partners"). RESULTS: 35% (7/20) of non-participating organizations and 100% (7/7) vaccine-partners responded. Non-participating organizations (n = 5) identified lack of staffing (100%) and insufficient provider time or clinical resources (80%) as the most common barriers. Staffing needs reported by non-participating organizations included: administrative (100%); medical doctor or advanced practice practitioner (67%); and registered nurse, medical assistant, or licensed nursing assistant (67%). Vaccine partners reported similar staffing requirements. Estimated additional monthly funding needs were $3,750 for non-participating organizations and $1,680 for vaccine-partners. CONCLUSIONS: A minority of NH healthcare facilities established public JYNNEOS vaccination clinics. The primary barrier was insufficient staffing; additional resources and funding needs were modest. Success of the next emergency vaccination campaign depends on sustained advocacy, resources, and partnership.

Global prevalence and determinants associated with the acceptance of monkeypox vaccination.

Assessing the acceptance of the monkeypox vaccine is crucial for the success of vaccination programs, yet the prevalence reports remain inconclusive. The aim of this study was to determine the global prevalence of monkeypox vaccine acceptance and identify its associated factors. A meta-analysis was conducted with a comprehensive search strategy on the following databases, including Scopus, Embase, and PubMed, for articles published up to April 5, 2024. This study utilizes a single-arm meta-analysis to calculate the pooled prevalence of monkeypox vaccine acceptance. A Z-test was employed to identify factors associated with the vaccine acceptance. Our study analyzed 51 articles encompassing 98,746 participants, revealing an overall monkeypox vaccine acceptance rate of 65%. Notably, the highest acceptance rates were observed among men who have sex with men (MSMs), while healthcare workers (HCWs) showed the lowest acceptance rates. Additionally, our findings indicated an increased acceptance in individuals with educational attainment beyond a bachelor's degree, a history of COVID-19 and influenza vaccination, homosexual orientation, and HIV-positive status. Conversely, lower acceptance risk was associated with those with educational attainment below a bachelor's degree, heterosexual orientation, and bisexual orientation. In conclusion, our current study has determined the rate of monkeypox vaccine acceptance and identified its associated factors. These findings offer valuable insights as the foundation for targeted policies to manage and increase acceptance rates.

Comparison of protection against mpox following mRNA or modified vaccinia Ankara vaccination in nonhuman primates.

In 2022, mpox virus (MPXV) spread worldwide, causing 99,581 mpox cases in 121 countries. Modified vaccinia Ankara (MVA) vaccine use reduced disease in at-risk populations but failed to deliver complete protection. Lag in manufacturing and distribution of MVA resulted in additional MPXV spread, with 12,000 reported cases in 2023 and an additional outbreak in Central Africa of clade I virus. These outbreaks highlight the threat of zoonotic spillover by Orthopoxviruses. mRNA-1769, an mRNA-lipid nanoparticle (LNP) vaccine expressing MPXV surface proteins, was tested in a lethal MPXV primate model. Similar to MVA, mRNA-1769 conferred protection against challenge and further mitigated symptoms and disease duration. Antibody profiling revealed a collaborative role between neutralizing and Fc-functional extracellular virion (EV)-specific antibodies in viral restriction and ospinophagocytic and cytotoxic antibody functions in protection against lesions. mRNA-1769 enhanced viral control and disease attenuation compared with MVA, highlighting the potential for mRNA vaccines to mitigate future pandemic threats.

Orthopoxvirus-specific antibodies wane to undetectable levels 1 year after MVA-BN vaccination of at-risk individuals, the Netherlands, 2022 to 2023.

In response to the mpox outbreak in 2022 and 2023, widespread vaccination with modified vaccinia Ankara-Bavarian Nordic (MVA-BN, also known as JYNNEOS or Imvanex) was initiated. Here, we demonstrate that orthopoxvirus-specific binding and MVA-neutralising antibodies waned to undetectable levels 1 year post vaccination in at-risk individuals who received two doses of MVA-BN administered subcutaneously with an interval of 4 weeks, without prior smallpox or mpox vaccination. Continuous surveillance is essential to understand the impact of declining antibody levels.