Breakthrough Mpox Outbreak Investigation, the Delicate Balance Between Host Immune Response and Viral Immune Escape

M Moretti, A Meuwissen, AM Rezende, S Zange, E Van Nedervelde, T de Block, K Vercauteren, T Demuyser, SD Allard

Research output: Contribution to journalA1: Web of Science-articlepeer-review

Abstract

Background
Limited data are available on Mpox breakthrough infections.

Purpose
The purpose of this study is to investigate a Mpox breakthrough outbreak in 3 vaccinated individuals.

Methods
Study participants provided informed consent. Serology testing was performed in one involved individual (ID-1) using an in-house assay detecting anti-orthopoxvirus IgG. Whole genome sequencing (WGS) was carried out and compared with the reference sequence ON563414.3 (https://www.ncbi.nlm.nih.gov/nuccore/ON563414.3/).

Results
Three individuals vaccinated with modified vaccinia Ankara–Bavaria Nordic contracted Mpox following one sexual intercourse event. One of them (ID-1) had received only one vaccine dose, while the other two were fully vaccinated. ID-1 presented to the sexual health clinic of the Universitair Ziekenhuis Brussel with proctitis related to Mpox. Despite one vaccination, serology testing Three months post vaccine showed absence of Mpox virus (MPXV) specific antibodies in ID-1. In contrast, 2 weeks after the sexual intercourse, seroconversion occurred. Whole genome sequencing of the isolated MPXV showed, compared with the reference sequence, a total of seven single nucleotide variants with four of them indicating protein amino-acid changes.

Conclusion
Incomplete MPXV vaccination as well as MPXV variants might result in breakthrough infections. Preventive measures, such as MPVX vaccination, could maintain immunity in individuals with higher risk of MPXV infection, and might lower disease severity.
Original languageEnglish
JournalSexually Transmitted Diseases
Volume51
Issue number7
Pages (from-to)499-503
Number of pages5
ISSN0148-5717
DOIs
Publication statusPublished - 2024

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