Nave Lior, Margalit Ili, Tau Noam, Cohen Ido, Yelin Dana, Lienert Florian, Yahav Dafna
Internal Medicine E, Sheba Medical Center, Ramat-Gan 52621, Israel.
Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel.
Vaccines (Basel). 2023 Aug 24;11(9):1410. doi: 10.3390/vaccines11091410.
Prevention of mpox has become an important public health interest. We aimed to evaluate the safety and immunogenicity of the Modified Vaccinia Ankara (MVA) vaccine. We conducted a systematic review and meta-analysis of randomized-controlled trials (RCTs) comparing MVA versus no intervention, placebo, or another vaccine. Outcomes included safety and immunogenicity outcomes. We also performed a systematic review of RCTs evaluating various MVA regimens. Fifteen publications were included in the quantitative meta-analysis. All but one (ACAM2000) compared MVA with placebo. We found that cardiovascular adverse events following two MVA doses were significantly more common compared to placebo (relative risk [RR] 4.07, 95% confidence interval [CI] 1.10-15.10), though serious adverse events (SAEs) were not significantly different. Following a single MVA dose, no difference was demonstrated in any adverse event outcomes. Seroconversion rates were significantly higher compared with placebo after a single or two doses. None of the RCTs evaluated clinical effectiveness in preventing mpox. This meta-analysis provides reassuring results concerning the immunogenicity and safety of MVA. Further studies are needed to confirm the immunogenicity of a single dose and its clinical effectiveness. A single vaccine dose may be considered according to vaccine availability, with preference for two doses.
预防猴痘已成为一项重要的公共卫生关注点。我们旨在评估改良安卡拉痘苗（MVA）疫苗的安全性和免疫原性。我们对比较MVA与无干预、安慰剂或另一种疫苗的随机对照试验（RCT）进行了系统评价和荟萃分析。结局包括安全性和免疫原性结局。我们还对评估各种MVA方案的RCT进行了系统评价。定量荟萃分析纳入了15篇出版物。除一项研究（ACAM2000）外，所有研究均将MVA与安慰剂进行了比较。我们发现，与安慰剂相比，两剂MVA后的心血管不良事件明显更常见（相对风险[RR] 4.07，95%置信区间[CI] 1.10 - 15.10），尽管严重不良事件（SAE）无显著差异。单剂MVA后，任何不良事件结局均未显示出差异。单剂或两剂后，血清转化率与安慰剂相比显著更高。没有一项RCT评估预防猴痘的临床有效性。这项荟萃分析提供了关于MVA免疫原性和安全性的令人放心的结果。需要进一步研究来确认单剂的免疫原性及其临床有效性。可根据疫苗供应情况考虑单剂疫苗，优先选择两剂。
