Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.
Vaccine. 2023 Nov 13;41(47):6952-6959. doi: 10.1016/j.vaccine.2023.10.013. Epub 2023 Oct 12.
May 2022, several countries reported mpox outbreaks among men-who-have-sex-with-men. In the Netherlands, high-risk contacts were offered the third-generation smallpox vaccine as post-exposure-prophylaxis (PEP) within 4 but maximum 14 days after exposure. We investigated their PEP acceptance, timeliness of uptake and development of mpox for the region of the Public Health Service (PHS) Amsterdam.
High-risk contacts identified during 20 May-22 July 2022 were included. Contacts were followed-up 21 days after exposure and classified as: no patient (no mpox symptoms or orthopoxvirus PCR-negative) or mpox patient (clinically suspected mpox or orthopoxvirus PCR-positive). We calculated time intervals between date of last exposure and first PHS consultation, PEP administration, and symptom onset.
Two-hundred-ninety contacts were at high-risk of mpox predominantly due to sexual and/or direct skin-skin contact (212/290, 73 %). First PHS consultation was a median of 5 (IQR 3, 7) days after exposure, at which point 26/290 (9 %) contacts were ineligible for PEP. 84 % (223/264) of contacts eligible for PEP, received PEP within a median of 6 (IQR 3, 8) days after exposure. Of 282 contacts (missing outcome n = 8) 38 (14 %) developed mpox a median of 7 (IQR 5, 12) days after exposure, of whom 50 % (19/38) developed mpox before their first PHS consultation. Among contacts eligible for PEP, 2/38 (5 %) unvaccinated and 16/218 (7 %) vaccinated contact developed mpox.
PEP acceptance among contacts of mpox patients was high. However, PEP timeliness was inadequate. Half of contacts received PEP 6 or more days after exposure, and half of contacts who developed mpox had an onset prior to their first PHS consultation. Estimating PEP vaccine effectiveness is problematic due to the timeliness of PEP and the time it takes to generate vaccine-induced immunity. It is important to assess how PEP timeliness may improve and to promote pre-exposure vaccination to control mpox outbreaks.
2022 年 5 月，多个国家报告了男男性行为者中的猴痘疫情。在荷兰，高风险接触者在暴露后 4 天但最长 14 天内被提供第三代天花疫苗作为暴露后预防（PEP）。我们调查了该地区公共卫生服务（PHS）阿姆斯特丹地区的 PEP 接受率、及时性和猴痘发病情况。
纳入 2022 年 5 月 20 日至 7 月 22 日期间确定的高风险接触者。接触者在暴露后 21 天进行随访，并分类为：无患者（无猴痘症状或正痘病毒 PCR 阴性）或猴痘患者（临床疑似猴痘或正痘病毒 PCR 阳性）。我们计算了从最后一次暴露日期到首次 PHS 咨询、PEP 给药和症状出现的时间间隔。
290 名接触者存在感染猴痘的高风险，主要是由于性接触和/或直接皮肤接触（212/290，73%）。首次 PHS 咨询的中位时间为暴露后 5 天（IQR 3，7），此时 290 名接触者中有 26 名（9%）不符合 PEP 条件。264 名符合 PEP 条件的接触者中有 223 名（84%）在暴露后中位 6 天（IQR 3，8）内接受了 PEP。在 282 名接触者（缺失结局 n=8）中，38 名（14%）在暴露后中位 7 天（IQR 5，12）出现猴痘，其中 50%（19/38）在首次 PHS 咨询前出现猴痘。在符合 PEP 条件的接触者中，2/38（5%）未接种疫苗和 16/218（7%）接种疫苗的接触者出现猴痘。
猴痘患者接触者的 PEP 接受率很高。然而，PEP 的及时性不足。一半的接触者在暴露后 6 天或更长时间内接受了 PEP，一半出现猴痘的接触者在首次 PHS 咨询前发病。由于 PEP 的及时性以及产生疫苗诱导免疫所需的时间，估计 PEP 疫苗的有效性存在问题。评估 PEP 及时性如何提高以及促进暴露前疫苗接种以控制猴痘疫情非常重要。
