第三代改良安卡拉痘苗接种和性行为对男男性行为者中猴痘发病率的影响：法国国家艾滋病研究机构-174多西环素疫苗试验参与者的分析
Impact of vaccination with third generation modified vaccinia Ankara and sexual behaviour on mpox incidence in men who have sex with men: analysis among participants of the ANRS-174 DOXYVAC trial.
作者信息
Ghosn Jade, Assoumou Lambert, Ouattara Moussa, Rubenstein Emma, Pialoux Gilles, Katlama Christine, Surgers Laure, Duvivier Claudine, Pavie Juliette, Viard Jean-Paul, Algarte-Genin Michèle, Gibowski Severine, Ollivier Manon, Costagliola Dominique, Molina Jean-Michel
机构信息
Assistance Publique-Hôpitaux de Paris.Nord, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris F75018, France.
Université Paris Cité, INSERM, UMRS 1137 IAME, Paris F75018, France.
出版信息
Lancet Reg Health Eur. 2024 Aug 1;45:101020. doi: 10.1016/j.lanepe.2024.101020. eCollection 2024 Oct.
BACKGROUND
Mpox was first reported in France on May 19 and third-generation live Modified Vaccinia Ankara (MVA-BN) vaccination of multiple-partner men who have sex with men (MSM) was recommended as of July 11, 2022. We assessed the impact of vaccination and of sexual behavior adopted during the epidemic period on mpox incidence in the ANRS-174-DOXYVAC trial enrolling MSM on HIV pre-exposure prophylaxis (PrEP) with history of sexually-transmitted infections (STI) in the previous year.
METHODS
We compared pre-epidemic socio-behavioral characteristics and change in sexual behaviors after the onset of the epidemic of participants with mpox and mpox-free. Then we compared incidence rates of mpox per 1000 person-months (p-m) between May 9-July 10 (before vaccination of MSM, period-1) and July 11-September 20 2022 (after vaccination launch, period-2) and explored factors explaining the period effect using Poisson regression model.
FINDINGS
472 MSM had data before and after May 9, 2022. Twenty percent had received smallpox vaccine during childhood. Mpox occurred in 77/472 participants (incidence 49.3 per 1000 p-m (95% CI 38.9-61.6)). MVA-BN vaccination roll-out was rapid, with 86% (341/398) of eligible participants having received at least one dose by September 20, 2022. Sexual behavior significantly changed before and after May 9, with a decrease in the proportion of mpox-free participants with >10 partners during last 3 months (45% vs 38%, p = 0.0035). Mpox incidence was 67.4 per 1000 p-m (95% CI 51.6-86.6) in period-1, and 24.4 per 1000 p-m (95% CI 13.9-39.6) in period-2, with an incidence rate ratio of 0.36 (95% CI 0.21-0.63). In multivariable Poisson regression model, only MVA-BN vaccination in 2022 remained significantly associated with mpox incidence, with a 99% risk reduction (95% CI 96.6-99.7).
INTERPRETATION
In MSM on PrEP enrolled in the ANRS-174-DOXYVAC trial, rapid roll-out of MVA-BN vaccination was associated with a strong reduction in mpox incidence.
FUNDING
ANRS Maladies Infectieuses Emergentes (ANRS/MIE).
背景
猴痘于5月19日在法国首次报告，自2022年7月11日起，建议对有多个性伴侣的男男性行为者（MSM）接种第三代减毒活安卡拉痘苗（MVA-BN）。我们在ANRS-174-DOXYVAC试验中评估了接种疫苗以及疫情期间所采取的性行为对猴痘发病率的影响，该试验招募了有性传播感染（STI）病史且正在接受艾滋病毒暴露前预防（PrEP）的男男性行为者。
方法
我们比较了猴痘患者和未患猴痘参与者在疫情前的社会行为特征以及疫情爆发后的性行为变化。然后，我们比较了2022年5月9日至7月10日（男男性行为者接种疫苗前，时期1）和2022年7月11日至9月20日（疫苗接种开始后，时期2）每1000人月（p-m）的猴痘发病率，并使用泊松回归模型探索解释时期效应的因素。
结果
472名男男性行为者在2022年5月9日前后有数据。20%的人在儿童时期接种过天花疫苗。472名参与者中有77人感染猴痘（发病率为每1000 p-m 49.3例（95%CI 38.9-61.6））。MVA-BN疫苗接种推广迅速，截至2022年9月20日，86%（341/398）符合条件的参与者至少接种了一剂。5月9日前后性行为发生了显著变化，过去3个月内有超过10个性伴侣的未患猴痘参与者比例有所下降（45%对38%，p = 0.0035）。时期1的猴痘发病率为每1000 p-m 67.4例（95%CI 51.6-86.6），时期2为每1000 p-m 24.4例（95%CI 13.9-39.6），发病率比为0.36（95%CI 0.21-0.63）。在多变量泊松回归模型中，只有2022年接种MVA-BN疫苗仍与猴痘发病率显著相关，风险降低99%（95%CI
96.6-99.7）。
解读
在ANRS-174-DOXYVAC试验中接受PrEP的男男性行为者中，MVA-BN疫苗的迅速推广与猴痘发病率的大幅降低相关。
资助
法国国家艾滋病研究机构新兴传染病项目（ANRS/MIE）。
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