Monkeypox: What about the reactive vaccination strategy in first-time vaccinees and children?

While the first case of infection with the monkeypox virus (monkey pox) was confirmed in France on May 19, 2022, there were already 183 as of June 16.

On May 20, the High Authority for Health (HAS) published a first recommendation for a post-exposure reactive vaccination strategy against this virus with the Imvanex vaccine.®said third generation. Administration should ideally be within 4 days of risky exposure and no more than 14 days later using a two-dose schedule (or three doses for immunocompromised individuals) 28 days apart. for contacts of adults at high risk of monkeypoxincluding exposed healthcare professionals without personal protective measures.

What about primary vaccinations and children?

HAS now provides details on this reactive vaccination strategy for two population groups:

  • Individuals who have been vaccinated against smallpox since childhood (primo-vaccinated), before 1980: The HAS recommends giving only one dose of vaccine to high-risk contacts, which has a booster effect, except in immunocompromised individuals who must receive 3 doses;
  • Children (< 18 years) who are exposed to the virus and are likely to develop a severe formespecially the most sensitive and immunocompromised: HAS suggests vaccination with the Imvanex vaccine® (3e generation) is checked in individual cases only by specialists after careful consideration of the risk-benefit ratio and with the consent of the parents or the young person. In fact, smallpox vaccination in infants and young children used to be available with April 1st, 2019 vaccinesD and 2e Generation. Imvanex today® is only allowed for adults.

To date, no pediatric case of monkeypox has been reported in France, but several studies conducted in African countries have shown that children are more likely to develop severe forms of the disease and are at greater risk of death. The HAS drew on several studies of other vaccines using the same platform as Imvanex® (the Modified virus Ankara – MVA), which has shown good tolerability in children over 4 months. In addition, no adverse reactions were reported following vaccination of children and infants during the UK monkeypox outbreak in 2018 and 2019.

HAS recommends accelerating clinical trials to expand the indication of third-generation smallpox vaccines to the pediatric population.

How do you know if a person was vaccinated as a child?

Prophylactic vaccination against human smallpox was compulsory in France until the 1980s (1979 for primary vaccination, 1984 for booster vaccination). To find out if a person has been vaccinated, the HAS recommends checking for the presence of an indelible embossed scar, characteristic of people who have received 1 vaccinationD or 2e Generation.

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