Clinical Scorecard: Protocol for the MpoxCARE Study: A Comprehensive Evaluation of Immunization Strategies During Emergency Outbreaks of Mpox
At a Glance
Category
Detail
Condition
Mpox disease caused by human Monkeypox virus (hMPXV)
Key Mechanisms
Transmission via close contact with infected animals or humans; clinical infection includes coryza, fever, lymphadenopathy, vesicular rash; morbidity from complications like bronchopneumonia and encephalitis
Target Population
Populations at high risk of exposure in endemic and outbreak regions, particularly in Central and West Africa including Rwanda and Democratic Republic of Congo
Care Setting
Public health and outbreak control settings with vaccination and diagnostic capabilities
Key Highlights
Mpox has two main clades with differing virulence: Clade I (Central Africa) with ~10.6% CFR and Clade II (West Africa) with ~4% CFR
WHO recommends three vaccines for Mpox prevention: ACAM2000, MVA-BN, and LC16, used for high-risk groups and post-exposure prophylaxis
MpoxCARE study aims to validate novel immunodiagnostic assays (ELISA and lateral flow test) and assess vaccine cold chain capacity in Rwanda
Guideline-Based Recommendations
Diagnosis
Use validated serum-based ELISA to detect anti-Mpox specific IgG antibodies
Employ blood-based lateral flow tests for point-of-care detection of Mpox-specific antibodies
Management
Vaccination recommended for high-risk individuals and as post-exposure prophylaxis within two weeks of exposure
Utilize ring vaccination strategies during outbreaks for rapid containment
Monitoring & Follow-up
Monitor antibody titres as potential surrogate markers of protection
Assess vaccine cold chain capacity to ensure effective vaccine deployment without disrupting routine immunizations
Risks
Potential morbidity and mortality from complications such as bronchopneumonia, bacterial superinfection, encephalitis, keratitis, and dehydration
Limited global vaccine availability may impact outbreak control efforts
Patient & Prescribing Data
Individuals at high risk of Mpox exposure, including those in outbreak regions and contacts of confirmed cases
Vaccination with ACAM2000, MVA-BN, or LC16 is advised; duration of protection is uncertain but smallpox vaccine immunity may last decades
Clinical Best Practices
Implement vaccination promptly in exposed or high-risk populations using WHO-recommended vaccines
Validate and utilize immunodiagnostic assays to accurately identify Mpox exposure and immunity status
Ensure robust vaccine cold chain infrastructure to support rapid and effective vaccine deployment during outbreaks
Collect and analyze clinical and serological data to inform public health strategies and vaccine efficacy
by Karishma Gokani, Herve Semukunzi, Gilbert Rukundo, Jenny Clarke, Sian E. Faustini, Jean Pierre Musabyimana, Siobhan Roche, Scott Jones, Ashley David Otter, Alex Richter, Claude Muvunyi, Jennifer Heaney, Christopher Aird Green
