{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:36:15Z","timestamp":1792622175484,"version":"4.5.0"},"reference-count":115,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018937","name":"Bavarian Nordic","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018937","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Human mpox, caused by the mpox virus, is a reemerging viral zoonosis that has gained global attention due to recent Clade IIb outbreaks outside of Africa, as well as ongoing Clade Ia and Ib outbreaks in the Democratic Republic of Congo (DRC) and surrounding regions. Since the start of these outbreaks in 2022, approximately 160,000 people have been affected across more than 100 countries. People with human immunodeficiency virus (HIV; hereafter referred to as PWH) have been disproportionately affected, accounting for approximately 50% of all cases. Mpox is typically a self-limiting illness causing smallpox-like symptoms lasting 2\u20134 weeks, which can cause significant pain and morbidity. People with uncontrolled or advanced HIV face an elevated risk of severe mpox, secondary complications, and worse outcomes. Vaccination with second- and third-generation vaccinia-based smallpox vaccines has emerged as an important tool in mpox prevention, alongside behavioural modification to mitigate risk. However, only the third-generation, live-attenuated, non-replicating vaccine, modified vaccinia Ankara (MVA-BN [Bavarian Nordic]), is approved for use in PWH. Real-world estimates suggest that two doses of MVA-BN administered as pre-exposure prophylaxis confers vaccine effectiveness in the range of 66\u201390%. Additionally, MVA-BN has been widely demonstrated to have an acceptable safety profile. This narrative review explores the changing epidemiology, clinical manifestations, and outcomes of mpox in PWH. We also summarise evidence from the Clade IIb outbreaks on the effectiveness and safety of MVA-BN among PWH. Despite progress in our understanding, knowledge gaps persist regarding vaccine performance in individuals with advanced immunosuppression. Furthermore, due to the emergent nature of outbreaks in the DRC and surrounding areas, limited information is available regarding implications for PWH in the context of Clade Ia and Ib. We aim to provide healthcare providers, community stakeholders, and researchers with a foundational understanding of mpox in PWH and the role of MVA-BN in mpox prevention among this group, while highlighting areas of uncertainty. These insights may be helpful in the planning of future research and to inform strategies for the prevention and management of mpox among PWH, particularly those with advanced or uncontrolled HIV.<\/jats:p>","DOI":"10.3390\/v17121526","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:41:58Z","timestamp":1763728918000},"page":"1526","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Mpox: Exploring Epidemiology, Disease Outcomes, and Preventative Vaccination Among People with HIV During the Ongoing Outbreaks"],"prefix":"10.3390","volume":"17","author":[{"given":"Chloe","family":"Orkin","sequence":"first","affiliation":[{"name":"SHARE Collaborative, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Torgler","sequence":"additional","affiliation":[{"name":"Bavarian Nordic Berna GmbH, CH-3174 Thoerishaus, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Dawson","sequence":"additional","affiliation":[{"name":"Word Monster, One, St. Peter\u2019s Road, Maidenhead SL6 7QU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian W.","family":"Holloway","sequence":"additional","affiliation":[{"name":"UCLA School of Nursing, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1082-8093","authenticated-orcid":false,"given":"Christian","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"ICH Study Center, 20146 Hamburg, Germany"},{"name":"Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref_1","unstructured":"Shchelkunov, S.N., Marennikova, S.S., and Moyer, R.W. (2005). Orthopoxviruses Pathogenic for Humans, Springer."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.1099\/vir.0.81215-0","article-title":"A tale of two clades: Monkeypox viruses","volume":"86","author":"Likos","year":"2005","journal-title":"J. Gen. Virol."},{"key":"ref_3","unstructured":"World Health Organization (2025, September 02). Monkeypox: Experts Give Virus Variants New Names. Available online: https:\/\/www.who.int\/news\/item\/12-08-2022-monkeypox--experts-give-virus-variants-new-names."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1038\/s41591-024-03130-3","article-title":"Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo","volume":"30","author":"Vakaniaki","year":"2024","journal-title":"Nat. Med."},{"key":"ref_5","unstructured":"Centers for Disease Control and Prevention (2025, October 08). Mpox in the United States and Around the World: Current Situation, Available online: https:\/\/www.cdc.gov\/mpox\/situation-summary\/index.html."},{"key":"ref_6","unstructured":"World Health Organization (2025, September 22). WHO Director-General Declares Mpox Outbreak a Public Health Emergency of International Concern. Available online: https:\/\/www.who.int\/news\/item\/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern."},{"key":"ref_7","unstructured":"World Health Organization (2025, October 31). 2022\u201324 Mpox (Monkeypox) Outbreak: Global Trends. Available online: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/#1_Overview."},{"key":"ref_8","unstructured":"Offical Records of the World Health Organization (2025, October 04). The Work of WHO 1971: Communicable Diseases. Available online: https:\/\/iris.who.int\/handle\/10665\/85845."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/br.37.1.1-18.1973","article-title":"Monkeypox virus","volume":"37","author":"Cho","year":"1973","journal-title":"Bacteriol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1007\/s10393-019-01435-1","article-title":"Temporal and Spatial Dynamics of Monkeypox in Democratic Republic of Congo, 2000\u20132015","volume":"16","author":"Mandja","year":"2019","journal-title":"Ecohealth"},{"key":"ref_11","first-page":"125","article-title":"Epidemiology of Human Mpox\u2014Worldwide, 2018\u20132021","volume":"72","author":"McCollum","year":"2023","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bunge, E.M., Hoet, B., Chen, L., Lienert, F., Weidenthaler, H., Baer, L.R., and Steffen, R. (2022). The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010141"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/S1473-3099(19)30294-4","article-title":"Outbreak of human monkeypox in Nigeria in 2017\u201318: A clinical and epidemiological report","volume":"19","author":"Aruna","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1056\/NEJMoa032299","article-title":"The detection of monkeypox in humans in the Western Hemisphere","volume":"350","author":"Reed","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_15","unstructured":"World Health Organization (2025, September 02). WHO Director-General Declares the Ongoing Monkeypox Outbreak a Public Health Emergency of International Concern. Available online: https:\/\/www.who.int\/europe\/news\/item\/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/infdis\/154.4.551","article-title":"Human monkeypox: A study of 2510 contacts of 214 Patients","volume":"154","author":"Jezek","year":"1986","journal-title":"J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1093\/cid\/ciaa143","article-title":"Clinical Course and Outcome of Human Monkeypox in Nigeria","volume":"71","author":"Ogoina","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","unstructured":"World Health Organization (2025, September 01). Department of Communicable Disease Surveillance and Response. Technical Advisory Group on Human Monkeypox. Report of a WHO Meeting. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/65998\/WHO_CDS_CSR_APH_99.5.pdf?sequence=1."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"434","DOI":"10.3201\/eid0703.017311","article-title":"Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997","volume":"7","author":"Hutin","year":"2001","journal-title":"Emerg. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1012","DOI":"10.1016\/S2214-109X(23)00198-5","article-title":"Description of the first global outbreak of mpox: An analysis of global surveillance data","volume":"11","author":"Sklenovska","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention (2025, October 04). Clade Ib Mpox Outbreak\u2014Kenya, July 2024\u2013February 2025, Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/74\/wr\/mm7422a2.htm?utm_source.","DOI":"10.15585\/mmwr.mm7422a2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.3201\/eid3009.240135","article-title":"Mpox Epidemiology and Risk Factors, Nigeria, 2022","volume":"30","author":"Ogoina","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_23","unstructured":"World Health Organization (2025, September 02). Mpox. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mpox."},{"key":"ref_24","unstructured":"World Health Organization (2024). Smallpox and mpox (orthopoxviruses) vaccine position paper. Wkly. Epidemiol. Rec., 99, 429\u2013456."},{"key":"ref_25","unstructured":"UNAIDS (2025, September 01). Global HIV Statistics. Available online: https:\/\/embargo.unaids.org\/static\/files\/uploaded_files\/Global_HIV_factsheet_2023_final_rev_13July.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"172","DOI":"10.3201\/eid3001.231164","article-title":"Clade I-Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo","volume":"30","author":"Kibungu","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S0140-6736(25)00047-9","article-title":"Epidemiological and clinical features of mpox during the clade Ib outbreak in South Kivu, Democratic Republic of the Congo: A prospective cohort study","volume":"405","author":"Brosius","year":"2025","journal-title":"Lancet"},{"key":"ref_28","first-page":"1033","article-title":"Clade Ia Monkeypox Virus Linked to Sexual Transmission, Democratic Republic of the Congo, August 2024","volume":"31","author":"Kenye","year":"2025","journal-title":"Emerg. Infect. Dis."},{"key":"ref_29","unstructured":"University of Nebraska Medical Center (2025, September 02). Mpox: German School Temporarily Closed After Case Reported. Available online: https:\/\/www.unmc.edu\/healthsecurity\/transmission\/2024\/12\/18\/mpox-german-school-temporarily-closed-after-case-reported\/."},{"key":"ref_30","unstructured":"World Health Organization (2025). Mpox: Multi-Country External Situation Report No. 50, WHO. Available online: https:\/\/cdn.who.int\/media\/docs\/default-source\/documents\/emergencies\/multi-country-outbreak-of-mpox--external-situation-report--50.pdf?download=true&sfvrsn=2a5b9630_4&utm."},{"key":"ref_31","unstructured":"European Centre for Disease Prevention and Control (2025, October 30). Local Transmission of Clade 1b Mpox Cases Detected in EU\/EEA, ECDC Urges Renewed Vigilance. Available online: https:\/\/www.ecdc.europa.eu\/en\/news-events\/local-transmission-clade-1b-mpox-cases-detected-eueea-ecdc-urges-renewed-vigilance."},{"key":"ref_32","unstructured":"California Department of Public Health (2025, November 03). Community Spread of Clade I Mpox Within California: 10\/17\/2025, Available online: https:\/\/www.cdph.ca.gov\/Programs\/OPA\/Pages\/CAHAN\/Community-Spread-of-Clade-I-Mpox-Within-California.aspx."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1093\/infdis\/156.2.293","article-title":"Human monkeypox: Clinical features of 282 patients","volume":"156","author":"Jezek","year":"1987","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e667","DOI":"10.1016\/S1473-3099(24)00564-4","article-title":"Mpox-is there a more dangerous new clade?","volume":"24","author":"Hoffmann","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1056\/NEJMra2208860","article-title":"Monkeypox","volume":"387","author":"Gessain","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/infdis\/jiad034","article-title":"Clinical Features, Antiviral Treatment, and Patient Outcomes: A Systematic Review and Comparative Analysis of the Previous and the 2022 Mpox Outbreaks","volume":"228","author":"Li","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Est\u00e9vez, S., Vara, M., Gamo, M., Manzano, S., Troya, J., Botezat, E., Jim\u00e9nez, E., Pedrero-Tom\u00e9, R., Martin, M.\u00c1., and de la Cueva, P. (2023). Epidemiological and Clinical Characteristics of Patients Admitted to a Secondary Hospital with Suspected MPOX Virus Infection: Is HIV Playing a Role?. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124124"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0140-6736(23)00273-8","article-title":"Mpox in people with advanced HIV infection: A global case series","volume":"401","author":"Alemany","year":"2023","journal-title":"Lancet"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jaad.2022.12.035","article-title":"A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring","volume":"88","author":"Prasad","year":"2023","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.7326\/M22-2183","article-title":"Detection of Monkeypox Virus in Anorectal Swabs from Asymptomatic Men Who Have Sex with Men in a Sexually Transmitted Infection Screening Program in Paris, France","volume":"175","author":"Ferre","year":"2022","journal-title":"Ann. Intern. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1038\/s41591-022-02004-w","article-title":"Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium","volume":"28","author":"Kenyon","year":"2022","journal-title":"Nat. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: A prospective observational cohort study","volume":"400","author":"Alemany","year":"2022","journal-title":"Lancet"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox Virus Infection in Humans across 16 Countries; April\u2013June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/j.jinf.2022.08.019","article-title":"Natural history of human Monkeypox in individuals attending a sexual health clinic in Milan, Italy","volume":"86","author":"Moschese","year":"2023","journal-title":"J. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e29511","DOI":"10.1002\/jmv.29511","article-title":"Long or complicated mpox in patients with uncontrolled HIV infection","volume":"96","author":"Cabello","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S1473-3099(22)00806-4","article-title":"Clinical features and management of individuals admitted to hospital with monkeypox and associated complications across the UK: A retrospective cohort study","volume":"23","author":"Fink","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1093\/cid\/ciad052","article-title":"Severe Mpox Infections in People with Uncontrolled Human Immunodeficiency Virus","volume":"76","author":"Govind","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12985-024-02392-0","article-title":"The impact of immunosuppression on the mortality and hospitalization of Monkeypox: A systematic review and meta-analysis of the 2022 outbreak","volume":"21","author":"Azzam","year":"2024","journal-title":"Virol. J."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Monta\u00f1o, M., Shapiro, A.E., Whitney, B.M., Bamford, L., Burkholder, G., Cachay, E.R., Christopoulos, K.A., Crane, H.M., Delaney, J.A.C., and Eron, J.J. (2024). Mpox in People with Human Immunodeficiency Virus: Predictors of Diagnosis, Outcomes, and Vaccine Effectiveness in a Multisite Cohort. Clin. Infect. Dis., ciae464.","DOI":"10.1093\/cid\/ciae464"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S243","DOI":"10.1093\/infdis\/jiad532","article-title":"Prolonged Mpox Disease in People with Advanced HIV: Characterization of Mpox Skin Lesions","volume":"229","author":"Zucker","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"404","DOI":"10.15585\/mmwr.mm7215a5","article-title":"Epidemiologic and Clinical Features of Mpox-Associated Deaths\u2014United States, May 10, 2022\u2013March 7, 2023","volume":"72","author":"Riser","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_52","unstructured":"Centers for Disease Control and Prevention (2025, October 20). Tecovirimat (TPOXX) for Treatment of Mpox, Available online: https:\/\/www.cdc.gov\/mpox\/hcp\/clinical-care\/tecovirimat.html."},{"key":"ref_53","unstructured":"Clinical Trials.Gov (2025, September 02). Study of Tecovirimat for Human Mpox Virus (STOMP); ID #NCT05534984, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05534984?cond=Mpox%20%5C(Monkeypox%5C)&term=NCT05534984&rank=1."},{"key":"ref_54","unstructured":"Clinical Trials.Gov (2025, September 21). Tecovirimat for the Treatment of Mpox; ID #NCT05559099, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05559099?cond=MPOX&term=PALM007&rank=4."},{"key":"ref_55","unstructured":"National Institutes of Health (2025, September 02). News Release: The Antiviral Tecovirimat Is Safe but Did Not Improve Clade I Mpox Resolution in Democratic Republic of the Congo, Available online: https:\/\/www.nih.gov\/news-events\/news-releases\/antiviral-tecovirimat-safe-did-not-improve-clade-i-mpox-resolution-democratic-republic-congo."},{"key":"ref_56","unstructured":"SIGA (2025, October 07). News Details: Interim Results from STOMP Study of SIGA\u2019s Tecovirimat in Treatment of Mpox Announced. Available online: https:\/\/investor.siga.com\/investors\/news\/news-details\/2024\/Interim-Results-from-STOMP-Study-of-SIGAs-Tecovirimat-in-Treatment-of-Mpox-Announced\/default.aspx."},{"key":"ref_57","unstructured":"Centers for Disease Control and Prevention (2025, September 08). Clinical Treatment of Mpox, Available online: https:\/\/www.cdc.gov\/mpox\/hcp\/clinical-care\/index.html."},{"key":"ref_58","unstructured":"Food and Drug Administration (2025, October 14). Highlights of Prescribing Information: ACAM2000, Available online: https:\/\/www.fda.gov\/media\/75792\/download."},{"key":"ref_59","unstructured":"Pharmaceutical and Medical Devices Agency (2025, October 02). Report on the Deliberation Results: LC16 \u201cKMB\u201d, Available online: https:\/\/www.pmda.go.jp\/files\/000247943.pdf."},{"key":"ref_60","unstructured":"Bavarian Nordic (2025, October 01). Highlights of Prescribing Information: Jynneos. Available online: https:\/\/bavariannordic.io\/uploads\/jynneos-pi.pdf."},{"key":"ref_61","unstructured":"Government of Newfoundland and Labrador (2025, September 03). Imvamune Vaccine Information Sheet for Healthcare Providers, Available online: https:\/\/www.gov.nl.ca\/hcs\/files\/Imvamune-Vaccine-Info-Sheet-for-HCP.pdf."},{"key":"ref_62","unstructured":"European Medicines Agency (2025, September 12). Summary of Product Characteristics: Imvanex. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/imvanex-epar-product-information_en.pdf."},{"key":"ref_63","unstructured":"Bavarian Nordic (2025, September 20). Bavarian Nordic Receives Approval of Smallpox and Mpox Vaccine in Singapore. Available online: https:\/\/www.bavarian-nordic.com\/media\/media\/news.aspx?news=6983."},{"key":"ref_64","unstructured":"Global Regulatory Partners (2025, September 30). Press Release. Available online: https:\/\/globalregulatorypartners.com\/press_release\/global-regulatory-partners-mexico-receives-marketing-approval-of-jynneos-mva-bn-monkeypox-vaccine-on-behalf-of-bavarian-nordic-in-mexico\/."},{"key":"ref_65","unstructured":"Bavarian Nordic (2025, October 05). Bavarian Nordic Submits Data to EMA to Extend Mpox\/Smallpox Vaccine Approval to Adolescents. Available online: https:\/\/www.bavarian-nordic.com\/media\/media\/news.aspx?news=6969#:~:text=While%20currently%20only%20indicated%20for%20adults%2018%20years,remains%20the%20only%20FDA%20and%20EMA-approved%20mpox%20vaccine."},{"key":"ref_66","unstructured":"World Health Organization (2025, September 11). WHO Prequalifies the First Vaccine Against Mpox. Available online: https:\/\/www.who.int\/news\/item\/13-09-2024-who-prequalifies-the-first-vaccine-against-mpox."},{"key":"ref_67","unstructured":"Meyer, H. (2013). Summary Report on First, Second and Third Generation Smallpox Vaccines, World Health Organization. Available online: https:\/\/terrance.who.int\/mediacentre\/data\/sage\/SAGE_Docs_Ppt_Nov2013\/8_session_smallpox\/Nov2013_session8_smallpox_vaccine.pdf?."},{"key":"ref_68","unstructured":"World Health Organization (2025, September 23). Vaccines and Immunization for Monkeypox. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/364527\/WHO-MPX-Immunization-2022.3-eng.pdf."},{"key":"ref_69","unstructured":"European AIDS Clinical Society (2025, October 03). Guidelines. Version 12.0. Available online: https:\/\/www.eacsociety.org\/media\/guidelines-12.0.pdf."},{"key":"ref_70","unstructured":"Ministry of Health: Ontario (2025, September 01). Mpox Vaccine (Imvamune\u00ae) Guidance for Health Care Providers. Version 5.0. Available online: https:\/\/www.ontario.ca\/files\/2024-09\/moh-mpox-vaccine-guidance-for-health-care-providers-en-2024-09-26.pdf."},{"key":"ref_71","unstructured":"Government of Canada, NACoIN (2025, October 05). Summary of NACI Statement of May 24, 2024: Interim Guidance on the Use of Imvamune\u00ae in the Context of a Routine Immunization Program. Available online: https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/vaccines-immunization\/national-advisory-committee-immunization-summary-interim-guidance-imvamune-routine-immunization-program.html."},{"key":"ref_72","unstructured":"European Medicines Agency (2025, October 12). EMA\u2019s Emergency Task Force Advises on Intradermal Use of Imvanex\/Jynneos Against Monkeypox. Available online: https:\/\/www.ema.europa.eu\/en\/news\/emas-emergency-task-force-advises-intradermal-use-imvanex-jynneos-against-monkeypox."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1056\/NEJMoa1817307","article-title":"Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine against Smallpox","volume":"381","author":"Pittman","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/infdis\/jiac455","article-title":"One- and Two-Dose Vaccinations with Modified Vaccinia Ankara-Bavarian Nordic Induce Durable B-Cell Memory Responses Comparable to Replicating Smallpox Vaccines","volume":"227","author":"Ilchmann","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_75","unstructured":"Food and Drug Administration (2025, October 06). Summary Basis for Regulatory Action Template: Jynneos, Available online: https:\/\/www.fda.gov\/media\/131802\/download."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"126409","DOI":"10.1016\/j.vaccine.2024.126409","article-title":"MVA-BN vaccine effectiveness: A systematic review of real-world evidence in outbreak settings","volume":"42","author":"Mason","year":"2024","journal-title":"Vaccine"},{"key":"ref_77","first-page":"57","article-title":"Safety Monitoring of JYNNEOS Vaccine During the 2022 Mpox Outbreak\u2014United States, May 22\u2013October 21, 2022","volume":"71","author":"Duffy","year":"2022","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.3201\/eid3010.240292","article-title":"Mpox Epidemiology and Vaccine Effectiveness, England, 2023","volume":"30","author":"Charles","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1089\/vim.2023.0147","article-title":"Safety and Efficacy of the Modified Vaccinia Ankara-Bavaria Nordic Vaccine Against Mpox in the Real World: Systematic Review and Meta-Analysis","volume":"37","author":"Pang","year":"2024","journal-title":"Viral Immunol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1093\/cid\/ciad584","article-title":"Single-dose Effectiveness of Mpox Vaccine in Quebec, Canada: Test-negative Design with and without Adjustment for Self-reported Exposure Risk","volume":"78","author":"Brousseau","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_81","first-page":"2200883","article-title":"Post-exposure vaccine effectiveness and contact management in the mpox outbreak, Madrid, Spain, May to August 2022","volume":"28","year":"2023","journal-title":"EuroSurveillance"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.vaccine.2023.12.066","article-title":"JYNNEOS effectiveness as post-exposure prophylaxis against mpox: Challenges using real-world outbreak data","volume":"42","author":"Rosen","year":"2024","journal-title":"Vaccine"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/S1473-3099(25)00180-X","article-title":"Effect of JYNNEOS vaccination on mpox clinical progression among cisgender male cases with confirmed infection","volume":"25","author":"Granskog","year":"2025","journal-title":"Lancet"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"4100","DOI":"10.1038\/s41467-023-38816-8","article-title":"The role of vaccination and public awareness in forecasts of Mpox incidence in the United Kingdom","volume":"14","author":"Brand","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.1093\/infdis\/jiad414","article-title":"The Fading of the Mpox Outbreak Among Men Who Have Sex with Men: A Mathematical Modelling Study","volume":"230","author":"Xiridou","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1136\/sextrans-2023-055922","article-title":"Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak","volume":"100","author":"Clay","year":"2024","journal-title":"Sex. Transm. Infect."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"10889","DOI":"10.1073\/pnas.0804985105","article-title":"Rapid protection in a monkeypox model by a single injection of a replication-deficient vaccinia virus","volume":"105","author":"Earl","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Keckler, M.S., Salzer, J.S., Patel, N., Townsend, M.B., Nakazawa, Y.J., Doty, J.B., Gallardo-Romero, N.F., Satheshkumar, P.S., Carroll, D.S., and Karem, K.L. (2020). IMVAMUNE((R)) and ACAM2000((R)) Provide Different Protection against Disease When Administered Postexposure in an Intranasal Monkeypox Challenge Prairie Dog Model. Vaccines, 8.","DOI":"10.3390\/vaccines8030396"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Back, S., Knox, B., Coakley, C., Deltour, N., Jacquot, E., Raad, H., and Garry, E.M. (2024). Effectiveness and Safety of the MVA-BN Vaccine against Mpox in At-Risk Individuals in the United States (USMVAc). Vaccines, 12.","DOI":"10.3390\/vaccines12060651"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"553","DOI":"10.15585\/mmwr.mm7220a3","article-title":"Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study\u2014United States, August 19, 2022\u2013March 31, 2023","volume":"72","author":"Dalton","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"125987","DOI":"10.1016\/j.vaccine.2024.05.035","article-title":"Effectiveness of JYNNEOS vaccine against symptomatic mpox disease in adult men in Los Angeles County, August 29, 2022 to January 1, 2023","volume":"42","author":"Yeganeh","year":"2024","journal-title":"Vaccine"},{"key":"ref_92","first-page":"e00062","article-title":"Evaluation of pre-exposure vaccine effectiveness against mpox during the 2022\u20132023 mpox outbreak in the Madrid region (Spain): A test-negative design","volume":"2","year":"2024","journal-title":"BMJ Public Health"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/S1473-3099(25)00018-0","article-title":"Safety and effectiveness of MVA-BN vaccination against mpox in at-risk individuals in Germany (SEMVAc and TEMVAc): A combined prospective and retrospective cohort study","volume":"25","author":"Hillus","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"460","DOI":"10.15585\/mmwr.mm7320a3","article-title":"Monkeypox Virus Infections After 2 Preexposure Doses of JYNNEOS Vaccine\u2014United States, May 2022\u2013May 2024","volume":"73","author":"Guagliardo","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.jiph.2024.02.015","article-title":"Breakthrough cases of mpox: One-dose vaccination is associated with milder clinical manifestations","volume":"17","author":"Allard","year":"2024","journal-title":"J. Infect. Public Health"},{"key":"ref_96","unstructured":"Boesecke, C., Breitschwerdt, S., Bickel, M., Appelhans, C., Jessen, H., Franz, S., Kolarikal, H., Krznaric, I., and Lenz, J. (2025, January 15\u201318). Smallpox vaccine reduces mpox disease and severity of symptoms. Proceedings of the 20th European AIDS Conference (EACS), Paris, France. Abstract RO1.2."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"8562","DOI":"10.1016\/j.vaccine.2007.10.017","article-title":"Clinical and immunologic responses to multiple doses of IMVAMUNE (Modified Vaccinia Ankara) followed by Dryvax challenge","volume":"25","author":"Frey","year":"2007","journal-title":"Vaccine"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"7321","DOI":"10.1016\/j.vaccine.2022.10.078","article-title":"Serological responses to the MVA-based JYNNEOS monkeypox vaccine in a cohort of participants from the Democratic Republic of Congo","volume":"40","author":"Priyamvada","year":"2022","journal-title":"Vaccine"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/S1473-3099(23)00352-3","article-title":"Mpox vaccine and infection-driven human immune signatures: An immunological analysis of an observational study","volume":"23","author":"Cohn","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.chom.2023.05.001","article-title":"Complement-dependent mpox-virus-neutralizing antibodies in infected and vaccinated individuals","volume":"31","author":"Hubert","year":"2023","journal-title":"Cell Host Microbe"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"5948","DOI":"10.1038\/s41467-023-41587-x","article-title":"Monkeypox virus-infected individuals mount comparable humoral immune responses as Smallpox-vaccinated individuals","volume":"14","author":"Otter","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/infdis\/jis753","article-title":"Safety, immunogenicity, and surrogate markers of clinical efficacy for modified vaccinia Ankara as a smallpox vaccine in HIV-infected subjects","volume":"207","author":"Greenberg","year":"2013","journal-title":"J. Infect. Dis."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"ofv040","DOI":"10.1093\/ofid\/ofv040","article-title":"Safety and Immunogenicity of Modified Vaccinia Ankara-Bavarian Nordic Smallpox Vaccine in Vaccinia-Naive and Experienced Human Immunodeficiency Virus-Infected Individuals: An Open-Label, Controlled Clinical Phase II Trial","volume":"2","author":"Overton","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"2600","DOI":"10.1016\/j.vaccine.2020.01.058","article-title":"A randomized phase II trial to compare safety and immunogenicity of the MVA-BN smallpox vaccine at various doses in adults with a history of AIDS","volume":"38","author":"Overton","year":"2020","journal-title":"Vaccine"},{"key":"ref_105","unstructured":"Bavarian, N. (2015). Addendum I to Clinical Study Report POX-MVA-Oll, Bavarian Nordic Restricted Business Proprietary. [1st ed.]. Document No. 93000023."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1093\/infdis\/jiae138","article-title":"Mpox-specific immune responses elicited by vaccination or infection in people living with HIV","volume":"230","author":"Gruner","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"102420","DOI":"10.1016\/j.eclinm.2023.102420","article-title":"Immunogenicity and reactogenicity of modified vaccinia Ankara pre-exposure vaccination against mpox according to previous smallpox vaccine exposure and HIV infection: Prospective cohort study","volume":"68","author":"Mazzotta","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"106309","DOI":"10.1016\/j.jinf.2024.106309","article-title":"Mpox Immune response elicited by MVA-BN vaccine over 12 months of follow-up","volume":"89","author":"Matusali","year":"2024","journal-title":"J. Infect."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Mazzotta, V., Matusali, G., Cimini, E., Colavita, F., Esvan, R., Notari, S., Micheli, G., Bettini, A., Tartaglia, E., and Giacinta, A. (Clin. Microbiol. Infect., 2025). Kinetics of the humoral and cellular immune response up to one year from mpox virus infection, Clin. Microbiol. Infect., Online ahead of print.","DOI":"10.1016\/j.cmi.2025.04.026"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Byrne, J., Murphy, A., Garcia Leon, A.A., Saini, G., Landay, A., Luong Nguyen, L.B., and O\u2019Broin, C. (2025, January 9\u201312). Antibody Responses Decline Post MVA-BN Vaccination but Persist Following Mpox Infection. Proceedings of the Conference on Retroviruses and Opportunistic Infections (CROI), San Francisco, CA, USA. Abstract #439.","DOI":"10.1093\/ofid\/ofaf536"},{"key":"ref_111","unstructured":"De la Calle-Jiminez, O., Fernandez, G.C., Armenteros-Yeguas, I., Aguilar, L.F.L., Perez-Garcia, J., Anover, J.R., and Mateos, E. (2025;, January 9\u201312). Immune Response to Mpox in PWH and PrEP Users After Infection, but not in Response to Vaccination. Proceedings of the Conference on Retroviruses and Opportunistic Infections (CROI), San Francisco, CA, USA."},{"key":"ref_112","unstructured":"Centers for Disease Control and Prevention (2025, September 01). Interim Clinical Considerations for Use of Vaccine for Mpox Prevention in the United States, Available online: https:\/\/www.cdc.gov\/monkeypox\/hcp\/vaccine-considerations\/vaccination-overview.html."},{"key":"ref_113","unstructured":"Haute Autorite de Sante (HAS) (2025, October 11). Mpox (MPXV): The HAS Updates Its Vaccination Recommendations to Better Fight Against the Circulation of the Virus. Press Release. Available online: https:\/\/www.has-sante.fr\/jcms\/p_3538112\/fr\/mpox-mpxv-la-has-actualise-ses-recommandations-vaccinales-pour-mieux-lutter-contre-la-circulation-du-virus."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1097\/QAD.0000000000003733","article-title":"Viral blips and virologic failures following mpox vaccination with MVA-BN among people with HIV","volume":"37","author":"Raccagni","year":"2023","journal-title":"AIDS"},{"key":"ref_115","unstructured":"World Health Organization (2025, October 04). Vaccine Doses Allocated to 9 African Countries Hardest Hit by Mpox Surge. Available online: https:\/\/www.who.int\/news\/item\/06-11-2024-vaccine-doses-allocated-to-9-african-countries-hardest-hit-by-mpox-surge."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1526\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T05:26:58Z","timestamp":1763875618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":115,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["v17121526"],"URL":"https:\/\/doi.org\/10.3390\/v17121526","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]}}}