Serological responses to smallpox A33 antigen and monkeypox A35 antigen in healthy people and people living with HIV-1 from Guangzhou, China.

People are expected to have been previously vaccinated with a Vaccinia-based vaccine, as until 1980 smallpox vaccination was a standard protocol in China. It is unclear whether people with smallpox vaccine still have antibody against vaccinia virus (VACV) and cross-antibody against monkeypox virus (MPXV). Herein, we assessed the binding antibodies with antigen of VACV-A33 and MPXV-A35 in the general population and HIV-1 infected patients. Firstly, we detected VACV antibody with A33 protein to evaluate the efficiency of smallpox vaccination. The result show that 29% (23 of 79) of hospital staff (age ≥ 42 years) and 63% (60 of 95) of HIV-positive patients (age ≥ 42 years) from Guangzhou Eighth People's Hospital were able to bind A33. However, among the subjects below 42 years of age, 1.5% (3/198) of the hospital volunteer samples and 1% (1/104) of the samples from HIV patients were positive for antibodies against A33 antigen. Then, we assessed the specific cross-reactive antibodies against MPXV A35 protein. 24% (19 of 79) hospital staff (age〉 = 42 years) and 44% (42 of 95) of HIV-positive patients (age〉 = 42 years) were positive. 98% (194/198) of the hospital staff and 99% (103/104) of the HIV patients had no A35-binding antibodies. Further, we found significant sex differences for the reactivity to A35 antigen were observed in HIV population, but no significant sex differences in hospital staff. Further, we analyzed the positivity rate of anti-A35 antibody of men who have sex with men (MSM) and non-MSM in HIV patients (age〉 = 42years). We found that 47% of no-MSM population and 40% of MSM population were positive for A35 antigen, with no significant difference. Lastly, we found only 59 samples were positive for anti-A33 IgG and anti-A35 IgG in all participants. Together, we demonstrated A33 and A35 antigens binding antibodies were detected in HIV patients and general population who were older than 42 years, and cohort studies only provided data of serological detection to support early response to monkeypox outbreak.

Sexual orientation was associated with intention to be vaccinated with a smallpox vaccine against mpox: A cross-sectional preliminary survey in Japan.

This survey aimed to assess the prevalence of intention to receive smallpox vaccine against mpox and its relationship with sexual orientation in Japan. A cross-sectional online survey was conducted in September-October 2022, with 12,900 assigned males and 13,413 assigned females participating. Modified Poisson regression analyses were performed to determine the relationship between vaccine willingness and sexual orientation, adjusting for socioeconomics, trust in government, COVID-19 vaccination status, and frequency of brothel visits. Vaccine willingness was higher in homosexual respondents than heterosexual counterparts, with proportions of 23.1 % among assigned males and 13.4 % among assigned females. Homosexual orientation was significantly associated with vaccine willingness, with prevalence ratios of 1.37 (95 % CI: 1.23-1.54) among assigned males and 1.34 (95 % CI: 1.13-1.59) among assigned females. These findings highlight the need for targeted vaccine promotion campaigns and ongoing monitoring of attitudes towards mpox and vaccine compliance in high-risk groups.

Comparison between COVID-19 and monkeypox vaccine uptake in a diverse London HIV cohort

Background: The COVID-19 pandemic caused millions of deaths, its impact lessened with effective vaccines and treatments. The subsequent monkeypox outbreak posed another global threat, disproportionately affecting men who have sex with men (MSM), with concerns around increasing community stigma. Vaccinating at risk groups is vital in minimising COVID-19 and monkeypox transmissions and adverse sequalae. Our HIV clinic serves a diverse population in a deprived area with a large immigrant population and high level of co-morbidities, associated with poorer outcomes. We explored factors associated with COVID-19 and monkeypox vaccine uptake. Method(s): We reviewed COVID-19 vaccine first, second and third/booster uptake and first smallpox vaccine among MSMs attending our HIV clinic. Monkeypox vaccination is a two-dose course. Initial limited vaccine availability meant first monkeypox vaccine was prioritised for all eligible patients;we therefore analysed first monkeypox vaccination uptake. 186 MSM PLWH were identified. 164 were included in our analysis;22 were excluded due to insufficient vaccination information. Data was recorded contemporaneously in patients' records. COVID-19 vaccine uptake was verified using NHS Summary Care Record and London Care Record. Data on age and ethnicity was collected. Result(s): Demographics: Age: mean 42.9 years, 49% <=40 years, 51% >40 years Ethnicity: 55% White, 26% Black, 5% Asian, 2% mixed, 7% other, 4% not stated COVID-19 vaccination uptake reached statistical significance between age groups: <=40y 53%, >40y 80% (p = 0.001) and ethnicities: White 73%, Black 50%, Asian 67% (p = 0.026). Monkeypox vaccination uptake did not reach significance: <40y 26%, >40y 29%;ethnicity: White 31%, Black 24%, Asian 33%. Additionally, COVID-19 vaccinated patients were not statistically significantly more likely to accept monkeypox vaccination. Conclusion(s): Monkeypox vaccination uptake was similar across ages and ethnicities. However, monkeypox vaccination uptake was considerably lower than COVID-19 vaccination. Further work is needed to identify and engage at risk groups and address obstacles affecting monkeypox vaccination in marginalised communities. Lessons from COVID vaccination campaigns should be employed to reach unvaccinated high-risk MSMs. (Table Presented).

Timeline: Key Stories and Topics in HIC This Century

The article presents the discussion on news related to various topics. Topics include Infection preventionists (IPs) urging to take a leadership role in the burgeoning national patient safety movement after the 1999 Institute of Medicine report;and MRSA killing more people annually than human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the US.

Monkeypox Knowledge and Vaccine Hesitancy of Czech Healthcare Workers: A Health Belief Model (HBM)-Based Study.

BACKGROUND: The recent human monkeypox virus (HMPXV) outbreak in non-endemic countries that started in May 2022 has raised concerns among public health authorities worldwide. Healthcare workers (HCWs) play a decisive role during epidemics in transmitting accurate information to the public and motivating them to pursue protective behaviours, including immunisation. METHODS: A cross-sectional survey-based study was conducted in the Czech Republic in September 2022 to evaluate HMPXV-related knowledge and vaccination perceptions among HCWs. The study utilised a digital self-administered questionnaire (SAQ) to collect data from the target population. The proposed SAQ inquired about participants' sociodemographic and anamnestic characteristics, perceived knowledge of HMPXV, factual knowledge, and vaccination perceptions according to the health belief model (HBM). RESULTS: A total of 341 participants were included in this study; most of them were females (88.9%), allied HCWs (89.4%), heterosexuals (87.1%), married (61.9%), and vaccinated against COVID-19 (91.2%). Only 8.8% of the participants agreed to receive vaccination against HMPXV; 44.9% rejected it, while 46.3% were hesitant. While digital news portals (47.5%) and social media (25.8%) were among the most utilised sources of information about HMPXV, the scientific journals (5.6%), ECDC (5%), and the U.S. CDC (1.5%) were the least common sources. The participants demonstrated suboptimal levels of factual knowledge, especially regarding HMPXV vaccines (1.5 ± 1.2 (0-4)) and treatments (0.9 ± 0.9 (0-4)). Additionally, several misconceptions were detectable among the participants, regarding topics such as the availability of effective vaccines and antivirals against HMPXV, the risk of vertical transmission, and homosexual stigmatisation. The HBM indicated that the cues to action and perceived susceptibility were the most important constructs to predict HMPXV vaccine acceptance. CONCLUSIONS: the findings of this study call upon public health practitioners and health policymakers in the Czech Republic to act accordingly in order to determine the drivers of vaccine hesitancy among Czech HCWs. Dedicated educational campaigns should aim to counter the HCWs' misconceptions around HMPXV, and future studies should aim to explore the prevalence and drivers of HMPXV vaccine hesitancy among the general population.

A TOUCH OF THE HEART AND THE TOOLS FOR DIAGNOSIS

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Myocarditis is inflammation of the heart muscle, and its onset is usually followed by an inciting event such as a viral infection. Here, we report a case of myocarditis in an adolescent male with no significant medical history who presented with chest pain after his second dose of the covid vaccine. CASE PRESENTATION: An 18-year old male presented with no significant past medical/surgical history presented with chest pain. His only triggering event was receiving the second dose of his covid vaccine. A physical examination, chest x-ray, electrocardiogram, and echocardiogram revealed no significant findings. His laboratory findings were positive for myocardial damage with elevated troponin. All other laboratories for autoimmune and inflammation were negative. He was transferred to another facility for cardiac MRI, which subsequently had findings consistent with myocarditis. He remained asymptomatic, and laboratories were normalized. He was discharged and, on follow-up, remained asymptomatic. DISCUSSION: Covid vaccine-induced myocarditis has become a prominent issue. As of March 2022, there are 2323 preliminary reports of myocarditis/pericarditis following either mRNA vaccine, with most cases being young male adolescents. Prior vaccination, such as the smallpox vaccine, has a well-documented history of causing myocarditis, initially thought to be a rare occurrence, it had a prevalence as high as 10% when reviewed. A similar pattern may be observed with the covid vaccine;thus, this complication can be significantly underestimated, and physicians must be vigilant. Thus, cardiac MRI should be pursued if clinically suspected. It has been shown to provide reliable clinical information even in the early phases of inflammation as well as the extent of the inflammatory process, and it avoids invasive procedures1 It can also be used prognostically to monitor disease status. Myocarditis may be immune-related. Key observations include increased systemic reactogenicity and immunogenicity in younger study participants in Pfizer-biotech clinical trials. However, another report showed no difference in spike antibody between patients with myocarditis and those without myocarditis post-covid mRNA vaccine, arguing against a hyperimmune response2. Another plausible mechanism is molecular mimicry between the spike protein and self-antigens, showing cross-reactivity between human peptides in the body, including alpha-myosin3, which may explain why only mRNA covid vaccine causes this complication. Currently, there is no causal relationship, but numerous hypotheses are being examined. CONCLUSIONS: Myocarditis must be recognized as a complication of the covid vaccine and a possible differential of chest pain,specifically in young men in the current pandemic.Early referral of cardiac MRI, if unavailable at centers, is essential for diagnosis and prognostication,given the unknown sequela of this disease. Reference #1: M. Giulia Gagliardi and Bruno Polletta Paolo Di Renzi, Gagliardi, M. G., M. Giulia Gagliardi Department of Cardiology and Cardiac Surgery, Polletta, B., Bruno Polletta Department of Cardiology and Cardiac Surgery, Renzi, P. D., & Paolo Di Renzi Department of Radiology Fatebenefratelli-Isola Tiberina Hospital. (1999, January 26). MRI for the diagnosis and follow-up of Myocarditis. Circulation. Retrieved April 13, 2022, from https://www.ahajournals.org/doi/full/10.1161/circ.99.3.457/a Reference #2: Muthukumar, A., Alagarraju Muthukumar Department of Pathology (A.M., Narasimhan, M., Madhusudhanan Narasimhan Department of Pathology (A.M., Li, Q.-Z., Quan-Zhen Li Department of Immunology (Q.-Z.L.), Mahimainathan, L., Lenin Mahimainathan Department of Pathology (A.M., Hitto, I., Imran Hitto https://orcid.org/0000-0002-9928-4175 Department of Pathology (A.M., Fuda, F., Franklin Fuda Department of Pathology (A.M., Batra, K., Kiran Batra Department of Radiology (K.B.), Jiang, X., Xuan Jiang Department of Internal Medicine (Q.-Z.L., Zhu, C., Chengsong Zhu Department of Internal Medicine (Q.-Z.L., Schoggins, J., … Al., E. (2021, June 16). In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mrna vaccine. Circulation. Retrieved March 31, 2022, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056038 Reference #3: Vojdani, A., & Kharrazian, D. (2020, August). Potential antigenic cross-reactivity between SARS-COV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clinical immunology (Orlando, Fla.). Retrieved March 31, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246018/ DISCLOSURES: No relevant relationships by Aaron Douen No relevant relationships by Sudhanva Hegde No relevant relationships by Marc Sukhoo-Pertab

Development of Modified Vaccinia Virus Ankara-Based Vaccines: Advantages and Applications.

Modified vaccinia virus Ankara (MVA) is a promising viral vector for vaccine development. MVA is well studied and has been widely used for vaccination against smallpox in Germany. This review describes the history of the origin of the virus and its properties as a vaccine, including a high safety profile. In recent years, MVA has found its place as a vector for the creation of vaccines against various diseases. To date, a large number of vaccine candidates based on the MVA vector have already been developed, many of which have been tested in preclinical and clinical studies. We discuss data on the immunogenicity and efficacy of some of these vaccines.

Multiparametric CMR Findings in Mrna COVID-19 Vaccine-induced Myocardit is: A Case Series

Introduction: Within weeks of the pediatric coronavirus disease 2019 (COVID-19) vaccination campaign beginning, reports of acute myocarditis after adolescents' second vaccination began. The present research describes the clinical and cardiovascular magnetic resonance (CMR) imaging characteristics of three adolescents recently vaccinated with a mRNA vaccine and admitted for myopericarditis treatment. Case Description: This retrospective case-series investigated adolescents admitted within a week of their second mRNA COVID-19 vaccination. The electronic medical record was queried for all patients ≥12 years old, admitted for acute myocarditis or pericarditis (International Classification Diseases-Version 10;I30.xx, I40.xx respectively) since April 1, 2021. Patients were included if they had a documented mRNA vaccination in the prior seven days. Three patients met inclusion criteria. All three had acute onset chest pain within 48 hours of receiving their second mRNA vaccine. All had elevated troponins, all were eventually admitted and had mild clinical courses. All met Lake Louise criteria for acute myocarditis despite only one patient having mild depression of cardiac function on echocardiography. All patients were negative for COVID-19 and none had a clinical history or immunologic evidence of prior COVID-19. The patient with the most diffuse pattern of late gadolinium enhancement on CMR (Figure 1) developed ventricular tachycardia three weeks after discharge. Discussion: Vaccine induced myopericarditis is rare in inactivated vaccines, but is a known entity with live vaccines, especially the smallpox vaccine. Since the 1950's, cases of myocarditis and pericarditis have been reported in association with vaccination. Research using VAERS has previously found that from 1990- 2018, 0.1% of reports were for myopericarditis associated with vaccination. The rates of mRNA vaccine-induced myocarditis are currently unknown, but our clinical findings are similar to other recently published case series of pediatric mRNA associated myopericarditis. We have observed differences in CMR patterns between our patients from this series and previous reports of patients with cardiac involvement from COVID-19 (Table 1). We remain uncertain regarding the precise pathophysiology in these patients with myocardial inflammation following mRNA vaccine administration. However, the relatively focal pattern of involvement, and the relative preservation of global function, suggest a milder involvement of the myocardium-in most of these patients-than has previously been observed in classic viral and COVID-19 myocarditis. Conclusion: Three adolescent males developed acute myocarditis within days of their second mRNA COVID-19 vaccination. CMR in combination with serum troponin measurements was critical for diagnosis, and arrythmia monitoring was critical in their follow up. Repeat CMR studies over the six months following diagnosis will be important to rule out development of post-inflammatory fibrosis and long-term arrhythmias. Legend: A and B: LGE (Magnitude IR) and PSIR (Phase sensitive IR), respectively, showing patchy epicardial enhancement at the basal inferolateral and inferior segments;C: Abnormal ECV at basal anterolateral, inferolateral and inferior segments;D and E: ECV and T1 bullseye maps with abnormal values;F and G: Patchy visible edema at basal inferolateral, anterolateral and inferior segments on the T2 and T2 color map;H: Bullseye map showing T2 values;I: Asymmetric Right axillary lymphadenopathy secondary to vaccination in the right arm.

Monkeypox Vaccination in the Republic of Korea: Identifying the High-Risk Target Group.

In June 2022, the first monkeypox case was reported as imported into Korea. The general public asked whether they should get vaccinated against monkeypox because of the recent COVID-19 vaccination experience. As of the current monkeypox outbreak situation, a ring vaccination strategy for the high-risk group is more appropriate than the mass population vaccination with smallpox vaccines. Therefore, identifying the proper target group by available vaccines based on the risk and benefit analysis is a key issue of the vaccination program. In addition, the target group should be reviewed by the epidemiological situation of the jurisdiction along with the updated evidence of the monkeypox virus on transmission dynamics, severity, and fatality.

CARDIAC ADVERSE EVENTS AFTER VACCINATION-A SYSTEMATIC REVIEW

Background: Myocarditis and pericarditis can present as mild to life-threatening inflammatory symptoms involving the heart. This has been associated with several drugs and vaccines. We present adverse cardiac events reported after vaccination. Methods: A systematic review of the literature using Medline, Embase, Cochrane, and Scopus was performed to identify cases of adults who developed adverse cardiac events after vaccination from inception through July 2021. Data is reported using descriptive statistics. Results: There were 33 studies describing adverse cardiac events after vaccination with a total of 270 patients. The majority described adverse cardiac events following smallpox vaccine administration, followed by COVID-19 vaccination (12.96%), influenza vaccination (2.59%), tetanus vaccination (0.74%), and pneumococcal vaccination (0.74%). Approximately 85% of cases were male, and 96% of the patients were younger than 65 years old. From the cardiac events, 63.3% described were myocarditis, 13.33% were myopericarditis, 6.66% were acute coronary syndrome, 2.96% were pericarditis and 0.70% developed a pericardial effusion. Troponin levels were elevated in 68.2% of patients. Most developed cardiac events seven days post vaccination and 23.49% developed symptoms within seven days. Management was not described in the majority of the reports. In the cases where treatment was described anti-inflammatory medications were used in 56.09%, colchicine was used in 41.46% and steroids were used in 19.51% of patients. One patient required extra-corporeal membrane oxygenation. All patients recovered except one mortality with smallpox vaccine where biopsy showed eosinophilic epicardial inflammation on autopsy. Conclusion: Adverse cardiac events after vaccination have been reported with different vaccines. Management varies for these patients. These events are rare, and unlikely to be fatal.

The contributions of William Money MRCS to smallpox vaccination and control - A little-known story.

This history of vaccinology article outlines the work of William Money (1790-1843), who conducted a study related to smallpox disease, immunity, and vaccination. His hitherto unpublished study demonstrated that smallpox could be contracted more than once; notably, results from his studies showed that vaccination was not dangerous. He was also the author of a celebrated Vade Mecum in human anatomy. Here, we outline the work he conducted in England: from serving as the house surgeon at Northampton Infirmary to his post as a surgeon at the Royal Metropolitan Hospital in London.