Should we all be vaccinated against monkey pox?

In the Netherlands, monkey pox has been diagnosed in almost 1000 people in recent months.

Due to the number of infections with the apenpokkenvirus the Dutch and European health authorities are on high alert.

This after the WHO recently warned that the situation is getting out of hand.

A vaccine is available in the Netherlands for people from the so-called risk group – in this case men who have sex with men.

Science in Focus has asked Christian Morberg Wejse, professor of public health at Aarhus University, whether we can expect a new vaccination program.

ALSO READ: Expert: That’s why monkey pox may have become more contagious.

Cost and mortality determine whether you should be vaccinated

Several factors play a role in the decision of researchers and doctors whether a vaccination belongs in the fixed vaccination schedule.

Christian Morberg Wejse was involved in 2012 in the question of whether a vaccine against rotavirus should be included in the regular vaccination program for Danish children.

Christian Morberg Wejse says researchers will assess the pros and cons of a monkeypox vaccine in the same way they did in 2012, when the so-called rotavirus was assessed.

‘Although it made economic sense to vaccinate against rotavirus, in the end it didn’t make it into the vaccination program. The reason for this is that the virus has a relatively mild course of disease and a very low mortality – and the same goes for monkey pox.’

Monkeypox is usually not fatal

On July 20, only 5 people had died worldwide monkey pox, and there were as many as 14,000 infections. That equates to a mortality of 0.04 percent.

By comparison, one of the most dangerous viruses, the Marberg virus, has a 50 percent mortality.

The researchers look at infectiousness, mortality and economic disadvantages of the disease, but also at the side effects of the vaccine and how expensive the vaccination would be.

‘Those are the factors we investigate for every disease for which there is a good vaccine. Sometimes the conclusion is that we aim to vaccinate the entire population – as with COVID – and sometimes not, as with pneumococci. The latter vaccine is only offered to risk groups.’

Monkeypox is half as contagious as COVID-19

The so-called reproduction number (R0) of monkeypox is between 1 and 2, which means that a person with monkeypox infects one to two other people on average.

In comparison, the delta variant of COVID-19 had a reproduction number of 5, and the omikron variant that later became dominant in much of the world was probably three to four times as contagious as the delta variant.

But despite the relatively low reproduction number, the Netherlands has already started a vaccine against monkey pox, which mainly spreads through sex.

Professor: We are far from vaccinating everyone

Although monkeypox has a relatively mild disease course, the GGD Amsterdam and GGD Haaglanden do offer a vaccine to people who are at increased risk.

According to Christian Morberg Wejse, this has three main reasons.

‘Most infections occur in this group, so hopefully it will be very effective to roll out the vaccination program here.’

In addition, the vaccine is already being used in Nigeria, where some oil workers have been vaccinated against monkey pox. That turned out to work in about 85 percent of the cases, so we know that the vaccine is sufficiently effective.’

‘In addition, we have a strong prevention program for the group of men who have sex with many other men, because the risk of other diseases that are also sexually transmitted, such as HIV, is also high.’

There is a limited number of vaccines available in the Netherlands, so it will take some time before the entire population can be vaccinated, if necessary.

Monkeypox hardly mutates

Another factor that plays a role in whether a disease is dangerous enough for a mass vaccination program is whether the disease mutates a lot or not.

But are there any signs that monkeypox has really mutated to any appreciable extent since the first outbreak in 1970. small changes, but nothing drastic’, says Christian Morberg Wejse. He explains that the entire current outbreak can be traced back to a traveler who has been to West Africa.

‘The most important factor in the spread of the virus – which mainly spreads through sex – is that the disease has ended up in a new group of people who are sexually active. That is why it makes sense to focus on that group for further prevention.’

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