Neutralizing antibodies (NAbs) against mpox decline substantially, often becoming undetectable, within two years of either mpox infection or vaccination with the modified vaccinia Ankara–Bavarian Nordic (Jynneos) vaccine, according to a small new study led by researchers at Vita-Salute San Raffaele University in Milan, Italy.
The study, published today in The Journal of Infectious Diseases, followed up with 90 men—48 with prior mpox infection and 42 who received Jynneos vaccination—and measured mpox virus (MPXV)–specific neutralizing antibodies more than two years after infection or vaccination.
At the two-year mark, antibodies were frequently low or undetectable in both previously infected participants and vaccine recipients, though participants with prior infection were more likely than vaccine recipients to retain some detectable antibodies (33 of 48 [68.8%] vs 20/42 [47.6%]).
Antibody levels measured at six months were also predictive: Participants with higher early titers were more likely to retain detectable antibodies at two years. In multivariate analysis, previous smallpox vaccination was also associated with higher titers at two years or later, while previous mpox infection was only marginally associated.
Protection may extend beyond neutralizing antibodies
Four mpox cases occurred among vaccine recipients during follow-up, but no cases occurred in participants who had a previous mpox infection.
“This trend finds confirmation in real life practice in our open access sexual health clinic, where the majority of new infections are diagnosed in persons with no history of Mpox,” write the researchers. They also note that, “as already reported in literature and as observed in our daily experience,” most mpox cases in vaccinated individuals are self-limiting and low severity.
This trend finds confirmation in real life practice in our open access sexual health clinic, where the majority of new infections are diagnosed in persons with no history of Mpox.
Considering that titers wane in vaccinated people and that mpox cases among vaccinated individuals are generally less severe, immunity to mpox likely extends beyond antibodies, argue the authors. Cellular immune responses and preexisting humoral immunity in people vaccinated against smallpox may confer protection even when antibody levels fall below detectable levels.
“Future research will need to focus on the complexity of immunological memory against Mpox and address the questions on durability and efficacy of protection after natural occurring infection or vaccination,” the researchers write.