Prospective Study for the FOLLOW-UP of Human Monkeypox Cases and Smallpox Vaccinees at Risk

Study Overview
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Brief Summary
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The goal of this observational study is to describe possible physical and psychological sequelae after an mpox infection and to evaluate the longevity of B- and T-cell immune responses in former mpox patients and vaccine recipients. The main questions it aims to answer are: Are there any physical or pschological sequelae after mpox infection? Is the humoral and/or cellular immune response to MPOX (or vaccinia) virus) durable? Do the patients develop strong local immunity in comparison to systemic immunity? How long is the virus still detectable in semen, saliva or the ano-rectal region? Participants will answer a questionnaire, samples with blood, saliva and semen as well as anal swabs will be collected. Follow-up visits 8, 16 and 24 months after infection or vaccination are planned. A healthy control group will be recruited in our HIV-PrEP clinic.

Detailed Description
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Long-term problems or sequelae after an acute viral infection are described. The study aim is to investigate if long-term symptoms and sequelae can be found in the ITM human mpox infection cohort previously diagnosed and confirmed by PCR at the Institute of Tropical Medicine in Antwerp during the mpox outbreak 2022 in Belgium. The immune response after a natural mpox infection and after a smallpox vaccination will additionally analysed over time. Consented participants Mpox patients, acute infection (n=169, 21% assumed smallpox vaccination in childhood) Mpox patients for follow-up (n=95, 20% assumed smallpox vaccination in childhood) Smallpox vaccinees, two intradermal doses (n=100) Smallpox vaccinees, two subcutaneous doses (n=100) Healthy unvaccinated controls (n=50) Design This prospective longitudinal study has the main objectives to describe possible physical and psychological sequelae after an mpox infection and to evaluate the longevity of B- and T-cell immune responses in former mpox patients and vaccine recipients. Participants are being followed up 8, 16 and 24 months after infection or vaccination. Sample collection Anal eSwabs from patients, controls and vaccinees Saliva (Omnigene-oral and dry swabs) from patients, controls and vaccinees Serum from patients, controls and vaccinees Optional semen samples from patients PBMC samples from a sub-group of patients, controls and vaccinees Laboratory analysis MPXV-PCR on saliva, anorectal and optional semen samples of former mpox patients, vaccinated individuals and healthy controls Mpox-specific antibody profiling from serum Mucosal immunity (IgA, IgG) mpox-specific/reactive from anal swabs and/or saliva Enumeration of MPXV-specific effector-memory T cells via flow cytometry-based AIM or ICS assays (peptide pool stimulation or HLA-restricted multimer-based capture assays) Enumeration of MPXV-specific memory B cells or plasma cells via flow cytometry-ased AIM or ICS assays (recombinant antigen stimulation or HLA-restricted multimer-based capture assays)

Official Title
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Prospective On-site and Questionnaire Study for the FOLLOW-UP of Mpox Cohort at ITM PLUS Evaluation of the Longevity of B- and T-cell Immune Responses in Former Mpox Patients and Vaccine Recipients

Conditions
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Monkeypox

Participation Criteria
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Eligibility Criteria
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Mpox patients for immunological study Inclusion criteria PCR-confirmed monkeypox infection since May 2022 ≥18 years Willingness to provide written informed consent Willingness to follow the study schedule Exclusion criteria Born before 1976 Any documented or remembered smallpox vaccination or typical scar for a smallpox vaccination Any vaccination 2 weeks before or after the visits (4 weeks for life-vaccines) Any immune-compromising drugs or diseases (treated and controlled HIV-infection is no exclusion criteria) Any mpox reinfection since study start Smallpox vaccinees for immunological study Inclusion criteria Two 3rd generation smallpox vaccinations either two subcutaneous or two intradermal vaccinations with a minimum of 4 weeks and a maximum of 8 weeks interval. First vaccination given after 01 August 2022. ≥18 years Willingness to provide written informed consent Willingness to follow the study schedule Exclusion criteria Born before 1976 Any documented or remembered smallpox vaccination or typical scar for a smallpox vaccination Any vaccination 2 weeks before or after the visits (4 weeks for life-vaccines) Any immune-compromising drugs or diseases (treated and controlled HIV-infection is no exclusion criteria) Any mpox infection in the past HIV-Prep patients Inclusion criteria On HIV-PrEP and a patient from ITM ≥18 years Willingness to provide written informed consent Willingness to follow the study schedule Exclusion criteria Born before 1976 Any documented or remembered smallpox vaccination or typical scar for a smallpox vaccination Any vaccination 2 weeks before or after the visits (4 weeks for life-vaccines) Any immune-compromising drugs or diseases Any mpox infection in the past

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| mpox patients<br>mpox cohort diagnosed and confirmed by PCR at the Institute of Tropical Medicine (ITM) in Antwerp during the recent mpox outbreak May-October 2022, 95 consented patients for follow-up | |
| Smallpox vaccine recipients<br>sub-group 1: 100 participants routinely vaccinated with two subcutaneous 3rd generation smallpox vaccines sub-group 2: 100 participants routinely vaccinated with two intradermal 3rd generation smallpox vaccines | |
| Healthy controls<br>50 controls recruited during HIV-PrEP consultation (no former mpox infection, no smallpox vaccination) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of individuals with a positive mpox serology in both groups | To compare the MPXV-specific serological response in naturally infected mpox male patients 8, 16 and 24 months after onset of symptoms with the MPXV-specific serological response in routinely (=2 either subcutaneous (SC) or intradermal (ID) vaccinations with an interval of 4-8 weeks) vaccinated men against smallpox 8 months after the first vaccination | 2 years | 
| Proportion of long-term problems or sequelae in mpox patients | To describe any possible long-term problem or sequela after an acute human mpox infection diagnosed and confirmed by PCR at ITM since the beginning of the mpox outbreak End of May 2022 | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| longevity of humoral and/or cellular immune response to mpox or vaccinia virus | B-cell and T-cell characteristics in former mpox patients and smallpox vaccinees 8, 16, 24 months after symptom | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mpox, immunology, mucosal immunity, sequelae, smallpox vaccination