Clinical trial NCT05879965: Prospective Study for the FOLLOW-UP of Human Monkeypox Cases and Smallpox Vaccinees at Risk
Official title: 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
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Monkeypox
Keywords: mpox
immunology
mucosal immunity
sequelae
smallpox vaccination
Lead sponsor: Institute of Tropical Medicine, Belgium
Sponsor class: OTHER
First posted: 2023-05-30
Enrollment: 345
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Former mpox patients ≥18 years, diagnosed by PCR at ITM since May 2022 Smallpox vaccine recipients (2xSC) or (2xID), routinely vaccinated at ITM since August 2022 Healthy HIV-PrEP users

Brief summary: 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: 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)

Eligibility criteria: 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

Primary outcomes:
measure: Proportion of individuals with a positive mpox serology in both groups
timeFrame: 2 years
measure: Proportion of long-term problems or sequelae in mpox patients
timeFrame: 2 years
Secondary outcomes:
measure: longevity of humoral and/or cellular immune response to mpox or vaccinia virus
timeFrame: 2 years
Other outcomes:
Locations:
city: Antwerp
country: Belgium
facility: Institute of Tropical Medicine
Study officials:
affiliation: Institute of Tropical Medicine
name: Nicole Berens-Riha, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Institute of Tropical Medicine
name: Laurens Liesenborghs, PhD
role: STUDY_DIRECTOR
References: