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VonPamela Dörhöfer
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The vaccine against monkeypox can now also be administered intradermally in the USA due to expected bottlenecks. German experts take a critical view of this.
Frankfurt – There is great concern among experts that monkeypox will also become endemic in our part of the world if the current outbreak is not contained. More than 31,000 cases are currently known worldwidein Germany the Robert Koch Institute (RKI) reported 3102 on Friday.
As in other countries, most men who have had sexual contact with other men are affected, but there are also eleven women, three adolescents and one child. In containing the infectious disease, the authorities are primarily relying on vaccination. so far stands with “Imvanex”, however, only the vaccine from a single manufacturer – the Danish-German company Bavarian-Nordic.
Monkeypox in Germany: There could be a shortage of the vaccine
And so there are already signs of bottlenecks. In Europe, the UK and Belgium have reported vaccine shortages, and the US is expected to. The national health authority FDA has therefore given the green light to inject the vaccine intradermally into the skin.
“Imvanex” from Bavarian-Nordic is currently the only available vaccine against monkeypox. Sven Hoppe/dpa
© Sven Hoppe/dpa
Usually, the live vaccine used is injected twice into the muscle with an attenuated cowpox virus. However, a study on the modified vaccinia Ankara virus used came to the conclusion that one-fifth of the standard dose given into the skin is not immunologically inferior to an injection into the muscle.
The probable reason: The skin contains large amounts of dendritic cells, which are particularly effective in presenting foreign antigens (pathogens, vaccines) to the immune system, to which antibodies and T-cells can then bind
Monkeypox vaccine is running out – vaccinations in the skin lead to more effective immunization
Intradermal administration is already practiced, for example in vaccination against tuberculosis. In the event of bottlenecks in influenza vaccines, the idea of vaccinating into the skin has already been considered. In one study, intradermal administration of one-fifth the normal dose of an influenza vaccine resulted in comparable, sometimes even better, immunogenicity. However, vaccinations in the skin usually lead to stronger vaccination reactions.
However, meeting the demand for monkeypox vaccine by increasing production capacity does not seem realistic. As Ulrike Protzer, Director of the Institute for Virology at the Technical University of Munich, says, the vaccine is “unfortunately not that easy to produce”.
Monkeypox: Rash is similar to that of chickenpox
She suggests discussing out-licensing to other manufacturers – and if that’s not possible, going back to the almost identical Modified Vaccinia Ankara virus that was administered in Bavaria as a smallpox vaccine in the 1970s and that the Free State still sells in small quantities have stored. It could be used as a basis for the monkeypox vaccine, “which will be needed in view of the worldwide spread. Not only here, but also in Africa, where monkeypox has been rampant for five years.
Monkeypox is spreading – more vaccine doses will be delivered in September
Ulrika Protzer is skeptical about the push for an intradermal vaccination from the USA, mainly because of the severe skin reactions that sometimes lasted for more than four weeks. That would also be “not good” for the “acceptance” of the vaccination, she says.
Gerd Fätkenheuer, Head of Infectious Diseases at Cologne University Hospital, considers the injection into the skin “not feasible for practical reasons alone”. For example, pulling five syringes from the already small amount in the ampoules is not so easy to manage. The injection itself is an “even bigger problem” and technically “quite difficult” without special devices. There are “currently only a few doctors who have experience with it. “All in all: I think very little of this idea.”
In Germany, the federal government has ordered 240,000 doses of Imvanex, of which 40,000 have initially been delivered. According to the Ministry of Health, some were also added from EU stocks. Further vaccine deliveries are expected by September. However, the German Aidshilfe assumes that around one million doses of vaccine are needed to offer permanent protection to half a million people with an increased risk of infection.
Monkeypox – not enough vaccine for all people at high risk of infection
This includes above all men who have sex with other men – simply because they Disease is transmitted through infectious skin sites and the risk of coming into close contact with it is higher in this group. In principle, however, anyone can become infected with monkeypox.
Infectiologist Gerd Fätkenheuer assumes that the vaccination alone will not be enough “to completely stop the current spread of monkeypox” – not even in Germany, where he, like the Aidshilfe, assumes that there are significantly more people with an increased risk of infection than with the ordered ones doses can be vaccinated.
Knowledge should therefore be imparted on a “broad basis” on “how to behave in order to prevent infection,” said Fätkenheuer. This campaign must be designed in such a way that it also appeals to the target group. “In my opinion, there is still a lot to do here.” (Pamela Dörhöfer)
List of rubrics: © Sven Hoppe/dpa