Evidence for Residual Immunity to Smallpox After Vaccination and Implications for Re-emergence

Military Medicine
Mohana Priya KunasekaranChandini Raina MacIntyre

Abstract

Smallpox has been eradicated but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty about the duration and degree of residual immunity. Both cell-mediated and humoral immunity are thought to be important but the exact mechanisms of protection are unclear. Guidelines usually suggest vaccine-induced immunity wanes to zero after 3-10 years post vaccination, whereas other estimates show long term immunity over decades. A systematic review of the literature was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. Twenty-nine papers related to quantifying residual immunity to smallpox after vaccination were identified: neutralizing antibody levels were used as immune correlates of protection in 11/16 retrospective cross-sectional studies, 2/3 epidemiological studies, 6/7 prospective vaccine trials and 0/3 modeling studies. Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Ch...Continue Reading

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Citations

May 24, 2020·Viruses·Valentina CostantinoRaina MacIntyre
Aug 25, 2020·Plasma Processes and Polymers·Hager MohamedVandana Miller

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