Letter to the Editor
Anti-Vaccinia Immunoglobulin and Post-exposure Prophylaxis with Vaccinia-based Vaccine for Management of the Monkeypox Outbreak
Inmunoglobulina anti-Vaccinia y profilaxis postexposición mediante vacuna basada en Vaccinia para el control del brote de viruela símica (Monkeypox)
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Fernández-Parrado" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Rodríguez-Cuadrado" "email" => array:1 [ 0 => "franciscojose.rodriguezcuadrado@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E.L." "apellidos" => "Pinto-Pulido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Fernández-Parrado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Príncipe de Asturias, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inmunoglobulina anti-<span class="elsevierStyleItalic">Vaccinia</span> y profilaxis postexposición mediante vacuna basada en <span class="elsevierStyleItalic">Vaccinia</span> para el control del brote de viruela símica (<span class="elsevierStyleItalic">Monkeypox</span>)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Some time ago, we published a brief review of treatments available or in development that could be of use in the control of the then incipient outbreak of monkeypox.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In that review, we highlighted the role of tecovirimat as the only antiviral drug approved by the European Medicines Agency (EMA) for the virus, given its good safety profile and proven efficacy in reducing mortality in animal models.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In response to that publication, Dr Sookaromdee and Dr Wiwanitkit published a letter entitled <span class="elsevierStyleItalic">Treatments for Monkeypox</span>,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> in which they shared their opinion on the use of tecovirimat and mentioned intravenous immunoglobulin as another potentially effective treatment for monkeypox, now declared a <span class="elsevierStyleItalic">Public Health Emergency of International Concern</span> by the World Health Organization (WHO).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the affirmations by Dr Sookaromdee and Dr Wiwanitkit is that, although tecovirimat has demonstrated efficacy, it is not a widely used drug in countries in which the <span class="elsevierStyleItalic">Monkeypox virus</span> has traditionally been considered endemic.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> A possible reason for the limited use of tecovirimat in those countries is that their healthcare resources and structure are not comparable to those in European countries.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In addition, we should add that approval by the EMA<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> is not applicable in Africa, and to date, it is the only health agency to have approved the drug for the indication of monkeypox.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The second aspect that we wanted to comment on is the possibility of using intravenously-administered anti-<span class="elsevierStyleItalic">Vaccinia</span> immunoglobulin, proposed by Sookaromdee and Wiwanitkit.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This immunoglobulin is indicated only for the treatment of certain complications such as <span class="elsevierStyleItalic">eczema vaccinatum</span>, progressive <span class="elsevierStyleItalic">Vaccinia</span>, and severe generalized <span class="elsevierStyleItalic">Vaccinia</span> caused by administration of the vaccine derived from the <span class="elsevierStyleItalic">Vaccinia virus</span>.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The regimen administered is 6000<span class="elsevierStyleHsp" style=""></span>U/kg as soon as possible after onset of the first symptoms of the disease, with possible dose repetitions according to the severity of the condition and response to the initial dose (doses can be increased to 9000<span class="elsevierStyleHsp" style=""></span>U/kg if the patient has not responded to the first dose).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Although there are factors to support its use against monkeypox, such as the similarity of <span class="elsevierStyleItalic">Orthopoxvirus</span> genomes,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> to date, there have been no human trials on its use in this indication.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, it is necessary to highlight the use of the <span class="elsevierStyleItalic">Vaccinia</span>-based vaccine as post-exposure prophylaxis. The WHO currently recommends administration of a second- or third-generation vaccine for case contacts in the first 4 days after exposure.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> It is estimated that the vaccine could provide cross-immunity against the <span class="elsevierStyleItalic">Monkeypox virus</span> with an efficacy of approximately 80%–85%,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> given the aforementioned genomic similarity among <span class="elsevierStyleItalic">Orthopoxvirus</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential treatments for monkeypox" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.J. 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Kinkela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1073/pnas.1005769107" "Revista" => array:6 [ "tituloSerie" => "Proc Natl Acad Sci U S A" "fecha" => "2010" "volumen" => "107" "paginaInicial" => "16262" "paginaFinal" => "16267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20805472" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000001/v1_202301060625/S0001731022009413/v1_202301060625/en/main.assets" "Apartado" => array:4 [ "identificador" => "6165" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000001/v1_202301060625/S0001731022009413/v1_202301060625/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022009413?idApp=UINPBA000044" ]
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| 2023 Agosto | 45 | 21 | 66 |
| 2023 Julio | 53 | 37 | 90 |
| 2023 Junio | 50 | 24 | 74 |
| 2023 Mayo | 43 | 30 | 73 |
| 2023 Abril | 26 | 22 | 48 |
| 2023 Marzo | 33 | 34 | 67 |
| 2023 Febrero | 37 | 29 | 66 |
| 2023 Enero | 134 | 68 | 202 |
| 2022 Diciembre | 64 | 46 | 110 |
| 2022 Noviembre | 69 | 47 | 116 |
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