Attenuated Smallpox Vaccine Suggested Against Monkeypox in Dermatologic Patients

Smallpox vaccines may provide cross-immunity for monkeypox with an efficacy of more than 80%.

An attenuated version of the smallpox vaccine can be useful to protect against the monkeypox virus in patients with dermatologic disorders, according to findings from a letter to the editor published in the Journal of the European Academy of Dermatology and Venereology.

There is no specific vaccine against the monkeypox virus but smallpox vaccines may provide cross-immunity with an efficacy of more than 80%. The second-generation vaccines contain live Vaccinia virus strains with replication capacity and have better safety profiles than first-generation orthopoxvirus vaccines, it was noted.

The vaccine is administered via multiple intradermal punctures, producing a papule that turns into a vesicle or pustule, forming a scab which leaves a small scar.

There are several dermatoses which are contraindications to receiving the orthopoxvirus vaccine, including a history of atopic dermatitis (AD), severe acne, Darier disease, psoriasis, impetigo, herpetic infection, extensive diaper dermatitis, and burns. This contraindication extends to those living with people who have these disorders to avoid the risk for contagion via the lesion which forms at the inoculation site.

“…the MVA vaccine could still mark a milestone in the history of public health.”

A third-generation Vaccinia virus strain vaccine, Modified Vaccinia Ankara (MVA), known as JYNNEOS in the US, contains a highly-attenuated viral strain which cannot replicate in mammals. This vaccine had comparable efficacy and an even greater safety profile than second-generation orthopoxvirus vaccines, allowing its administration to patients with HIV, AD, or other dermatoses. It can protect against smallpox after infection.

“At this stage, although mass vaccination does not seem necessary for the time being according to the World Health Organization, the MVA vaccine could still mark a milestone in the history of public health,” the letter’s authors wrote.


Fernández-Parrado M, Rodríguez-Cuadrado FJ, Pinto-Pulido EL. Monkeypox vaccine: special considerations for dermatologic patients. J Eur Acad Dermatol Venereol. Published online September 29, 2022. doi:10.1111/jdv.18622