ArticleThe Lancet. Infectious diseases2023
The global landscape of smallpox vaccination history and implications for current and future orthopoxvirus susceptibility: a modelling study.
Article in The Lancet. Infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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Who cites it
32 citing papers in PubMed, 54 citations in OpenAlex.
- Multiroute pathogen transmission is different.Science advances · 2026Article
- Preventing Disease Emergence Following Eradication: Application to Mpox.bioRxiv : the preprint server for biology · 2026Article
- Insights into Monkeypox Virus: Host Immunity, Viral Immune Evasion, Recent Advances in Vaccines, Therapeutic Development, and Future Perspectives.Microorganisms · 2026Review
- Sero-genomic evidence for occult mpox exposure in healthy Nigerian adults.Nature communications · 2026Article
- Disentangling Temporal Trends of Clade Ib Monkeypox Virus Transmission in Burundi.The Journal of infectious diseases · 2026Article
- Role of community and sexual contacts as drivers of MPXV clade I.Nature health · 2026Article
- Serological differentiation between Mpox infection and vaccine-induced immunity: a mini-review.Frontiers in immunology · 2026Review
- Associations between the 2022 global mpox outbreak and multifaceted factors: A multi-geographical retrospective study.One health (Amsterdam, Netherlands) · 2025Article
- From neglected to notoriety: a review of Mpox clinical features, virology, epidemiology, treatment and prevention strategies.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Review
- Article
- Vaccination strategies to achieve outbreak control for MPXV Clade I with a one-time mass campaign in sub-Saharan Africa: A scenario-based modelling study.PLoS medicine · 2025Article
- Antibody Responses are Sustained 2 Years Post-Mpox Infection but not Following Modified Vaccinia Ankara-Bavarian Nordic Vaccination.Open forum infectious diseases · 2025Article
- Immune Response to MVA-BN Vaccination for Mpox: Current Evidence and Future Directions.Vaccines · 2025Review
- Orthopoxvirus zoonosis: A potential threat across the Balkan countries.Journal of public health research · 2025Article
- Article
- Effectiveness of different border control strategies for reducing mpox importation risk: a modelling study.The Lancet regional health. Southeast Asia · 2025Article
- Development and validation of a quantitative Orthopoxvirus immunoassay to evaluate and differentiate serological responses to Mpox infection and vaccination.EBioMedicine · 2025Article
- Viral genomic features predict Orthopoxvirus reservoir hosts.Communications biology · 2025Article
- Suspected and confirmed mpox cases in DR Congo: a retrospective analysis of national epidemiological and laboratory surveillance data, 2010-23.Lancet (London, England) · 2025Article
- Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundMore than four decades after the eradication of smallpox, the ongoing 2022 monkeypox outbreak and increasing transmission events of other orthopoxviruses necessitate a greater understanding of the global distribution of susceptibility to orthopoxviruses. We aimed to characterise the current global landscape of smallpox vaccination history and orthopoxvirus susceptibility.
methodsWe characterised the global landscape of smallpox vaccination at a subnational scale by integrating data on current demography with historical smallpox vaccination programme features (coverage and cessation dates) from eradication documents and published literature. We analysed this landscape to identify the factors that were most associated with geographical heterogeneity in current vaccination coverage. We considered how smallpox vaccination history might translate into age-specific susceptibility profiles for orthopoxviruses under different vaccination effectiveness scenarios.
findingsWe found substantial global spatial heterogeneity in the landscape of smallpox vaccination, with vaccination coverage estimated to range from 7% to 60% within admin-1 regions (ie, regions one administrative level below country) globally, with negligible uncertainty (99·6% of regions have an SD less than 5%). We identified that geographical variation in vaccination coverage was driven mostly by differences in subnational demography. Additionally, we found that susceptibility for orthopoxviruses was highly age specific based on age at cessation and age-specific coverage; however, the age profile was consistent across vaccine effectiveness values.
interpretationThe legacy of smallpox eradication can be observed in the current landscape of smallpox vaccine protection. The strength and longevity of smallpox vaccination campaigns globally, combined with current demographic heterogeneity, have shaped the epidemiological landscape today, revealing substantial geographical variation in orthopoxvirus susceptibility. This study alerts public health decision makers to non-endemic regions that might be at greatest risk in the case of widespread and sustained transmission in the 2022 monkeypox outbreak and highlights the importance of demography and fine-scale spatial dynamics in predicting future public health risks from orthopoxviruses.
fundingUS National Institutes of Health and US National Science Foundation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.