Here’s a bold statement: catching mpox might actually offer stronger and longer-lasting immunity than getting vaccinated. But here’s where it gets controversial—does this mean we should rethink our approach to mpox prevention? A recent study published in The Lancet Infectious Diseases by researchers in Belgium and the Netherlands suggests that natural infection with the mpox virus (MPXV) provides robust protection against future infections for up to two years, outperforming the immunity conferred by vaccines, which tends to wane over time and requires boosters. This finding raises important questions about how we balance the risks of infection with the benefits of vaccination.
The study, which began in 2022, tracked the long-term effects of mpox infection in adults, including the persistence of the virus in saliva, semen, and the anorectal area, as well as the durability of antibodies post-infection compared to those generated by the Jynneos smallpox/mpox vaccine. Participants were enrolled in a clinical registry with follow-ups at one month, eight months, 16 months, and 24 months post-infection. A parallel group of adults who received two doses of Jynneos (or one dose if they had childhood smallpox vaccination) was also monitored from August 2022 to January 2023.
And this is the part most people miss—while vaccines are a cornerstone of public health, natural infection appears to trigger a more robust immune response. Among 237 infected participants, 47% attended the eight-month follow-up, 57% at 16 months, and 27% at 24 months. In contrast, 98% of the 210 Jynneos recipients attended the eight-month follow-up, 77% at 16 months, and 69% at 24 months. By month eight, Jynneos recipients who hadn’t been vaccinated against smallpox had lower binding antibody concentrations compared to those who had recovered from mpox. Only 4% of vaccinated individuals showed detectable MPXV neutralizing antibodies, highlighting the disparity in immune responses.
Scarring was observed in 46% of mpox patients at month eight, 30% at month 16, and 32% at month 24, though most other symptoms resolved within a year. Importantly, all saliva, semen, and anorectal swabs tested negative for MPXV throughout the follow-up period, indicating that viral shedding is not a long-term concern.
The study’s authors emphasize the need for further research to determine if booster doses can improve the durability of vaccine-induced immunity. If boosters prove effective, targeted revaccination campaigns will be essential to maintain population-level protection. But here’s a thought-provoking question: If natural infection provides such strong immunity, should we reconsider the risks and benefits of exposure, especially in populations at lower risk of severe disease?
In a commentary accompanying the study, Raianna Fantin, PhD, and Camila Coelho, PhD, from the Icahn School of Medicine at Mount Sinai, argue that next-generation vaccines must focus on antigens that elicit long-lasting and cross-reactive immunity against multiple orthopoxviruses. By incorporating specific epitopes into prime-boost vaccine platforms, we could enhance both the strength and longevity of antibody-mediated protection while ensuring safety and global accessibility, particularly in regions like Latin America and Africa, where mpox has had a disproportionate impact.
What do you think? Is natural infection a viable alternative to vaccination, or do the risks outweigh the benefits? Share your thoughts in the comments—let’s spark a conversation about the future of mpox prevention.
