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Modified vaccinia Ankara

Modified Vaccinia Ankara (MVA) is a highly attenuated, replication-deficient strain of the vaccinia virus developed as a safe and effective third-generation vaccine against smallpox and related orthopoxviruses, such as monkeypox, and widely used as a viral vector platform for recombinant vaccines targeting various infectious diseases and cancers.^[1]^[2]^[3] MVA originated from the chorioallantois vaccinia virus Ankara (CVA) strain, which was subjected to over 570 serial passages in chicken embryo fibroblast cells during the 1950s and 1960s by Anton Mayr at the Institute of Medical Microbiology, Infectious and Tropical Diseases at the University of Munich and the Bavarian State Institute for Vaccines, resulting in approximately 30 kilobases of genomic deletions that eliminated virulence factors and rendered it non-replicative in mammalian and human cells.^[1] The strain was renamed MVA after its 516th passage in 1968, and these modifications led to the loss of six major immunomodulatory genes, enhancing its safety profile while preserving strong immunogenicity through efficient expression of viral and inserted recombinant genes.^[1] First administered to humans as a smallpox vaccine in 1971 and licensed in Germany in 1977, MVA was given to over 120,000 individuals by 1980 with an excellent safety record, demonstrating no serious adverse events even in vulnerable populations.^[1] Further development by Bavarian Nordic A/S produced the MVA-BN variant, marketed under brand names including Imvanex in Europe, Imvamune in Canada, and Jynneos in the United States, which received European Medicines Agency approval in 2013 for active immunization against smallpox, Canadian approval that same year, and U.S. Food and Drug Administration approval in 2019 for prevention of smallpox and monkeypox in adults aged 18 and older.^[2]^[3] Unlike first- and second-generation vaccinia vaccines like Dryvax or ACAM2000, which can replicate in humans and cause complications such as myocarditis or skin lesions, MVA does not replicate in human cells, making it suitable for immunocompromised individuals, those with atopic dermatitis, HIV, or cancer, and earning it a Biosafety Level 1 classification.^[1]^[3] The World Health Organization's Strategic Advisory Group of Experts on Immunization recommends MVA-BN for high-risk groups during mpox outbreaks, such as close contacts of cases, and for laboratory personnel handling orthopoxviruses, with its inclusion in the U.S. Strategic National Stockpile underscoring its role in public health emergency preparedness.^[2]^[3] Beyond orthopoxvirus protection, MVA's genetic stability and ability to induce robust innate and adaptive immune responses— including type I interferon production via the cGAS/STING pathway—have made it a cornerstone for vaccine vector development over the past 25 years, with recombinant versions in clinical trials for pathogens like HIV, tuberculosis, malaria, influenza, Ebola, and MERS-CoV, as well as cancer immunotherapies.^[1] Its versatility stems from efficient foreign gene insertion without interference from viral replication, enabling single-dose regimens that elicit long-lasting immunity, and ongoing research continues to explore its potential against emerging infectious threats.^[1]

History and Development

Origin of the Ankara Strain

The Ankara strain of vaccinia virus, designated as Chorioallantois Vaccinia virus Ankara (CVA), was developed at the Turkish Vaccine Institute in Ankara, Turkey, through repeated serial passages alternating between donkeys and calves to produce smallpox vaccine material. Pustule harvests from these animal passages served as the primary source for vaccine propagation, reflecting standard practices in poxvirus vaccine manufacturing during the mid-20th century. This strain emerged as a variant of earlier vaccinia lineages, likely tracing back to the New York City Board of Health strain from the early 1900s, and was maintained for routine vaccine production in Turkey.^[4]^[1] In 1953, the Ankara strain was transferred to the Institute for Infectious Diseases and Tropical Medicine in Munich, Germany, where it underwent purification via ultracentrifugation and two additional passages in cattle via cutaneous vaccination. Following this, it was introduced for public smallpox vaccination in the Federal Republic of Germany starting in the 1954/55 season, demonstrating typical vaccinia virus properties such as robust replication in mammalian hosts and induction of protective immunity, though with occasional side effects including secondary pox formations in approximately 781 reported cases that year. Early characterization confirmed its standard poxvirus morphology, antigenicity, and pathogenicity profile akin to other vaccinia strains used at the time.^[4]^[1] During the 1960s, Turkish and German researchers conducted animal experiments with the Ankara strain to evaluate its propagation efficiency and immunogenicity, alongside limited human trials as part of ongoing smallpox vaccination efforts, which by then had reached over 100,000 administrations globally with a favorable safety profile compared to less attenuated strains. These studies highlighted the strain's potential for broader application amid the World Health Organization's Intensified Smallpox Eradication Programme, launched in 1967 to accelerate global elimination through improved surveillance and safer vaccines.^[1]^[5]

Attenuation and Serial Passaging

Modified vaccinia Ankara (MVA) was developed by Anton Mayr and his colleagues at the Institute of Medical Microbiology, Infectious and Epidemic Diseases, University of Munich, in the late 1960s and early 1970s as a safer alternative to conventional vaccinia virus strains for smallpox vaccination.^[1] The process began with the chorioallantois vaccinia virus Ankara (CVA) strain, which was subjected to extensive serial passaging to attenuate its virulence while preserving immunogenicity.^[6] The attenuation was accomplished through more than 570 serial passages of CVA in primary chicken embryo fibroblast (CEF) cells, a non-permissive host for most poxviruses, which selected for mutants with restricted host range. This prolonged adaptation process favored the emergence of replication-deficient variants incapable of productive replication in mammalian cells, as the virus evolved to propagate efficiently only in avian CEF cultures.^[7] By the 516th passage in 1968, the strain was renamed MVA, and passaging continued to refine its safety profile.^[1] These passages resulted in substantial genomic alterations, including the loss of approximately 31 kb—about 15% of the original genome—manifested as six major deletions that truncated or eliminated 31 open reading frames, primarily those involved in host immune evasion and virulence. The deletions, designated I through VI, disrupted key genes essential for replication in human and other mammalian cells, rendering MVA highly host-restricted. Attenuation was verified in preclinical animal models, where MVA demonstrated markedly reduced virulence compared to wild-type vaccinia strains. In rabbits, intradermal inoculation produced no skin lesions, unlike the pronounced pock formation seen with parental CVA. Intracerebral challenge in mice showed survival rates exceeding 90% at doses lethal to wild-type vaccinia, indicating negligible neurovirulence.^[1] Similarly, in nonhuman primates such as macaques, MVA induced no systemic pathology and provided protective immunity against orthopoxvirus challenges without evidence of dissemination or severe adverse effects. These findings confirmed MVA's safety margin, paving the way for its evaluation in human trials.^[8]

Role in Smallpox Eradication

In the mid-1970s, Modified Vaccinia Ankara (MVA) was introduced in Germany as a safer alternative to traditional smallpox vaccines for primary vaccination, particularly in children and immunocompromised individuals.^[1] Developed through extensive attenuation, MVA demonstrated reduced virulence while eliciting protective immunity against orthopoxviruses, addressing concerns over the reactogenicity of earlier vaccinia strains. Its deployment marked a shift toward third-generation vaccines during the waning phases of the global eradication effort, prioritizing safety in vulnerable populations without compromising efficacy.^[1] During the final years of the World Health Organization's (WHO) smallpox eradication campaign from 1976 to 1980, MVA was administered to over 120,000 individuals, primarily in Germany, with an exemplary safety record.^[1] No serious adverse events were attributed to MVA, with recipients experiencing only mild local reactions and no systemic complications such as fever or progressive vaccinia. In comparison to first-generation vaccines like Dryvax, which carried risks of severe side effects including myocarditis and encephalitis in approximately 1 in 1,000 primary vaccinations, MVA exhibited significantly lower reactogenicity while preserving robust immunogenicity and seroconversion rates.^[1] This profile made it ideal for the intensified surveillance and containment strategies employed in the campaign's endgame. Following the WHO's declaration of smallpox eradication in 1980, MVA production and use were discontinued, and remaining stocks were archived.^[1] Interest in MVA revived in the late 1990s amid growing bioterrorism concerns, as intelligence revealed potential state-sponsored variola virus programs and the risks of accidental release from retained laboratory stocks.^[9] This resurgence positioned MVA as a key candidate for modern biodefense stockpiles, leveraging its historical safety data to support renewed clinical evaluation and manufacturing scale-up.^[9]

Biological Characteristics

Genomic Modifications

Modified vaccinia Ankara (MVA) exhibits a reduced genome size of approximately 178 kilobase pairs (kbp), compared to about 192 kbp in its parental chorioallantois vaccinia virus Ankara (CVA) strain, primarily due to the accumulation of deletions during serial passaging in chicken embryo fibroblasts.^[10] These deletions total around 31 kbp and encompass six major genomic regions (deletions I through VI), affecting over 30 open reading frames (ORFs) involved in host interaction and viral replication.^[11] Specifically, the deletions remove or fragment genes encoding host-range factors and immunomodulatory proteins, while preserving essential viral genes necessary for antigen production and presentation.^[7] Key deletions include region II in the left terminal inverted repeat, spanning about 4.5 kbp and eliminating the K1L gene, which encodes an ankyrin repeat-containing protein that restricts host range by inhibiting cellular signaling pathways.^[7] Deletion I, the largest at around 12 kbp in the left terminus, disrupts the C12L gene (homologous to the cowpox SPI-1 serine protease inhibitor) and several immunomodulatory ORFs that modulate innate immune activation.^[7] Other notable losses in deletions III, IV, and VI involve genes like A52R and A53R (NF-κB signaling inhibitors) and C3L/C2L (chemokine binding proteins), further impairing the virus's ability to evade host defenses.^[7] These genomic alterations contribute to MVA's avirulent phenotype by abolishing virulence factors required for efficient DNA replication and spread in mammalian hosts, rendering the virus replication-deficient in human cells.^[12] Notably, the deletion of K1L prevents inhibition of the NF-κB pathway, as K1L normally blocks IκBα degradation and RelA acetylation, leading to unchecked activation of this transcription factor and heightened innate immune stimulation upon infection. This enhanced immune signaling, combined with the loss of other immunomodulatory genes, underscores MVA's safety and immunogenicity as a vaccine platform.^[13]

Replication Cycle and Host Restriction

Modified vaccinia Ankara (MVA) exhibits a highly restricted replication cycle in most mammalian cells, including human cells, where infection is abortive despite successful viral entry and uncoating. Upon entry via membrane fusion, MVA initiates early gene expression, producing viral proteins necessary for genome replication, which proceeds to a limited extent. However, progression to late gene expression and virion assembly is severely impaired, resulting in the accumulation of aberrant, non-infectious viral particles rather than mature progeny virions. This block is attributed to host restriction factors such as the zinc-finger antiviral protein (ZAP), which targets late-stage morphogenesis, and other innate defenses that prevent full viral dissemination.^[14]^[15]^[16] In contrast, MVA undergoes productive replication exclusively in avian cells, such as chicken embryo fibroblasts (CEF), where all stages of the poxvirus life cycle—early and late gene expression, DNA replication, and virion assembly—occur efficiently, yielding high titers of infectious particles. This host range restriction, stemming from genomic deletions in host adaptation genes, enables large-scale vaccine production in CEF cultures while ensuring safety in mammalian hosts. For instance, in CEF, MVA DNA replication can increase over 400-fold within 24 hours, supporting robust amplification without the need for mammalian cell lines.^[16]^[17] MVA infection potently activates host antiviral responses in mammalian cells, more efficiently than replicating poxviruses, due to its inability to fully evade innate immunity. It strongly induces type I interferons through the cGAS-STING pathway, leading to upregulation of interferon-stimulated genes, and triggers apoptosis via pro-apoptotic factors like NOXA while downregulating anti-apoptotic MCL1. These responses, including NF-κB activation and inflammasome signaling, limit viral spread and enhance immunogenicity without productive infection.^[15]^[16] In vivo, MVA expresses antigens transiently in directly infected cells but fails to replicate or spread systemically in mammalian hosts, minimizing tissue damage and pathogenicity. This localized expression suffices to prime robust adaptive immunity, as seen in mouse models where low doses elicit strong CD8+ T-cell responses without dissemination to distant organs or induction of lesions. Such behavior underscores MVA's safety profile, with no observed virulence in primates or humans even at high doses.^[1]^[6]

Safety Profile and Immunogenicity

Modified vaccinia Ankara (MVA) exhibits an attenuated reactogenicity profile characterized by predominantly mild and transient local reactions, such as injection-site erythema, induration, pain, and swelling, which occur in the majority of recipients but resolve within days without sequelae.^[18] Unlike replication-competent vaccinia vaccines like ACAM2000, MVA does not cause severe adverse events such as myocarditis or pericarditis at rates above background, with only rare cases reported across multiple clinical evaluations as of 2025, and no established causality.^[18]^[19] Systemic reactions, including headache, myalgia, and fatigue, are also mild to moderate and occur at rates comparable to placebo, underscoring MVA's favorable safety margin due to its replication deficiency in human cells.^[20] MVA elicits broad immunogenicity, inducing robust CD8+ T-cell, CD4+ T-cell, and humoral immune responses, facilitated by its ability to support prolonged antigen expression in non-permissive host cells despite abortive replication.^[21] This results in strong neutralizing antibody production and T-cell mediated immunity, often superior to placebo and noninferior to traditional vaccinia strains in seroconversion rates.^[20] MVA demonstrates suitability for vulnerable populations, including HIV-positive individuals with CD4 counts above 350 cells/mm³, where it maintains a benign safety profile without impacting viral load or CD4 counts, and generates comparable immune responses to those in immunocompetent hosts.^[18] Limited data support its use in pregnant women at high risk of exposure, as a non-replicating vaccine with no observed fetal harm in preclinical models, though human evidence remains preliminary.^[22] As of 2025, phase 3 trials in children, adolescents, and pregnant women have further confirmed its safety profile, with mild reactogenicity similar to adults and no serious adverse events observed.^[23]^[24] Antibody responses to MVA wane over time, typically within 1–2 years post-vaccination, but T-cell memory persists for several years, providing durable cellular protection.^[25] Booster doses effectively restore and enhance both humoral and cellular immunity, supporting long-term vaccination strategies.^[20]

Applications as a Poxvirus Vaccine

Smallpox Vaccination

Modified vaccinia Ankara (MVA) serves as a third-generation smallpox vaccine, designed for enhanced safety in modern populations while providing robust immunogenicity against orthopoxviruses like variola virus.^[26] As a non-replicating live vaccine, MVA-BN (the Bavarian Nordic strain) was developed under the U.S. Project BioShield initiative to address biodefense needs following the 2001 anthrax attacks, which heightened concerns over potential bioterrorism involving smallpox.^[27] The U.S. Food and Drug Administration (FDA) approved JYNNEOS (MVA-BN), the commercial formulation of MVA, on September 24, 2019, for the prevention of smallpox disease in adults 18 years and older at high risk for infection.^[26] In the European Union, it is approved as Imvanex, with similar indications.^[28] This approval marked MVA as a safer alternative to first- and second-generation vaccines like ACAM2000, which replicate in human cells and carry risks of severe adverse events such as myocarditis and progressive vaccinia.^[29] A pivotal phase 3, randomized, open-label trial published in 2019 demonstrated MVA-BN's efficacy through non-inferiority to ACAM2000 in inducing protective immune responses.^[29] In the study involving 440 healthy adults, two subcutaneous doses of MVA-BN (28 days apart) achieved seroconversion rates of 95.6% by vaccinia-specific plaque reduction neutralization test (PRNT) and 95.0% by enzyme-linked immunosorbent assay (ELISA) for vaccinia-specific IgG, comparable to 94.3% and 94.8% with ACAM2000, respectively.^[29] The trial confirmed MVA-BN's ability to elicit take rates (vesicle formation indicating immune response) in 91.8% of recipients after the second dose, supporting its protective potential against smallpox.^[29] MVA-BN exhibits a superior safety profile compared to replicating vaccines, with significantly fewer systemic and local adverse events.^[29] In the phase 3 trial, grade 3 or higher adverse events occurred in 8.2% of MVA-BN recipients versus 35.0% in the ACAM2000 group, and cardiac events were rare (0.3% versus 1.5%).^[29] No cases of myocarditis or pericarditis were reported with MVA-BN, making it suitable for broader use, including in individuals with atopic dermatitis or immunosuppression where ACAM2000 is contraindicated.^[29] In response to bioterrorism threats, the U.S. and European Union have prioritized stockpiling MVA-BN vaccines for emergency preparedness.^[27] The U.S. government, through the Biomedical Advanced Research and Development Authority (BARDA), has procured millions of doses of JYNNEOS for the Strategic National Stockpile, with ongoing contracts ensuring supply into 2026.^[30] Similarly, the European Commission has established framework agreements enabling member states to stockpile MVA-BN as a critical countermeasure.^[28] The standard dosing regimen for MVA-BN involves two 0.5 mL doses, each containing 10^8 infectious units (measured as TCID50), administered subcutaneously or intradermally 4 weeks apart.^[31] This schedule elicits durable humoral and cellular immunity, with geometric mean titers peaking 2 weeks post-second dose and persisting for at least 2 years.^[29]

Mpox Prevention

In response to the 2022 global mpox outbreak, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) on August 9, 2022, for JYNNEOS, allowing intradermal administration in adults aged 18 years and older and subcutaneous administration in at-risk adolescents aged 12-17 to prevent mpox disease, building on its 2019 approval for subcutaneous use in high-risk adults.^[32] Similarly, the European Medicines Agency (EMA) recommended approval of Imvanex for mpox prevention in at-risk adults on July 22, 2022, extending its prior authorization for smallpox based on the same cross-protective evidence.^[33] Observational studies during the 2022 clade IIb mpox outbreak estimated JYNNEOS vaccine effectiveness at 66-85% against symptomatic mpox infection following two doses administered 28 days apart, with lower protection (around 35-75%) after a single dose.^[34] By the end of 2023, over 1 million doses of MVA-based vaccines like JYNNEOS had been administered globally as part of outbreak response efforts, primarily targeting high-risk groups such as men who have sex with men and close contacts.^[35] In 2024-2025, amid the emergence and spread of the more virulent clade Ib mpox variant in Africa and beyond, MVA-based vaccines were deployed in vaccination campaigns, with modeling analyses indicating that targeted immunization averted thousands of potential cases by reducing transmission in outbreak hotspots.^[36] In March 2025, the FDA approved a freeze-dried formulation of JYNNEOS, improving shelf-life and ease of distribution. As of November 2025, amid ongoing clade Ib mpox transmission in Africa, the WHO has allocated over 5.85 million doses of MVA-based vaccines to affected countries, though access and deployment challenges persist.^[37] ^[38] A longitudinal cohort study published in The Lancet Infectious Diseases in 2025 tracked antibody responses up to 12 months post-vaccination or infection, finding that neutralizing antibodies waned significantly after JYNNEOS vaccination (declining by over 50% at 6-12 months) but remained stable in individuals recovering from natural mpox infection, suggesting durable long-term protection from prior exposure compared to vaccine-induced immunity.^[39] JYNNEOS is recommended for both pre-exposure prophylaxis (PrEP) in high-risk individuals and post-exposure prophylaxis (PEP) when administered within 4-14 days of exposure to potentially mitigate disease severity, though PEP efficacy data remain limited by study biases.^[40] To address vaccine supply constraints during outbreaks, an FDA-authorized intradermal dosing regimen (0.1 mL per dose) was implemented in 2022, allowing each vial to yield up to five doses while maintaining comparable immunogenicity to subcutaneous administration.^[32]

Use as a Viral Vector

Construction of Recombinant MVAs

The construction of recombinant Modified Vaccinia Ankara (MVA) viruses primarily relies on homologous recombination to insert foreign genes into the viral genome, enabling its use as a versatile viral vector. This process involves transfecting permissive host cells, such as chicken embryo fibroblasts (CEF) or DF-1 chicken fibroblast cells, that are simultaneously infected with wild-type MVA. A shuttle or transfer plasmid carrying the target gene, flanked by sequences homologous to the desired insertion site in the MVA genome (typically 500–1,000 base pairs on each side), facilitates site-specific recombination during viral replication. The foreign gene is placed under the control of poxvirus-specific promoters, such as the synthetic early/late promoter Psyn for robust late-phase expression or the modified H5 promoter (PmH5) for balanced early and late transcription, ensuring efficient antigen production without interfering with viral fitness.^[41] Insertion sites are strategically chosen in non-essential regions of the MVA genome to preserve core replication and host restriction functions. Common loci include the deletion III (del III) region or intergenic regions (IGRs), such as those between essential genes like MVA069R and MVA070L, which correspond to areas already fragmented by the six major genomic deletions (I–VI) accumulated during MVA's attenuation. These sites, including del II and del III, accommodate foreign DNA without restoring pathogenicity, as they lie outside conserved poxvirus genes critical for intracellular lifecycle. For multi-gene constructs, sequential insertions or multi-plasmid approaches target multiple non-essential loci to avoid overcrowding a single site.^[41] To identify and isolate recombinants, selection markers like green fluorescent protein (GFP), mCherry, or β-galactosidase (lacZ) are incorporated into the transfer plasmid, allowing visual screening of positive plaques under fluorescence microscopy or enzymatic assays. The recombination efficiency is low (approximately 0.1% of progeny viruses), necessitating multiple rounds of plaque purification on CEF monolayers to enrich for stable recombinants and excise transient markers via intragenomic recombination or Cre-loxP systems. Final clones are verified by PCR, restriction enzyme digestion, and sequencing to confirm insert integrity and absence of unwanted mutations.^[41]^[42] Compared to other viral vectors, recombinant MVA offers a large foreign DNA insert capacity of up to 30 kb, enabling the expression of complex multi-antigen cassettes while maintaining genetic stability over serial passaging. As a cytoplasmic replicating DNA virus, MVA recombinants do not integrate into the host genome, minimizing risks of insertional mutagenesis and ensuring transient, high-level transgene expression in permissive cells. This combination of safety, capacity, and ease of engineering has made MVA a preferred platform for vaccine development.^[43]

Delivery of Heterologous Antigens

Modified vaccinia Ankara (MVA) serves as an effective viral vector for the delivery of heterologous antigens by incorporating foreign genes into its genome, enabling their expression in host cells following vaccination. These inserted genes, such as those encoding HIV-1 Env and Gag proteins, Ebola virus glycoprotein (GP), or SARS-CoV-2 spike protein, are driven by poxvirus promoters to produce the antigens de novo in infected cells, including antigen-presenting cells like dendritic cells. This process facilitates antigen processing and presentation via both major histocompatibility complex (MHC) class I and class II pathways: endogenous antigens are degraded by proteasomes and presented on MHC I to activate CD8+ T cells, while autophagy and proteasomal pathways contribute to MHC II presentation for CD4+ T cell stimulation, enhancing both cellular and humoral immunity.^[44]^[21] MVA vectors support multivalent designs, allowing the co-expression of multiple heterologous antigens within a single construct to broaden immune coverage against related pathogens. A prominent example is MVA-BN-Filo, which simultaneously expresses glycoproteins from Zaire ebolavirus, Sudan ebolavirus, Marburg marburgvirus, and Taï Forest ebolavirus, enabling a single vaccine to target multiple filoviruses responsible for hemorrhagic fevers; it was approved in the European Union as Mvabea in 2020 for immunization against Ebola virus disease in individuals aged 1 year and older when given as a booster in a prime-boost regimen with Ad26.ZEBOV (Zabdeno).^[45] This approach induces robust, cross-reactive antibody and T cell responses, with heterologous prime-boost regimens (e.g., with adenovirus vectors) further amplifying glycoprotein-specific neutralizing antibodies and cellular immunity.^[46]^[47] The non-replicating nature of MVA in human cells confers key immunological advantages for heterologous antigen delivery, as it promotes strong cytotoxic T-lymphocyte (CTL) responses without the immune evasion mechanisms employed by wild-type poxviruses, such as interference with host antigen presentation. By aborting replication late in the viral cycle, MVA avoids downregulation of MHC molecules and enhances antigen availability for cross-presentation, leading to potent, polyfunctional CD8+ T cell activation that is critical for controlling intracellular pathogens. This safety profile minimizes anti-vector immunity in repeat dosing, allowing sustained focus on transgene-specific responses.^[21]^[48] In HIV vaccine development, MVA vectors expressing antigens like clade B gp120 Env have been tested in heterologous regimens, such as the HVTN 505 trial (DNA prime/MVA boost), which elicited CD4+ and CD8+ T cell responses but failed to prevent HIV acquisition, highlighting challenges in achieving protective efficacy despite immunogenicity. Conversely, for Ebola, MVA-BN-Filo has shown success as a booster in heterologous schedules with rVSV-ZEBOV, enhancing durable GP-specific antibodies and T cell responses that contributed to protection during the 2014-2016 outbreak. For SARS-CoV-2, MVA-based candidates like MVA-SARS-2-S, expressing the full-length spike protein, have demonstrated strong neutralizing antibodies and T cell immunity in preclinical models and early trials; as of 2025, related candidates such as MVA-SARS-2-ST are in clinical evaluation as potential boosters for variant containment.^[49]^[50]^[51]^[52]

Clinical Research and Trials

Preclinical and Early Human Studies

Preclinical studies of Modified vaccinia Ankara (MVA) demonstrated robust protection in various animal models against orthopoxvirus challenges, establishing its potential as a safe vaccine platform. In murine models of vaccinia infection, high-dose MVA (10^8 PFU) provided full protection against lethal intranasal vaccinia virus WR challenge (25 LD50), with survival rates comparable to the licensed Dryvax vaccine, while lower doses (10^6 PFU) offered partial protection (60-80% survival).^[53] In rabbits, a model for aerosolized smallpox, MVA (IMVAMUNE, 10^8 TCID50) administered as one or two doses achieved 100% survival following challenge with ~500 LD50 rabbitpox virus, reducing clinical signs and lesions compared to unvaccinated controls that succumbed by day 7.^[54] Nonhuman primate (NHP) studies further validated MVA's efficacy; for instance, MVA vaccination in cynomolgus macaques resulted in 100% survival against lethal mpox virus (MPXV) clade I challenge (5 × 10^7 PFU), with significantly reduced blood viremia and throat infectious virus loads versus controls (1/6 survival).^[55] Similarly, in Ebola challenge models, an MVA-BN-Filo boost following Ad26.ZEBOV priming protected 100% of cynomolgus macaques (25/25) from intramuscular EBOV Kikwit (100 PFU), correlating with high EBOV glycoprotein-binding antibody levels.^[56] Early human studies in the 2000s focused on Phase I dose-escalation trials assessing MVA's safety and immunogenicity in healthy volunteers. A 2002-2003 Phase I trial of MVA as a smallpox vaccine (10^7-10^8 TCID50) in vaccinia-naive adults showed no serious adverse events, with mild local reactions and transient systemic symptoms, alongside induction of vaccinia-specific neutralizing antibodies and T-cell responses in most participants.^[57] For HIV applications, a 2005 Phase I trial of DNA-prime/MVA-boost regimens (MVA-HIV at 10^8 PFU) in healthy volunteers confirmed safety across doses, eliciting strong HIV-specific CD4+ and CD8+ T-cell responses without vector-specific interference.^[58] Proof-of-concept for MVA as a viral vector emerged in early Phase I/II studies targeting heterologous antigens, highlighting its capacity for Th1-biased immunity. In a 2008 Phase I/IIa trial of MVA-H5 (expressing avian influenza A H5N1 hemagglutinin) in healthy adults, doses of 10^7-10^8 TCID50 were safe and induced H5-specific antibody and T-cell responses, with cytokine profiles indicating a Th1-dominant profile (elevated IFN-γ). For cancer, a 2003 Phase I trial of recombinant MVA expressing carcinoembryonic antigen (MVA-CEA) in advanced colorectal cancer patients demonstrated safety and CEA-specific T-cell proliferation, with ELISPOT assays showing Th1-skewed responses (IFN-γ over IL-4) in responders.^[59] These foundational studies identified limitations, such as variable responses in low-responders, where approximately 10-20% of participants showed suboptimal T-cell induction, prompting exploration of adjuvants like TLR agonists to enhance immunogenicity without compromising safety.^[60]

Approved Vaccines and Efficacy Data

The JYNNEOS vaccine (also known as Imvamune or Imvanex), based on the modified vaccinia Ankara-Bavarian Nordic (MVA-BN) strain, received approval from the U.S. Food and Drug Administration (FDA) in September 2019 for the prevention of smallpox and mpox in adults aged 18 years and older at high risk of exposure.^[31] In response to the 2022 mpox outbreak, the vaccine's indication was expanded to include broader use for mpox prevention, with the European Medicines Agency (EMA) granting similar approvals for smallpox in 2013 and mpox in 2022. In September 2024, the EMA extended the indication of Imvanex to adolescents aged 12-17 years.^[61] Pivotal trials demonstrated immunogenicity through significant fold increases in vaccinia-specific neutralizing antibody titers (e.g., over 20-fold) following the two-dose regimen, establishing a correlate of protection against orthopoxviruses. Another MVA-based product, MVA-BN-Filo, was approved by the EMA in July 2020 as a component of a heterologous prime-boost regimen (with Ad26.ZEBOV) for active immunization against Ebola virus disease caused by Zaire ebolavirus in individuals aged one year and older.^[45] This vaccine targets filovirus glycoproteins and has shown durable humoral immune responses, with seroconversion rates exceeding 95% after the full regimen in clinical studies.^[45] The LC16m8 vaccine, an attenuated vaccinia strain developed in Japan and distinct from MVA though sharing third-generation safety features, was licensed in Japan in 1975 for smallpox prevention and received World Health Organization emergency use listing in November 2024 for mpox in individuals aged one year and older.^[62] Pooled efficacy data from meta-analyses of clinical and real-world studies indicate that MVA-BN vaccines provide 70-90% protection against orthopoxvirus infections, with two doses conferring higher effectiveness than one.^[63] For mpox specifically, real-world evidence from 2022-2024 outbreaks in the United States and Europe reported vaccine effectiveness (VE) of 78% against symptomatic infection after a single dose and up to 89% after two doses, based on case-control studies involving over 10,000 participants.^[64] These findings underscore the vaccines' role in outbreak control, particularly among high-risk groups such as men who have sex with men. Post-licensure surveillance through systems like the Vaccine Adverse Event Reporting System (VAERS) and v-safe has confirmed the favorable safety profile of JYNNEOS, with no unexpected serious adverse events identified despite administration of over 5 million doses globally by mid-2025, predominantly in adults during mpox outbreaks.^[65] Mild to moderate reactogenicity, such as injection-site pain and fatigue, remains the most common side effect, occurring in 50-70% of recipients after the first dose.^[66]

Ongoing and Future Developments

Research into Modified vaccinia Ankara (MVA) continues to expand its applications beyond established vaccines, with active clinical pipelines targeting emerging infectious diseases and oncology. For COVID-19, MVA-based candidates such as COH04S1, which encodes the SARS-CoV-2 spike protein, are advancing in Phase 2 trials to evaluate their potential as boosters, demonstrating robust cross-reactive immunity against variants in preclinical models.^[67] In oncology, MVA-BN-PRO, a recombinant MVA expressing prostate-specific antigen, was investigated in a Phase 1 trial for men with biochemically recurrent prostate cancer, aiming to elicit tumor-specific T-cell responses to delay disease progression.^[68] Additionally, ongoing Phase 3 and Phase 2 trials are assessing MVA-BN for mpox prevention in special populations, including pregnant women and children aged 2-11 years, to address gaps in current immunization strategies.^[24]^[69] Key challenges in MVA vaccine development include optimizing multi-epitope constructs to broaden immune coverage without inducing tolerance, particularly for rapidly evolving pathogens. For mpox, the emergence of clade Ib variants poses risks of immune escape from existing MVA-BN formulations, necessitating updated antigens to maintain efficacy against diverse strains.^[70] Furthermore, waning antibody responses post-MVA-BN vaccination, observed within 6-12 months, highlight the need for strategies to enhance long-term immunity duration.^[71] Innovations in MVA platforms are addressing production and efficacy hurdles. Synthetic MVA constructs, developed in 2024 studies, enable faster genetic engineering and higher yields, facilitating rapid adaptation for outbreak responses while preserving immunogenicity.^[67] Combining MVA vectors with mRNA vaccines in heterologous regimens has shown synergistic effects, boosting T-cell responses and protection against SARS-CoV-2 and mpox in animal models.^[72]^[73] Looking ahead, MVA's role in pandemic preparedness is strengthening, bolstered by the World Health Organization's prequalification of MVA-BN in 2024, which facilitates equitable global distribution and procurement for up to 13 million doses by the end of 2025. Efforts are underway to integrate MVA platforms into broader vaccine alliances, targeting enhanced access in low-resource settings by 2026.^[74]^[75]^[76]

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Das MVA-Virus repräsentiert ein Labor-Virus, das sich durch zahlreiche biologische Marker von den bekannten Vaccinia-Stämmen wie auch von den anderen Viren ...Missing: al. | Show results with:al.
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Smallpox Eradication Programme - SEP (1966-1980)
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Introduction of the Six Major Genomic Deletions of Modified Vaccinia ...
The six major genomic deletions of modified Vaccinia virus Ankara (MVA) into the parental Vaccinia virus is not sufficient to reproduce an MVA-like phenotype.
[8]
Highly attenuated modified vaccinia virus Ankara (MVA) as an ...
In summary, MVA has now been compared, to replication competent vaccinia strains, in three animal models, including influenza virus and SIV. In each ...<|control11|><|separator|>
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Smallpox and Bioterrorism - PMC - PubMed Central - NIH
This chapter will focus on information regarding smallpox and smallpox vaccination since 2001, notably, the persisting threat of smallpox as a bioterrorist ...
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The Complete Genomic Sequence of the Modified Vaccinia Ankara ...
The complete genomic DNA sequence of the highly attenuated vaccinia strain modified vaccinia Ankara (MVA) was determined. The genome of MVA is 178 kb in ...
[11]
Expanding the Repertoire of Modified Vaccinia Ankara-Based ...
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[12]
Repair of a previously uncharacterized second host-range gene ...
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Deletion of the K1L Gene Results in a Vaccinia Virus That Is Less ...
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Zinc-finger antiviral protein (ZAP) is a restriction factor for replication ...
Aug 31, 2020 · Zinc-finger antiviral protein (ZAP) is a restriction factor for replication of modified vaccinia virus Ankara (MVA) in human cells · Chen Peng.
[15]
Quantitative proteomics defines mechanisms of antiviral defence ...
Dec 8, 2023 · Through serial passage in chicken embryo fibroblasts, the MVA genome has accumulated six major deletions and many small insertion and ...
[16]
Differences and Similarities in Viral Life Cycle Progression and Host ...
As a result of the deletion of genes involved in host-range restriction, replication of MVA in most nonavian cell types aborts at a late stage of the virus life ...
[17]
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Safety and Immunogenicity of Modified Vaccinia Ankara-Bavarian ...
May 5, 2015 · Conclusions. Modified vaccinia Ankara was safe and immunogenic in subjects infected with HIV and represents a promising smallpox vaccine ...Missing: papers | Show results with:papers
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Immunogenicity and Safety of Modified Vaccinia Ankara (MVA ...
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[20]
Modified vaccinia virus Ankara as antigen delivery system
After more than 570 passages in tissue culture MVA had lost the broad cellular host range of VV, being unable to productively grow in many cells of mammalian ...
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Vaccines and Antiviral Therapies for Mpox Virus in Pregnant and ...
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Prioritizing Vulnerable Populations in Clinical Research - PMC
Oct 10, 2025 · Overall, the interim analysis found that the MVA-BN vaccine was safe and well tolerated in adolescents, with similar adverse events except for ...
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Immune Response to MVA-BN Vaccination for Mpox - PubMed Central
MVA-BN induces both humoral and cellular responses, including the production of binding and neutralising antibodies and pathogen-specific memory B cells and T ...
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JYNNEOS | FDA
May 14, 2025 · Indicated for prevention of smallpox and monkeypox disease in adults 18 years of age and older determined to be at high risk for smallpox or ...
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JYNNEOS (MVA-BN) Mpox Smallpox Vaccine - Vax-Before-Travel
Approved by the U.S. Food and Drug Administration (FDA) in 2019, JYNNEOS was the first smallpox vaccine successfully developed under the Project BioShield ...<|separator|>
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News | Bavarian Nordic
Oct 31, 2025 · The framework agreement also allowed the European Commission and European Member States to stockpile MVA-BN as a critical medical countermeasure ...
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Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine ...
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US Government Orders Another 2.5 Million Doses of Monkeypox ...
Jul 15, 2022 · Bavarian Nordic to supply an additional 2.5 million doses of JYNNEOS® vaccine, bringing deliveries in 2022 and 2023 to a total of nearly 7 ...Missing: size | Show results with:size
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[PDF] Package Insert - JYNNEOS (Refrigerator) - FDA
Each 0.5 mL dose of JYNNEOS is formulated to contain 0.5 x 108 to 3.95 x 108 infectious units of. MVA-BN live virus. Each 0.5 mL dose contains 0.61 mg of Tris ( ...Missing: regimen | Show results with:regimen
[30]
[PDF] EMERGENCY USE AUTHORIZATION OF JYNNEOS (SMALLPOX ...
Aug 9, 2022 · The FDA has granted an EUA for the emergency use of JYNNEOS for active immunization by subcutaneous injection for prevention of mpox disease in ...
[31]
EMA recommends approval of Imvanex for the prevention of ...
Jul 22, 2022 · The medicine has been approved in the EU since 2013 for the prevention of smallpox. It contains an attenuated (weakened) form of the vaccinia ...
[32]
Global perspectives on smallpox vaccine against monkeypox
However, recent research on the 2022 US mpox outbreak determined that the JYNNEOS vaccine had an estimated efficacy of 35%–75% after one dose and 66%–85 ...
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Mpox vaccines – frequently asked questions (FAQs) | NCIRS
JYNNEOS vaccine has been proven to be a safe vaccine, and more than a million doses have been given worldwide since the 2022 mpox outbreak. To date, most ...
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Combining mpox vaccination and behavioural changes to control ...
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Interim Clinical Considerations for Use of Vaccine for Monkeypox ...
Sep 5, 2025 · JYNNEOS® vaccine is licensed to prevent smallpox and monkeypox and ... On August 9, 2022, FDA issued an EUA for JYNNEOS monkeypox vaccine.
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Construction and Isolation of Recombinant Vaccinia Virus by ...
The efficiency of homologous recombination event for vaccinia virus is relatively low, and recombinant viruses only account for 0.1% of progeny viruses.
[38]
Intergenic region 3 of modified vaccinia ankara is a functional site for ...
Aug 1, 2010 · In this report, we evaluate an alternative insertion site known as intergenic region 3 (IGR3). Recombinant MVA carrying the cytomegalovirus pp65 ...
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Modified Vaccinia Virus Ankara-Infected Dendritic Cells Present ...
Here we characterized the MHCII antigen presentation pathways that are possibly involved in the immune response upon vaccination with modified vaccinia virus ...
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Safety and immunogenicity of 2-dose heterologous Ad26.ZEBOV ...
Jan 11, 2022 · ZEBOV, MVA-BN-Filo Ebola vaccination was safe and immunogenic in healthy African children. What did the researchers do and find? In this ...
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Modified Vaccinia Virus Ankara (MVA) as Production Platform for ...
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An MVA Vector Expressing HIV-1 Envelope under the Control of a ...
We have generated and characterized the biology and immunogenicity of an optimized MVA-based vaccine candidate against HIV/AIDS expressing HIV-1 clade B gp120 ...
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Immunogenicity and efficacy of the COVID-19 candidate vector ...
Jun 23, 2021 · MVA-SARS-2-S expresses and safely delivers the full-length SARS-CoV-2 S protein, inducing balanced SARS-CoV-2–specific cellular and humoral immunity, and ...
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Enhanced immunogenicity and protective effect conferred by ...
In the present study, a variety of immune responses elicited by MVA and the licensed smallpox vaccine Dryvax in a murine model were compared.
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Evaluation of the efficacy of modified vaccinia Ankara (MVA ... - NIH
In this study, we tested the efficacy of IMVAMUNE® [modified vaccinia Ankara-Bavarian Nordic (MVA-BN®)] for protecting rabbits against aerosolized RPXV.
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Nonhuman primate to human immunobridging to infer the protective ...
Dec 17, 2020 · The 100% survival observed in these studies for the Ad26.ZEBOV, MVA-BN-Filo regimen with an 8-week interval between doses precluded conducting ...
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Study Details | NCT00046397 | Phase I Trial of Smallpox Vaccine
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Phase I clinical trial safety of DNA- and modified virus Ankara ...
Phase I clinical trial safety of DNA- and modified virus Ankara-vectored human immunodeficiency virus type 1 (HIV-1) vaccines administered alone and in a prime- ...Missing: smallpox 1990s 2000s
[51]
Phase I immunotherapy with a modified vaccinia virus (MVA ...
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Efficacy and safety of a modified vaccinia Ankara (MVA) vectored ...
Aug 16, 2010 · ... vaccines have several disadvantages. They generally require strong adjuvants, elicit poor CD8+ T cell responses and have short shelf lives [60].
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Mvabea | European Medicines Agency (EMA)
Mvabea is a vaccine to protect adults and children aged one year and older against Ebola virus disease caused by Zaire ebolavirus. It is used with another Ebola ...Overview · Product information · Product details · Authorisation details
[54]
WHO adds LC16m8 mpox vaccine to Emergency Use Listing
Nov 19, 2024 · On 13 September 2024, WHO prequalified the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine and expanded its indication to include use ...
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Predicting vaccine effectiveness for mpox | Nature Communications
May 8, 2024 · This study provides a quantitative evidence-based approach for using antibody measurements to predict the effectiveness of mpox vaccination.
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Effectiveness of a single dose of JYNNEOS vaccine in real world
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[57]
Evidence to Recommendations (EtR) Framework for Use of ... - CDC
Jun 16, 2025 · During May 22, 2022 to January 13, 2023, a total of 1,125,168 JYNNEOS vaccine doses were administered. CDC monitored JYNNEOS safety using VAERS, ...
[58]
Safety Monitoring of JYNNEOS Vaccine During the 2022 Mpox ... - NIH
Dec 9, 2022 · During May 22–October 21, 2022, nearly 1 million JYNNEOS doses were administered in the United States. The vaccine safety profile was consistent ...
[59]
Synthetic modified vaccinia Ankara vaccines confer cross-reactive ...
Feb 16, 2024 · This is the first challenge study in a relevant animal model showing protection by an MVA-based vaccine against the newly emerged MPXV clade IIb ...
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Phase I dose escalation trial of MVA-BN-PRO in men with ... - ASCO
Background: MVA-BN-PRO is an investigational prostate cancer immunotherapy comprising of a highly attenuated non-replicating vaccinia virus engineered to ...
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NCT06844500 | Phase 3 Maternal Safety & Immunogenicity Trial of ...
This Phase 3 open-label study aims to assess the safety and immune response of the MVA-BN mpox vaccine when administered subcutaneously to pregnant and ...
[62]
Bavarian Nordic Announces the Initiation of Clinical Trials of Mpox ...
Jun 26, 2025 · Topline results from this trial (NCT06549530) are anticipated in the third quarter of 2025. ... MVA-BN or Modified Vaccinia Ankara-Bavarian Nordic ...
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Clade Ib Mpox Virus: How Can We Respond? - PMC
Jul 18, 2025 · This review aims to provide an overview of the current understanding of mpox virus Clade Ib, including its genetic characteristics, ...
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Rapid Decline of Mpox Antibody Responses Following MVA-BN ...
Jul 25, 2025 · In this study, we show that the MVA-BN vaccine generated mpox serum antibody responses that largely waned after 6-12 months. Last updated on 07/ ...
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Heterologous mRNA/MVA delivering trimeric-RBD as effective ...
This study explores a heterologous mRNA/Modified Vaccinia virus Ankara (MVA) prime/boost regimen employing a trimeric form of the receptor binding domain (RBD) ...
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Comparison of protection against mpox following mRNA or modified ...
Sep 4, 2024 · MVA-immunized animals exhibited reduced viral loads in blood viremia and infectious virus in the throat compared with PBS-treated animals; ...
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Search - Bavarian Nordic
Bavarian Nordic Receives WHO Prequalification for Mpox Vaccine First mpox vaccine to obtain prequalification by the WHO Approval will help accelerate access ...
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Gavi Signs Agreement with Bavarian Nordic to Rapidly Secure ...
Sep 18, 2024 · The doses will be for delivery in 2024. The vaccines will be funded by Gavi's First Response Fund, a new financial mechanism created in June ...
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WHO prequalifies first vaccine against mpox - BioSpectrum Asia
Sep 16, 2024 · The World Health Organization (WHO) has announced MVA-BN vaccine as the first vaccine against mpox to be added to its prequalification list.