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Impact of Mpox Vaccination on Mpox Infection among High-Risk Populations in Nigeria

Abstract

Mpox is an emerging public health concern that can cause significant morbidity and place additional demands on healthcare systems, particularly among populations with increased risk of exposure. The disease may spread through close physical contact, contact with infectious lesions or contaminated materials, and other forms of exposure. In Nigeria, sustained surveillance and preventive measures are important for reducing transmission, particularly among populations considered to have increased risk of exposure. Mpox vaccination provides an opportunity to reduce the risk of infection and may contribute to improved outbreak preparedness and disease control. However, challenges including limited vaccine availability, inadequate vaccination coverage, vaccine hesitancy, limited awareness, access barriers, and difficulties reaching eligible populations may affect the effectiveness of vaccination programmes. Against this background, this study investigates the impact of mpox vaccination on mpox infection among high-risk populations in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how perceived susceptibility to mpox, perceived severity, perceived benefits of vaccination, perceived barriers, and cues to action may influence vaccination uptake and completion. The Social Ecological Model emphasizes the influence of individual, interpersonal, community, healthcare, and policy factors on vaccination behaviour and infection risk. The Health Systems Framework emphasizes service delivery, health workforce, health information systems, vaccine availability, financing, governance, and accessibility as essential components of effective vaccination programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how mpox vaccination may influence infection among high-risk populations in Nigeria. The study will adopt a quantitative analytical cohort, cross-sectional, or quasi-experimental research design, depending on the availability of vaccination and surveillance records. The study population will comprise adults and other eligible individuals classified as being at increased risk of mpox exposure in selected Nigerian communities and healthcare settings. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible participants. Mpox vaccination will be assessed using indicators such as vaccination status, number of doses received, vaccination completion, time since vaccination, access to vaccination services, vaccine availability, vaccination coverage, and previous vaccination history. Mpox infection will be assessed using indicators such as laboratory-confirmed mpox infection, suspected mpox cases, date of symptom onset, date of diagnosis, clinical manifestations, hospitalization where applicable, and history of exposure. Data will be collected using structured questionnaires, vaccination registers, electronic immunization records where available, mpox surveillance databases, laboratory records, healthcare facility records, and case investigation forms. Descriptive statistics will be used to summarize participants' characteristics, vaccination coverage, and infection patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of mpox vaccination on mpox infection. Where a cohort or quasi-experimental design is adopted, infection rates among vaccinated and unvaccinated participants may be compared, while appropriate adjustment will be made for relevant differences in exposure and other potential confounding factors. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that mpox vaccination has a significant protective impact on mpox infection among high-risk populations in Nigeria. Vaccinated individuals are expected to have a lower risk of laboratory-confirmed mpox infection compared with comparable unvaccinated individuals, particularly where vaccination is completed according to the recommended schedule. Increased vaccination coverage may also reduce the number of severe cases and contribute to improved outbreak control. However, limited vaccine availability, delayed access to vaccination, incomplete vaccination, vaccine hesitancy, inadequate risk communication, and continued high-risk exposure may reduce the overall effectiveness of vaccination programmes. The study therefore expects accessible, appropriately targeted, adequately supplied, and well-monitored mpox vaccination programmes to contribute significantly to reducing mpox infection among high-risk populations in Nigeria. The study is expected to contribute to the literature on mpox vaccination, mpox infection, vaccine-preventable diseases, outbreak preparedness, infectious disease prevention, immunization programmes, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, public health professionals, immunization programme managers, development partners, and policymakers regarding strategies for strengthening mpox prevention and control. The study will also provide evidence-based recommendations for improving access to mpox vaccination, strengthening vaccination coverage and completion, improving vaccine availability and distribution, addressing vaccine hesitancy through targeted risk communication, strengthening surveillance of vaccinated and unvaccinated populations, and integrating mpox vaccination into broader outbreak preparedness and infectious disease prevention programmes in Nigeria.

Keywords: Mpox vaccination, mpox infection, high-risk populations, vaccine uptake, immunization, infectious disease prevention, outbreak preparedness, disease surveillance, Nigeria, public health.