Table 2.
| Vaccine | Original VACV strain | Production method | Usage | Efficacy and reactogenicity | Dose/route |
|---|---|---|---|---|---|
| Second-generation vaccines | |||||
| ACAM2000 | NYCBH | Vero cells | Part of US national stockpile, approved by FDA in 2008 | Immunogenicity equivalent to Dryvax. Safety profile similar to Dryvax. | 0.0025 mL of live VACV containing 2.5–12.5 × 105 pfu, 1 dose, percutaneous |
| CCSV (DynPort)* | NYCBH | MRC-5 cells | Clinical trials | Immunogenicity equivalent to Dryvax. Safety profile not well established. | 1 Dose, delivered dose similar to Dryvax, percutaneous |
| Elstree-BN* | Lister | Chicken embryo fibroblast cells | Clinical trials | Similar efficacy and safety as Elstree/Lister. | 1 Dose, percutaneous, 1 × 108 pfu/mL |
| CJ-50300 | NYCBH | MRC-5 cells | Clinical trials | Similar efficacy as Dryvax. | 1 Dose, percutaneous, 1 × 108 pfu/mL |
| Third-generation vaccines Live, attenuated vaccinia virus strains | |||||
| MVA (IMVAMUNE, TBC-MVA, ACAM3000) |
Ankara, serially passaged in chicken embryo fibroblast cells | Cell culture | Used in 120,000 people at end of eradication. Extensive clinical and animal trials. |
Excellent safety profile. Immunogenicity may be lower than replication-competent vaccines. | 2 Doses, subcutaneous, 5 × 107 TCID50 |
| LC16m8 | Lister, serially passaged in rabbit kidney cells | Cell culture | Used in Japan at the end of eradication. Stockpiled in Japan. | Excellent safety profile. Similar reactogenicity to Dryvax. | 1 Dose, percutaneous, ~4 uL of 1 × 108 pfu/mL |
| NYVAC | Copenhagen, with genomic deletions | Cell culture | Early clinical trials | 18 ORFs deleted, coding genes related to pathogenicity, virulence, and host range. Immunogenicity may be lower than live vaccines | Likely 2 doses, intramuscular |
| dVV-L | Lister, with deleted UDG enzyme | Cell culture | Animal trials | Early animal studies show good immunogenicity and safety profiles in mice. | Likely 2 doses, intramuscular, 1 × 106 pfu in mouse |
| Subunit vaccines | |||||
| Protein-based, various | Various | Nonhuman trials | Theoretically better safety profile. Sufficient immunogenicity in animals when adjuvanted and boosted. | 2–3 Doses, intramuscular, likely adjuvanted, human dosage TBD | |
| DNA-based, various | Various | Nonhuman trials | Theoretically better safety profile. Sufficient immunogenicity in animals when adjuvanted and boosted. | 2–3 Doses, intramuscular, likely adjuvanted, human dosage TBD | |
*No longer in development.