The largest outbreak of monkeypox in history began in May, 2022, and has rapidly spread across the globe ever since. The purpose of this Review is to briefly describe human immune responses to orthopoxviruses; provide an overview of the vaccines available to combat this outbreak; and discuss the various clinical data and animal studies evaluating protective immunity to monkeypox elicited by vaccinia virus-based smallpox vaccines, address ongoing concerns regarding the outbreak, and provide suggestions for the appropriate use of vaccines as an outbreak control measure. Data showing clinical effectiveness (~85%) of smallpox vaccines against monkeypox come from surveillance studies conducted in central Africa in the 1980s and later during outbreaks in the same area. These data are supported by a large number of animal studies (primarily in non-human primates) with live virus challenge by various inoculation routes. These studies uniformly showed a high degree of protection and immunity against monkeypox virus following vaccination with various smallpox vaccines. Smallpox vaccines represent an effective countermeasure that can be used to control monkeypox outbreaks. However, smallpox vaccines do cause side-effects and the replication-competent, second-generation vaccines have contraindications. Third-generation vaccines, although safer for use in immunocompromised populations, require two doses, which is an impediment to rapid outbreak response. Lessons learned from the COVID-19 pandemic should be used to inform our collective response to this monkeypox outbreak and to future outbreaks.

历史上最大规模的猴痘疫情始于 2022 年 5 月，此后迅速蔓延至全球。本综述的目的是简要描述人类对正痘病毒的免疫反应；概述可用于抗击此次疫情的疫苗；并讨论评估基于牛痘病毒的天花疫苗引起的猴痘保护性免疫力的各种临床数据和动物研究，解决对爆发的持续关注，并为适当使用疫苗作为爆发控制措施提供建议。显示天花疫苗对猴痘的临床有效性 (~85%) 的数据来自 1980 年代在中非以及后来同一地区爆发期间进行的监测研究。这些数据得到大量动物研究（主要是非人类灵长类动物）的支持，这些研究通过各种接种途径进行活病毒攻击。这些研究一致表明，在接种各种天花疫苗后，对猴痘病毒具有高度的保护和免疫力。天花疫苗是一种有效的对策，可用于控制猴痘的爆发。然而，天花疫苗确实会引起副作用，而且具有复制能力的第二代疫苗也有禁忌症。第三代疫苗虽然在免疫功能低下的人群中使用更安全，但需要两剂，这不利于快速应对疫情。从 COVID-19 大流行中吸取的教训应该被用来指导我们对这次猴痘爆发和未来爆发的集体反应。