Description of the first global outbreak of mpox: an analysis of global surveillance data

Laurenson-Schafer, Henry; Sklenovská, Nikola; Hoxha, Ana; Kerr, Steven M; Ndumbi, Patricia; Fitzner, Julia; Almiron, Maria; de Sousa, Luis Alves; Briand, Sylvie; Cenciarelli, Orlando; Colombe, Soledad; Doherty, Meg; Fall, Ibrahima Soce; García-Calavaro, Christian; Haussig, Joana M; Kato, Masaya; Mahamud, Abdi Rahman; Morgan, Oliver W; Nabeth, Pierre; Naiene, Jeremias Domingos; Navegantes, Wildo Araujo; Ogundiran, Opeayo; Okot, Charles; Pebody, Richard; Matsui, Tamano; Ramírez, Hugo López-Gatell; Smallwood, Catherine; Tasigchana, Raúl Francisco Pérez; Vaughan, Aisling M; Williams, George Sie; Mala, Peter Omondi; Lewis, Rosamund F; Pavlin, Boris I; le Polain de Waroux, Olivier; Abdelgawad, Basma; Babu, Amarnath; Buliva, Evans; Campbell, Finlay; Cardoso Portela Câmara, Daniel; Eleiba, Zainab; Greene-Cramer, Blanche Johanna; Hamblion, Esther; Hassan, Mahmoud; Kaasik-Aaslav, Kaja; Mohamed, Basant; Ndarukwa, Victoria; Otieno, James Richard; Pires, Jeffrey; Pukkila, Jukka; Sanni, Felix; Schultz, Craig; Sedai, Tika; Skrowny, Laila; Phengxay, Manilay; Ochirpurev, Ariuntuya; Skufca, Jozica; Goddard, Laura; Biaukula, Viema

doi:10.1016/s2214-109x(23)00198-5

Cited by 70 publications

(61 citation statements)

References 25 publications

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“…38,39 Alternatively, it could be explained by the possibility that a rash on the partner's genitals or skin was neglected during sexual activity due to factors such as the rash's location, inadequate lighting, The clinical symptoms and epidemiological characteristics of mpox patients identified in this study exhibit similarities to those reported in studies conducted in Europe and the United States. 10,37,41 A study encompassing 41 countries within the WHO European Region revealed that the majority of cases (97%) were among MSM, with rash as the prevailing symptom (95%), and transmission primarily occurring through close contact during sexual activity. 41 Similarly, a CDC report observed that 94% of 1195 patients in the United States had engaged in male-to-male sexual contact or close intimate contact within 3 weeks before the onset of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta‐analysis showed that skin lesions, fever, and lymphadenopathy were the most common symptoms in the current outbreak 9 . Skin lesions can manifest on various parts of the body, including the face, hands, feet, extremities, trunk, and more 10 . However, anogenital lesions were the most frequently observed dermatological manifestations 1,9 .…”

Section: Introductionmentioning

confidence: 99%

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Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross‐sectional study in China

Fu,

Wang,

et al. 2023

Journal of Medical Virology

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Human mpox is occurring worldwide, however, evidence from the Asian Pacific Region is limited. In this multicenter cross‐sectional study, information of confirmed mpox cases diagnosed between June 1 and July 31, 2023 in China. Information included demographic and epidemiological characteristics, and clinical manifestations, laboratory results, and mental health status of mpox cases. A total of 115 confirmed mpox cases were enrolled. All cases were men. A total of 102 (90.3%) identified as homosexual. The median age was 31.0 years (interquartile range 27.0–36.5). A total of 65 (56.5%) were HIV‐positive, of whom 92.3% were receiving antiretroviral therapy (ART). A total of 19/39 (40.4%) had a CD4 cell count <500 cells/μL. Systemic features such as fever (73.0%), lymphadenopathies (49.6%), and myalgia (28.7%) were commonly observed. Skin lesions were present in all participants: 49.6% in the genital area and 27.0% in the perianal area. Vesicular rash (78.3%) and papular rash (44.3%) were the most common lesion morphologies. People living with HIV were more likely to have anxiety than those living without HIV. The majority of mpox cases had primary genital lesions and sexual activities before diagnosis, which supports the likelihood of sexual contact transmission. Guidelines on hospitalization and isolation protocols for mpox patients necessitate further confirmation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross‐sectional study in China

Fu,

Wang,

et al. 2023

Journal of Medical Virology

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“…Sexual diseases, such as HIV were common among mpox cases in multiple-countries mpox outbreak. 12,28 Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance released by WHO put forward that the indicators of mpox cases should possibly include demographic information, clinical and risk factors. 29 These features not previously documented could provide more detail information of key population in health education.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of mpox and its association with sexual behavior among Chinese men who have sex with men in early August 2023

Du,

Zheng,

Liu

et al. 2023

Journal of Medical Virology

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Study investigating mpox infection and its association with sexual behavior among men who have sex with men (MSM) in China was lacking. This observational survey aimed to provide evidence on detail characteristics of mpox cases and sexual behavior, then analyze their relationship among MSM in China to help formulate prevention and control policies. An anonymous cross‐sectional study was conducted in 27 MSM social organizations across 21 provinces, municipalities, and autonomous regions from July 31 to August 4, 2023. A safe sexual behavior index was constructed based on three risky sexual behaviors in the last month, including condomless anal intercourse, commercial sex and group sex. High safe sexual behavior indicated that the participant engaged in none of the three, and low safe sexual behavior indicated that they engaged in all three behaviors; otherwise, moderate safe sexual behavior was indicated. Among 7538 MSM, the prevalence of mpox was 0.73% (55/7538). The proportion of high safe sexual behavior was 79.64% (6003/7538). The crude prevalence of mpox was lower in the high safe sexual behavior group (0.35%, 21/6003), compared with the low (12.12%, 8/66) and moderate safe (1.78%, 26/1469) sexual behavior group. In the multivariable‐adjusted analysis, after adjusting for all covariates, compared with low safe sexual behavior group, moderate safe sexual behavior group (aOR = 0.21; 95% CI = 0.08, 0.54) and high safe sexual behavior group (aOR = 0.04; 95% CI = 0.02, 0.12) both had lower risk of mpox. Of three sexual behaviors, MSM who reported no commercial sex had the lowest risk of mpox (aOR = 0.23; 95% CI = 0.13, 0.41), compared with those who reported commercial sex in the last month. The other two safe sexual behaviors both were associated with lower risk of mpox (no group sex vs. group sex: aOR = 0.15; 95% CI = 0.08, 0.28; no condomless anal intercourse vs. condomless anal intercourse: aOR = 0.23; 95% CI = 0.13, 0.41). The prevalence of mpox virus infection was nearly 1% among MSM in China. Strengthening mpox surveillance, emphasizing safe sexual behavior in health education are essential for the control of mpox among MSM in China.

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“…The World Health Organization (WHO) declared mpox (then termed monkeypox) a Public Health Emergency of International Concern (PHEIC) between July2022 and May 2023. The 2022 mpox outbreak was associated with sustained human-to-human transmission that had not been previously described (1). Historically, mpox occurred primarily in west and central Africa, with infection commonly reported in persons who had contact with probable animal reservoirs, cases of secondary transmission were most often reported in household contacts (2).…”

Section: Introductionmentioning

confidence: 87%

Infection prevention and control measures to reduce the transmission of mpox: a systematic review

Kuehn

Fox

Guyatt

et al. 2023

Preprint

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Objectives: To assess the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox in humans and to inform future focused reviews on mpox transmission. Methods: The WHO Clinical Management and Infection Prevention and Control guideline 2022 development group developed three structured research questions concerning respiratory and isolation infection prevention control measures for mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies. Results: To inform the questions the review team synthesized route of transmission data in mpox. There were 2420/3924 (61.7%) cases in which investigators identified transmission occurring through direct physical sexual contact. There proved to be no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/3924 (0.05%) cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies generally failed to isolate mpox virus in saliva, oropharangeal swabs, mpox skin lesions, and hospital room air. Conclusions: Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone the impact of respiratory infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients.

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Description of the first global outbreak of mpox: an analysis of global surveillance data

Cited by 70 publications

References 25 publications

Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross‐sectional study in China

Epidemiological characteristics, clinical manifestations, and mental health status of human mpox cases: A multicenter cross‐sectional study in China

The prevalence of mpox and its association with sexual behavior among Chinese men who have sex with men in early August 2023

Infection prevention and control measures to reduce the transmission of mpox: a systematic review

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