Potential for Recurrent Mpox Outbreaks Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2023

Pollock, Emily D.; Clay, P. A.; Keen, Adrienne; Currie, Dustin W.; Carter, Rosalind J.; Quilter, Laura; Gundlapalli, Adi V.; Mermin, Jonathan; Spicknall, Ian H.

doi:10.15585/mmwr.mm7221a1

Cited by 20 publications

(9 citation statements)

References 5 publications

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“…Although the national and global mpox incidence has declined, 33 minor outbreaks continue to be reported globally (e.g. in the Western Pacific Region), 33 presenting a risk of importation into, and resurgence within Canada 34 . Corresponding with recent data suggesting small, sporadic, localized outbreaks in Canada, 9 this work highlights the role of global mpox incidence, via case importation, in influencing the likelihood of sustained resurgent outbreaks 30,34,35 .…”

Section: Discussionmentioning

confidence: 70%

“…in the Western Pacific Region), 33 presenting a risk of importation into, and resurgence within Canada 34 . Corresponding with recent data suggesting small, sporadic, localized outbreaks in Canada, 9 this work highlights the role of global mpox incidence, via case importation, in influencing the likelihood of sustained resurgent outbreaks 30,34,35 . Additionally, increased levels of both vaccine‐ and infection‐induced immunity likely resulted in a growing proportion of the population with protection against future infection, thus impacting the likelihood and outcome of future outbreaks in the short/medium term 34 …”

Section: Discussionmentioning

confidence: 99%

“…30,34,35 Additionally, increased levels of both vaccine-and infection-induced immunity likely resulted in a growing proportion of the population with protection against future infection, thus impacting the likelihood and outcome of future outbreaks in the short/medium term. 34 There are inherent limitations within this study. While the compartmental model is simplistic and does not include standard sexual contact patterns 36 typically used in compartmental models of sexually transmitted infections, the purpose was to explore population-level community transmission patterns, especially at the epidemic onset when there were uncertainties regarding the transmission route and minimal surveillance data.…”

Section: Discussionmentioning

confidence: 99%

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Exploring the dynamics of the 2022 mpox outbreak in Canada

Milwid,

Li,

Fazil

et al. 2023

Journal of Medical Virology

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The 2022 mpox outbreak predominantly impacted gay, bisexual, and other men who have sex with men (gbMSM). Two models were developed to support situational awareness and management decisions in Canada. A compartmental model characterized epidemic drivers at national/provincial levels, while an agent‐based model (ABM) assessed municipal‐level impacts of vaccination. The models were parameterized and calibrated using empirical case and vaccination data between 2022 and 2023. The compartmental model explored: (1) the epidemic trajectory through community transmission, (2) the potential for transmission among non‐gbMSM, and (3) impacts of vaccination and the proportion of gbMSM contributing to disease transmission. The ABM incorporated sexual‐contact data and modeled: (1) effects of vaccine uptake on disease dynamics, and (2) impacts of case importation on outbreak resurgence. The calibrated, compartmental model followed the trajectory of the epidemic, which peaked in July 2022, and died out in December 2022. Most cases occurred among gbMSM, and epidemic trajectories were not consistent with sustained transmission among non‐gbMSM. The ABM suggested that unprioritized vaccination strategies could increase the outbreak size by 47%, and that consistent importation (≥5 cases per 10 000) is necessary for outbreak resurgence. These models can inform time‐sensitive situational awareness and policy decisions for similar future outbreaks.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Exploring the dynamics of the 2022 mpox outbreak in Canada

Milwid,

Li,

Fazil

et al. 2023

Journal of Medical Virology

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“…Vaccine coverage is an important indicator, as it may affect the risk and size of future outbreaks. A CDC analysis demonstrating the relationship between population mpox immunity and the risk for outbreak recurrence underscored the need for sustained mpox vaccination services, particularly in communities with low vaccination coverage [ 21 ]. Recent CDC vaccine coverage estimates demonstrated a range of state-wide coverage, from 4.6% to 66.2%, with 23% of the at-risk population estimated to be fully vaccinated in the United States [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Preparing for Mpox Resurgence: Surveillance Lessons From Outbreaks in Toronto, Canada

Sachdeva,

Shahin,

Ota

et al. 2023

The Journal of Infectious Diseases

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Background Along with many global jurisdictions, Toronto, Canada experienced an outbreak of mpox in the spring/summer of 2022. Case counts declined following the implementation of a large vaccination campaign. A surge of case reports in early 2023 led to speculation that asymptomatic and/or undetected local transmission was occurring in the city. Methods Mpox cases and positive laboratory results are reported to Toronto Public Health. Epidemic curves and descriptive risk factor summaries for the 2022 and 2023 outbreaks were generated. First and second dose vaccination was monitored. Monkeypox virus wastewater surveillance and whole genome sequencing (WGS) were conducted to generate hypotheses about the source of the 2023 resurgence. Results 515 cases were reported in the spring/summer outbreak of 2022 and 17 in the 2022-2023 resurgence. Wastewater data correlated with the timing of reported cases. WGS showed that the 2022-2023 resurgent cases were distinct from the other 2022 cases and closer to sequences from another country, suggesting a new importation as a source for recent cases. At the start of the 2022-2023 resurgence, it was estimated that only 16% of first dose vaccine recipients had completed their second dose vaccination. Discussion This investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing pre-exposure vaccine promotion remains important to mitigate disease burden.

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“…Across all urban-rural levels, incidence peaked in August 2022. Although the number of mpox cases decreased sharply after this date, the risk for outbreak and recurrence is dependent on the estimated immunity level, which is calculated by the number of cases during the 2022 outbreak and vaccination rates ( 6 ).…”

Section: Discussionmentioning

confidence: 99%