Understanding sexual transmission dynamics and transmission contexts of monkeypox virus: a mixed-methods study of the early outbreak in Belgium (May–June 2022)

Abstract

ObjectiveThe available epidemiological and clinical evidence from the currently ongoing monkeypox (MPX) outbreak in non-endemic areas suggests an important factor of sexual transmission. However, limited information on the behaviour and experiences of individuals with an MPX infection has to date been provided. We aimed to describe the initial phase of the MPX outbreak in Belgium, and to provide a more in-depth description of sexual behaviour and transmission contexts.MethodsWe used routine national surveillance data of 139 confirmed MPX cases with date of symptom onset until 19 June 2022, complemented with 12 semistructured interviews conducted with a subsample of these cases.ResultsSexualised environments, including large festivals and cruising venues for gay men, were the suspected exposure setting for the majority of the cases in the early outbreak phase. In-depth narratives of sexual behaviour support the hypothesis of MPX transmission through close physical contact during sex. Despite awareness of the ongoing MPX outbreak, low self-perceived risk of MPX acquisition and confusing initial signs and symptoms for other STIs or skin conditions delayed early detection of an MPX infection. In addition, we describe relevant contextual factors beyond individual behaviour, related to sexual networks, interpersonal interactions and health systems. Some of these factors may complicate early MPX detection and control efforts.ConclusionOur results highlight the role of sexual contact and networks in the transmission of MPX during the early phase of the outbreak in Belgium. Risk communication messages should consistently and transparently state the predominant sexual transmission potential of MPX virus, and prevention and control measures must be adapted to reflect multilevel factors contributing to MPX transmission risk.

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

“… Pooled frequency of genitalia involvement in post-2022 studies. Tarín-Vicente, 2022 [ 27 ], Angelo, 2022 [ 28 ], Betancort-Plata, 2022 [ 29 ], Caria, 2022 [ 30 ], Vanhamel 2022 [ 31 ], Girometti, 2022 [ 33 ], Orviz, 2022 [ 34 ], Hoffmann1, 2022 [ 35 ], Cobos, 2022 [ 36 ], Hoffmann2, 2022 [ 37 ], Van Ewijk, 2022 [ 38 ], Mailhe, 2022 [ 39 ], Nunez, 2022 [ 40 ], Catala, 2022 [ 41 ], Cassir, 2022 [ 42 ], Pascom, 2022 [ 70 ], Suner, 2022 [ 43 ], Maldonado, 2023 [ 44 ]. …”

Prevention of sexual transmission of mpox: a systematic review and qualitative evidence synthesis of approaches

“…After screening, four qualitative interview-based studies were found to have addressed the question: ‘What are the views and experiences of interventions to prevent sexual transmission of mpox among communities at risk of infection?’ Study characteristics for three cross-sectional [ 32–34 ] and one longitudinal [ 35 ] are given in Table 3 . Two European studies collected data in the initial phases of the outbreak [ 33 , 34 ]; one study in Australia was conducted after the initial outbreak [ 35 ]; and one in China was conducted at a time when reported cases were still increasing [ 32 ].…”

“…Three studies [ 32 , 33 , 35 ] only included men (mostly MSM) with experience of mpox. The fourth study [ 34 ] included only MSM.…”

“…All studies included participants’ views on mpox prevention measures, focusing particularly on: behaviour prior to the onset of symptoms [ 33 ], behaviour and practices from the time of symptom onset to recovery [ 32 ], participants’ experiences of treatment and care [ 35 ], and engagement in primary and/or secondary prevention measures [ 34 ].…”

Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe

“… 83 Moreover, the role of networks in the transmission of Monkeypox virus (MPXV) during the early phase of the outbreak in Belgium has been recently described. 84 Pandemics: COVID-19 …”