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Ogaz D, Enayat Q, Brown JRG, Phillips D, Wilkie R, Jayes D, Reid D, Hughes G, Mercer CH, Saunders J, Mohammed H. Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022. Emerg Infect Dis 2024; 30:916-925. [PMID: 38573160 PMCID: PMC11060451 DOI: 10.3201/eid3005.230676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.
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Luo S, Jiao K, Zhang Y, Xu Y, Zhou J, Huang S, Li Y, Xiao Y, Ma W, He L, Ren X, Dai Z, Sun J, Li Q, Cheng F, Liang W. Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e47165. [PMID: 38502181 PMCID: PMC10988377 DOI: 10.2196/47165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 10/31/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022. OBJECTIVE This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM. METHODS An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention. RESULTS A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001). CONCLUSIONS Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.
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Affiliation(s)
- Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Kedi Jiao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yutong Xu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jingtao Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Siwen Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yongkang Xiao
- Department of Acute Infectious Diseases Control and Prevention, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xianlong Ren
- Department of AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Zhen Dai
- Department of AIDS/STD Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Jiaruo Sun
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qingyu Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Morino E, Mine S, Tomita N, Uemura Y, Shimizu Y, Saito S, Suzuki T, Okumura N, Iwasaki H, Terada J, Ainai A, Sakai Y, Park E, Seki S, Akazawa D, Shimojima M, Shiwa-Sudo N, Virhuez-Mendoza M, Miyauchi K, Moriyama S, Iwata-Yoshikawa N, Harada M, Harada S, Hishiki T, Kotaki R, Matsumura T, Miyamoto S, Kanno T, Isogawa M, Watashi K, Nagata N, Ebihara H, Takahashi Y, Maeda K, Matano T, Wakita T, Suzuki T, Sugiura W, Ohmagari N, Ujiie M. Mpox Neutralizing Antibody Response to LC16m8 Vaccine in Healthy Adults. NEJM EVIDENCE 2024; 3:EVIDoa2300290. [PMID: 38411447 DOI: 10.1056/evidoa2300290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND: Vaccination against mpox (formerly known as monkeypox), an infectious disease caused by the monkeypox virus (MPXV), is needed to prevent outbreaks and consequent public health concerns. The LC16m8 vaccine, a dried cell-cultured proliferative live attenuated vaccinia virus–based vaccine, was approved in Japan against smallpox and mpox. However, its immunogenicity and efficacy against MPXV have not been fully assessed. We assessed the safety and immunogenicity of LC16m8 against MPXV in healthy adults. METHODS: We conducted a single-arm study that included 50 participants who were followed up for 168 days postvaccination. The primary end point was the neutralizing antibody seroconversion rate against MPXVs, including the Zr599 and Liberia strains, on day 28. The secondary end points included the vaccine “take” (major cutaneous reaction) rate, neutralizing titer kinetics against MPXV and vaccinia virus (LC16m8) strains, and safety outcomes. RESULTS: Seroconversion rates on day 28 were 72% (36 of 50), 70% (35 of 50), and 88% (44 of 50) against the Zr599 strain, the Liberia strain, and LC16m8, respectively. On day 168, seroconversion rates decreased to 30% (15 of 50) against the Zr599 and Liberia strains and to 76% (38 of 50) against LC16m8. The vaccine “take” (broad definition) rate on day 14 was 94% (46 of 49). Adverse events (AEs), including common solicited cutaneous reactions, occurred in 98% (45 of 48) of participants; grade 3 severity AEs occurred in 16% (8 of 50). No deaths, serious AEs, or mpox onset incidences were observed up to day 168. CONCLUSIONS: The LC16m8 vaccine generated neutralizing antibody responses against MPXV in healthy adults. No serious safety concerns occurred with LC16m8 use. (Funded by the Ministry of Health, Labour and Welfare of Japan; Japan Registry of Clinical Trials number, jRCTs031220171.)
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Affiliation(s)
- Eriko Morino
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
- Department Respiratory Medicine, National Center for Global Health and Medicine, Tokyo
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo
| | - Sohtaro Mine
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Noriko Tomita
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
| | - Nobumasa Okumura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
| | - Haruka Iwasaki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
| | - Junko Terada
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
- Department Respiratory Medicine, National Center for Global Health and Medicine, Tokyo
| | - Akira Ainai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Yusuke Sakai
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Eunsil Park
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo
| | - Sayuri Seki
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo
| | - Daisuke Akazawa
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Tokyo
| | - Nozomi Shiwa-Sudo
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | | | - Kosuke Miyauchi
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo
| | - Saya Moriyama
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | | | - Michiko Harada
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo
| | - Shigeyoshi Harada
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo
| | - Takayuki Hishiki
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Ryutaro Kotaki
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Takayuki Matsumura
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Sho Miyamoto
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Takayuki Kanno
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Masanori Isogawa
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Koichi Watashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Noriyo Nagata
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Hideki Ebihara
- Department of Virology I, National Institute of Infectious Diseases, Tokyo
| | - Yoshimasa Takahashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo
| | - Ken Maeda
- Department of Veterinary Science, National Institute of Infectious Diseases, Tokyo
| | - Tetsuro Matano
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo
| | | | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
| | - Mugen Ujiie
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo
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O’Connor LF, Byrne M, Baskaran A, Andersen EW, Horberg MA, Benator DA, Lucar J, Denyer RV, Lee R, Castel AD, Monroe AK. Characterizing Indicators of Engagement in HIV-Associated Healthcare and Clinical Outcomes among People with HIV and Mpox in Washington, DC: A Nested Case-Control Study of the DC Cohort. Pathogens 2024; 13:117. [PMID: 38392854 PMCID: PMC10892472 DOI: 10.3390/pathogens13020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
The high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.
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Affiliation(s)
- Lauren F. O’Connor
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Morgan Byrne
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Anuja Baskaran
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Elisabeth W. Andersen
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA
| | - Debra A. Benator
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Jose Lucar
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Rachel V. Denyer
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Rachel Lee
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Amanda D. Castel
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Anne K. Monroe
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
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Silva MST, Coutinho C, Torres TS, Peixoto EM, Bastos MO, Mesquita MB, Tavares ICF, Andrade HB, Reges PPS, Martins PS, Echeverría-Guevara A, Moreira RI, Lessa FCS, Hoagland B, Nunes EP, Cardoso SW, Veloso VG, Grinsztejn B. Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil. AIDS 2024; 38:105-113. [PMID: 37812389 PMCID: PMC10715691 DOI: 10.1097/qad.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization. DESIGN We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV. METHODS This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons, we used chi-squared, Fisher's exact and the Moods median tests whenever appropriate. RESULTS From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people with HIV (PWH). PWH presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% ( n = 43), especially for pain control. Among hospitalized participants, PWH had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4 + cell counts. All deaths ( n = 2) occurred in PWH with CD4 + less than 50 cells/μl. CONCLUSION HIV-related immunosuppression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.
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Affiliation(s)
- Mayara S T Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil
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Zucker J, Hazra A, Titanji BK. Mpox and HIV-Collision of Two Diseases. Curr HIV/AIDS Rep 2023; 20:440-450. [PMID: 37994953 DOI: 10.1007/s11904-023-00682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The global outbreak of mpox has brought renewed attention to a previously neglected disease which is particularly severe in people with underlying untreated HIV co-infection. For this population, the disease is progressive, severe, and often lethal. In this review, we examine the pathogenesis of mpox disease and its collision with co-existent HIV infection and discuss key considerations for management as well as emerging clinical dilemmas and areas for future research. RECENT FINDINGS Co-existent untreated HIV infection characterized by severe immunocompromise potentiates the nefarious effects of monkeypox virus infection leading to severe manifestations of mpox. Treating mpox in the context of HIV requires mpox-directed therapies, supportive care, and HIV-specific treatment to restore immune function. Preventative measures for PWH are like those in healthy individuals, but the effectiveness and durability of protection conferred by existing vaccines in PWH remain to be fully characterized. Mpox is an important opportunistic infection in PWH. Clinicians should be aware of the unique features of the disease in this population and approaches to care and management of mpox in PWH.
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Affiliation(s)
- Jason Zucker
- Department of Infectious Diseases, Columbia University, New York, NY, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Health Sciences Research Building I, Emory University School of Medicine, 1760 Haygood Drive NE, W300, Rm 327, Atlanta, GA, USA.
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O'Shea JG, Bonacci RA, Cholli P, Kimball A, Brooks JT. HIV and mpox: a rapid review. AIDS 2023; 37:2105-2114. [PMID: 37877274 PMCID: PMC10962215 DOI: 10.1097/qad.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV.
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Affiliation(s)
- Jesse G O'Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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