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Ponce L, Linton NM, Toh WH, Cheng HY, Thompson RN, Akhmetzhanov AR, Dushoff J. Incubation Period and Serial Interval of Mpox in 2022 Global Outbreak Compared with Historical Estimates. Emerg Infect Dis 2024; 30:1173-1181. [PMID: 38781950 PMCID: PMC11138990 DOI: 10.3201/eid3006.231095] [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: 05/25/2024] Open
Abstract
Understanding changes in the transmission dynamics of mpox requires comparing recent estimates of key epidemiologic parameters with historical data. We derived historical estimates for the incubation period and serial interval for mpox and contrasted them with pooled estimates from the 2022 outbreak. Our findings show the pooled mean infection-to-onset incubation period was 8.1 days for the 2022 outbreak and 8.2 days historically, indicating the incubation periods remained relatively consistent over time, despite a shift in the major mode of transmission. However, we estimated the onset-to-onset serial interval at 8.7 days using 2022 data, compared with 14.2 days using historical data. Although the reason for this shortening of the serial interval is unclear, it may be because of increased public health interventions or a shift in the mode of transmission. Recognizing such temporal shifts is essential for informed response strategies, and public health measures remain crucial for controlling mpox and similar future outbreaks.
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Yeganeh N, Yin S, Moir O, Danza P, Kim M, Finn L, Fisher R, Kulkarni S, Perez M, Poortinga K, Garland W, Foo C, Haddix M, Archer R, Frey N, Balter S, Singhal R, Kim A. Effectiveness of JYNNEOS vaccine against symptomatic mpox disease in adult men in Los Angeles County, August 29, 2022 to January 1, 2023. Vaccine 2024:S0264-410X(24)00594-2. [PMID: 38789368 DOI: 10.1016/j.vaccine.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
We describe real-world estimates of JYNNEOS vaccine effectiveness (VE) against symptomatic mpox in Los Angeles County (LAC). We conducted a retrospective cohort study of men aged ≥18 years residing in LAC who were at risk for mpox and eligible for the JYNNEOS vaccine from 5/19/2022 to 1/1/2023. Case demographics and route of JYNNEOS administration were obtained through vaccine administration data systems. HIV and sexually transmitted infection (STI) status was obtained through disease reporting systems for HIV and STI diagnoses in LAC. To estimate VE, we calculated weekly incidence of confirmed mpox for unvaccinated, partially vaccinated (episode date ≥14 days after first dose), and fully vaccinated (episode date ≥14 days after second dose) cohorts starting on 8/29/2022, when fully vaccinated coverage exceeded 3 %, and ending on 1/1/2023. Overall, 2,171 men had confirmed mpox, and 1,002 (46 %) of those were persons living with diagnosed HIV (PLWDH). 2,019 (93 %) mpox cases were unvaccinated, 114 (5 %) were partially vaccinated and 38 (2 %) were fully vaccinated. VE was 69 % (95 % CI 59-77) for partially vaccinated and 84 % (95 % CI 80-87) for fully vaccinated individuals. Among PLWDH, VE was 72 % (95 % CI 57-82) for fully vaccinated and 28 % (95 % CI -96 to 73) VE for partially vaccinated individuals. Among persons not living with diagnosed HIV, VE was 88 % (95 % CI 86-90) for fully vaccinated and 80 % (95 % CI 76-83) for partially vaccinated individuals. Of 111 individuals hospitalized with mpox, one was partially vaccinated, and the remaining were unvaccinated. Our results align with other published studies that reported that two doses of the JYNNEOS vaccine provided significant protection against symptomatic mpox.
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Affiliation(s)
- Nava Yeganeh
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States.
| | - Sherry Yin
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Olivia Moir
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Phoebe Danza
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Moon Kim
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Lauren Finn
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Rebecca Fisher
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Sonali Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Mario Perez
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Kathleen Poortinga
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Wendy Garland
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chelsea Foo
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Meredith Haddix
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Roxanne Archer
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Natalie Frey
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Sharon Balter
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Rita Singhal
- Disease Control Bureau, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Andrea Kim
- Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, United States
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Phillips G, Curtis MG, Felt D, Davoudpour S, Rodriguez-Ortiz AE, Cortez A, French AL, Hosek SG, Serrano PA. Changes in Sexual Behaviors Due to Mpox: a Cross-Sectional Study of Sexual and Gender Minority Individuals in Illinois. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:628-637. [PMID: 37906357 PMCID: PMC11112966 DOI: 10.1007/s11121-023-01604-3] [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: 10/17/2023] [Indexed: 11/02/2023]
Abstract
The spread of the monkeypox virus (mpox) in 2022 primarily within the sexual networks of men who have sex with men (MSM) triggered a potentially stigmatizing public health response in the USA. Despite mpox being primarily spread through skin-to-skin contact, most messaging has promoted abstinence and/or reduction in sexual risk behaviors. More research is needed on decreases in sexual risk behaviors among sexual and gender minority (SGM) youth and young adults (YYA) related to the most recent mpox epidemic and whether there are factors associated with these decreases in sexual risk behavior. Participants within an ongoing cohort study of SGM YYA who reside in Illinois were offered the opportunity to participate in an mpox survey between September 10th and September 20th, 2022. Analyses looked at demographic factors associated with sexual activity since the start of the outbreak, as well as associations with two sexual risk reduction factors. Survey participation was 68.7% (322/469). Three-quarters of participants (82.6%) reported sexual activity since June 1st. Most sexually active participants (83.5%) adopted at least one sexual risk reduction behavior due to mpox. Black and Latinx individuals were less likely to be sexually active but more likely to report risk reduction behaviors (31.3% and 22.6%, respectively). Participants who received the mpox vaccine were more likely to report sexual activity. SGM YYA in Illinois reported that their sexual behaviors were impacted by the mpox outbreak. However, associations between vaccination and sexual behavior demonstrate that those who are vaccinated do adopt protective methods despite not decreasing sexual activity. Therefore, sex-positive communications and harm reduction messaging may be more appropriate as opposed to abstinence-only prevention, which can further stigmatize an already marginalized group.
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Affiliation(s)
- Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA.
| | - Michael G Curtis
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA
| | - Shahin Davoudpour
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA
| | - Anthony E Rodriguez-Ortiz
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA
| | - Alfred Cortez
- Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL, 60611, USA
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Haverkate MR, Willemstein IJ, van Ewijk CE, Adam PC, Lanooij SJ, Jonker-Jorna P, van Bokhoven C, van Rijckevorsel GG, Hoornenborg E, David S, Mollema L, Te Wierik MJ, Lange J, Franz E, de Melker HE, Op de Coul EL, Hahné SJ. Factors potentially contributing to the decline of the mpox outbreak in the Netherlands, 2022 and 2023. Euro Surveill 2024; 29:2300608. [PMID: 38785092 PMCID: PMC11128738 DOI: 10.2807/1560-7917.es.2024.29.21.2300608] [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: 11/03/2023] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
BackgroundIn 2022 and 2023, a global outbreak of mpox affected mostly gay, bisexual and other men having sex with men (GBMSM). Outbreak control in the Netherlands included isolation, quarantine, post-exposure prophylaxis vaccination and primary preventive vaccination (PPV).AimWe describe the course of the outbreak, the vaccination programme, vaccine effectiveness (VE) of full vaccination against symptomatic disease, and trends in behaviour to generate hypotheses about factors that influenced the outbreak's decline.MethodsIn this observational study, we collected data from public health services on notified cases, number of PPV invitations and PPV doses administered. We calculated PPV uptake and coverage. Trends in behavioural data of GBMSM visiting sexual health centres were analysed for all consultations in 2022. We estimated VE using the screening method.ResultsUntil 31 December 2023, 1,294 mpox cases were reported. The outbreak peaked in early July 2022 and then declined sharply. PPV started on 25 July 2022; in total 29,851 doses were administered, 45.8% received at least one dose, 35.4% were fully vaccinated. The estimated VE was 68.2% (95% CI 4.3-89.5%). We did not observe an evident decrease in high-risk behaviour.DiscussionIt is unlikely that PPV was a driver of the outbreak's decline, as incidence started to decline well before the start of the PPV programme. The possible impact of behavioural change could not be demonstrated with the available indicators, however, the data had limitations, hampering interpretation. We hypothesise that infection-induced immunity in high-risk groups was an important factor explaining the decline.
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Affiliation(s)
- Manon R Haverkate
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Inge Jm Willemstein
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Catharina E van Ewijk
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Philippe Cg Adam
- Institute for Prevention and Social Research, Utrecht, the Netherlands
- University of New South Wales Sydney, Sydney, Australia
| | - Susan J Lanooij
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | - Gini Gc van Rijckevorsel
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Public Health Service Amsterdam, Amsterdam, the Netherlands
| | | | - Silke David
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Liesbeth Mollema
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Margreet J Te Wierik
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jente Lange
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eelco Franz
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hester E de Melker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eline Lm Op de Coul
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Susan Jm Hahné
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Allan-Blitz LT, Khan T, Elangovan K, Smith K, Multani A, Mayer KH. Addressing mpox at a Frontline Community Health Center: Lessons for the Next Outbreak. Public Health Rep 2024; 139:294-300. [PMID: 37846528 PMCID: PMC11037218 DOI: 10.1177/00333549231201682] [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: 10/18/2023] Open
Abstract
The 2022 mpox (formerly monkeypox) outbreak affected predominantly men who have sex with men (MSM), likely through sexual transmission, which resulted in institutions specializing in sexual health being at the frontlines of the mpox outbreak. Fenway Health in Boston serves close to 10 000 MSM annually, which includes more than 2400 MSM who are living with HIV and 3320 MSM with active HIV preexposure prophylaxis (PrEP) prescriptions. We report on the programs implemented and changes to clinical practice at Fenway Health during the mpox outbreak. Fenway Health diagnosed its first case of mpox in June 2022 and treated this patient with tecovirimat. In early July 2022, Fenway Health administered its first dose of the Jynneos vaccine under the Emergency Use Authorization for protection against mpox. As of October 6, 2022, 69 people had tested positive for the mpox virus at Fenway Health. Among the 69 people who tested positive, 43 (62.3%) self-identified as male, with the remaining not reporting a sex or gender identity, and 40 (58.0%) reported their sexual orientation as gay or bisexual. Twenty-five people (36.2%) were treated with tecovirimat. As of October 30, 2022, Fenway Health had administered 6376 doses of the Jynneos vaccine. The programmatic changes involved in rollout and scale-up of vaccination, treatment, and community outreach services at Fenway Health during the 2022 mpox outbreak that we describe here could inform strategies to address subsequent outbreaks.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | | | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Cheung DH, Chen S, Fang Y, Sun F, Zhang Q, Yu FY, Mo PKH, Wang Z. Influences of mpox disease perceptions, sources and contents of information exposure on mpox vaccine uptake among gay, bisexual, and other men who have sex with men in Hong Kong, China. Vaccine 2024; 42:2337-2346. [PMID: 38480102 DOI: 10.1016/j.vaccine.2024.02.083] [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: 12/13/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Following the global mpox outbreak in 2022, multiple regions in Asia have been reporting ongoing mpox cases within high-risk groups, including gay, bisexual, and other men who have sex with men (GBMSM). An optimal level of vaccination rate is essential to prevent further mpox outbreaks. However, no existing studies have examined mpox vaccine uptake among GBMSM in East Asia. METHODS A cross-sectional survey was conducted among a sample of 531 GBMSM in Hong Kong, China, between March and October 2023. The study used multivariable logistic regression models to investigate the associations between mpox-related disease perceptions, exposures to sources and contents of mpox-related information, and mpox vaccine uptake. RESULTS The prevalence of mpox vaccine uptake among GBMSM in Hong Kong was 21.7%, with 7.7% completing one dose and 13.9% completing two doses. GBMSM who were younger or earning less monthly income were less likely to have been vaccinated. After adjusting for confounding variables, participants who perceived more negative impacts on their lives if they were to contract mpox, more severe symptoms, and a more coherent understanding of mpox were positively associated with mpox vaccine uptake. In addition, more frequent exposure to information through the following sources: TV, newspaper, radio and posters, government websites, news websites or apps, other people's social media, and communication over the phone or face-to-face was positively associated with mpox vaccine uptake. Finally, more frequent exposure to the following information contents: mpox statistics from other countries, the Hong Kong government's responses to mpox cases, negative information about patients with mpox, and information on prevention and treatment of mpox were positively associated with mpox vaccine uptake. CONCLUSIONS This study provides timely and evidence-based implications to address health communication and messaging needs in promoting mpox vaccination among GBMSM in Hong Kong, relevant to regions with similar sociocultural contexts.
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Affiliation(s)
- Doug H Cheung
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | - Siyu Chen
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong Special Administrative Region.
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong Special Administrative Region
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Fuk-Yuen Yu
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Doyle TJ, Gumke M, Stanek D, Moore J, Buck B, Locksmith T, Tomson K, Schmedes S, Churchwell G, Hubsmith SJ, Krishnamoorthy B, Poschman K, Danforth B, Chacreton D. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021-2022. Emerg Infect Dis 2024; 30. [PMID: 38526187 PMCID: PMC10977815 DOI: 10.3201/eid3004.231392] [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: 03/26/2024] Open
Abstract
In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March--June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.
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Sachdeva H, Shahin R, Ota S, Isabel S, Mangat CS, Stuart R, Padhi S, Chris A, Mishra S, Tan DHS, Braukmann TW, Eshaghi A, Mejia EM, Hizon NA, Finkelstein M. Preparing for Mpox Resurgence: Surveillance Lessons From Outbreaks in Toronto, Canada. J Infect Dis 2024; 229:S305-S312. [PMID: 38035826 DOI: 10.1093/infdis/jiad533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND With many global jurisdictions, Toronto, Canada, experienced an mpox outbreak in spring/summer 2022. Cases declined following implementation of a large vaccination campaign. A surge 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. Mpox virus wastewater surveillance and whole genome sequencing were conducted to generate hypotheses about the source of the 2023 resurgence. RESULTS An overall 515 cases were reported in spring/summer 2022 and 17 in the 2022-2023 resurgence. Wastewater data correlated with the timing of cases. Whole genome sequencing showed that 2022-2023 cases were distinct from 2022 cases and closer to sequences from another country, suggesting a new importation as a source. At the start of the resurgence, approximately 16% of first-dose vaccine recipients had completed their second dose. CONCLUSIONS 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 preexposure vaccine promotion remains important to mitigate disease burden.
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Affiliation(s)
- Herveen Sachdeva
- Toronto Public Health
- Dalla Lana School of Public Health, University of Toronto
| | - Rita Shahin
- Toronto Public Health
- Dalla Lana School of Public Health, University of Toronto
| | | | - Sandra Isabel
- Public Health Ontario, Toronto
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval
| | - Chand S Mangat
- Wastewater Surveillance Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | | | - Shovita Padhi
- Toronto Public Health
- Dalla Lana School of Public Health, University of Toronto
| | - Allison Chris
- Toronto Public Health
- Dalla Lana School of Public Health, University of Toronto
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto
- Department of Medicine, Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation and Institute of Medical Science, University of Toronto
- Institute for Clinical Evaluative Sciences (ICES)
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Darrell H S Tan
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto
- Department of Medicine, Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation and Institute of Medical Science, University of Toronto
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Edgard M Mejia
- Wastewater Surveillance Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Nikho A Hizon
- Wastewater Surveillance Unit, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
| | - Michael Finkelstein
- Toronto Public Health
- Dalla Lana School of Public Health, University of Toronto
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Brooks JT, Reynolds MG, Torrone E, McCollum A, Spicknall IH, Gigante CM, Li Y, Satheshkumar PS, Quilter LAS, Rao AK, O'Shea J, Guagliardo SAJ, Townsend M, Hutson CL. How the Orthodox Features of Orthopoxviruses Led to an Unorthodox Mpox Outbreak: What We've Learned, and What We Still Need to Understand. J Infect Dis 2024; 229:S121-S131. [PMID: 37861379 DOI: 10.1093/infdis/jiad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Orthopoxviruses have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV), originally characterized in the late 1950s during outbreaks among captive primates, has been recognized since the 1970s to cause human disease (mpox) in West and Central Africa, where interhuman transmission has largely been associated with nonsexual, close physical contact. In May 2022, a focus of MPXV transmission was detected, spreading among international networks of gay, bisexual, and other men who have sex with men. The outbreak grew in both size and geographic scope, testing the strength of preparedness tools and public health science alike. In this article we consider what was known about mpox before the 2022 outbreak, what we learned about mpox during the outbreak, and what continued research is needed to ensure that the global public health community can detect, and halt further spread of this disease threat.
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Affiliation(s)
- John T Brooks
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary G Reynolds
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Torrone
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea McCollum
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian H Spicknall
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura A S Quilter
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Townsend
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Hutson
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Vincent W. Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis. J Med Internet Res 2024; 26:e47448. [PMID: 38457790 PMCID: PMC10960216 DOI: 10.2196/47448] [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] [Received: 03/20/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. OBJECTIVE This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. METHODS We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. RESULTS On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. CONCLUSIONS In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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11
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [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: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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12
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Clay PA, Asher JM, Carnes N, Copen CE, Delaney KP, Payne DC, Pollock ED, Mermin J, Nakazawa Y, Still W, Mangla AT, Spicknall IH. Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak. Sex Transm Infect 2024; 100:70-76. [PMID: 38050171 DOI: 10.1136/sextrans-2023-055922] [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: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The 2022 mpox outbreak has infected over 30 000 people in the USA, with cases declining since mid-August. Infections were commonly associated with sexual contact between men. Interventions to mitigate the outbreak included vaccination and a reduction in sexual partnerships. Understanding the contributions of these interventions to decreasing cases can inform future public health efforts. METHODS We fit a dynamic network transmission model to mpox cases reported by Washington DC through 10 January 2023. This model incorporated both vaccine administration data and reported reductions in sexual partner acquisition by gay, bisexual or other men who have sex with men (MSM). The model output consisted of daily cases over time with or without vaccination and/or behavioural adaptation. RESULTS We found that initial declines in cases were likely caused by behavioural adaptations. One year into the outbreak, vaccination and behavioural adaptation together prevented an estimated 84% (IQR 67% to 91%) of cases. Vaccination alone averted 79% (IQR 64% to 88%) of cases and behavioural adaptation alone averted 25% (IQR 10% to 42%) of cases. We further found that in the absence of vaccination, behavioural adaptation would have reduced the number of cases, but would have prolonged the outbreak. CONCLUSIONS We found that initial declines in cases were likely caused by behavioural adaptation, but vaccination averted more cases overall and was key to hastening outbreak conclusion. Overall, this indicates that outreach to encourage individuals to protect themselves from infection was vital in the early stages of the mpox outbreak, but that combination with a robust vaccination programme hastened outbreak conclusion.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason M Asher
- Office of the Director, Center for Forecasting and Outbreak Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey E Copen
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne & Environmental Diseases, National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily D Pollock
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Mermin
- Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori Nakazawa
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William Still
- DC Department of Health, Washington, District of Columbia, USA
| | - Anil T Mangla
- DC Department of Health, Washington, District of Columbia, USA
| | - Ian H Spicknall
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, Lorusso N, Vázquez Torres M, Barbas del Buey JF, Roig-Sena J, Pastor E, Galmés Truyols A, Artigues Serra F, Sancho Martínez RM, Latasa Zamalloa P, Pérez Martínez O, Vázquez Estepa A, García Rojas AJ, Barreno Estévez AI, Sánchez-Migallón Naranjo A, Pérez Martín JJ, Peces Jiménez P, Morales Romero R, Castilla J, García Cenoz M, Huerta Huerta M, Boone ALD, Macías Ortiz MJ, Álvarez Río V, Rodríguez Recio MJ, Merino Díaz M, Berradre Sáenz B, Villegas-Moreno MT, Limia A, Diaz A, Monge S. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study. Clin Infect Dis 2024; 78:476-483. [PMID: 37864849 PMCID: PMC10874271 DOI: 10.1093/cid/ciad645] [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: 07/30/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Community of Madrid, Spain
| | - Victoria Hernando
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Carmen Olmedo
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ermengol Coma
- Primary Healthcare Information Systems, Health Institute of Catalonia, Catalonia, Spain
| | - Montse Martínez
- Preventive Medicine Service, General Sub-directorate for Health Promotion, Health Department, Secretariat of Public Health,Catalonia, Spain
| | - David Moreno-Perez
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - Nicola Lorusso
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - María Vázquez Torres
- Healthcare Department, General Sub-directorate of Health Prevention and Promotion, General Directorate of Public Health, Community of Madrid, Spain
| | - José Francisco Barbas del Buey
- General Sub-directorate of Public Health Surveillance, General Directorate of Public Health, Madrid, Community of Madrid, Spain
| | - Javier Roig-Sena
- Department of Universal Healthcare and Public Health, Epidemiological Surveillance Service, Valencian Community, Spain
| | - Eliseo Pastor
- Universal Healthcare and Public Health Department, Health Promotion and Prevention Programs Service, Valencian Community, Spain
| | - Antònia Galmés Truyols
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Francisca Artigues Serra
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Rosa María Sancho Martínez
- Epidemiology Unit, General Sub-directorate of Public Health and Addictions of Gipuzkoa, Basque Country, Spain
| | - Pello Latasa Zamalloa
- Epidemiology and Vaccination Service, General Directorate of Public Health, Basque Country, Spain
| | - Olaia Pérez Martínez
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Ana Vázquez Estepa
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Amós José García Rojas
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | - Ana Isabel Barreno Estévez
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | | | - Jaime Jesús Pérez Martín
- Vaccination Progamme, Prevention and Health Protection Service, Health Department, General Directorate of Public Health and Addictions, Murcia Region, Spain
| | - Pilar Peces Jiménez
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Raquel Morales Romero
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA – CIBERESP, Pamplona, Spain
| | | | - Marta Huerta Huerta
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - An Lieve Dirk Boone
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - María José Macías Ortiz
- Vaccination Program, General Directorate of PublicHealth, Healthcare Service of Extremadura, Spain
| | - Virginia Álvarez Río
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla y León, Spain
| | | | - María Merino Díaz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | - Belén Berradre Sáenz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | | | - Aurora Limia
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asuncion Diaz
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Susana Monge
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
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Lin YC, Wen TH, Shih WL, Vermund SH, Fang CT. Impact of vaccination and high-risk group awareness on the mpox epidemic in the United States, 2022-2023: a modelling study. EClinicalMedicine 2024; 68:102407. [PMID: 38235420 PMCID: PMC10789643 DOI: 10.1016/j.eclinm.2023.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
Background The unprecedented global outbreak of mpox in 2022 posed a public health challenge. In addition to the mpox vaccine campaign in the United States (US), community organisations and public health agencies initiated educational efforts to promote sexual risk reduction. This modelling study estimated the impact of the two-dose vaccination campaign and sexual behaviour changes coincident with high-risk group awareness on the mpox epidemic in the US. Methods We fitted a deterministic, risk-structured SEIARV model to the epidemic curve of reported mpox cases in the US between May 22, 2022 and December 22, 2022. We evaluated the putative effects of the two preventive responses in the US -- vaccination and sexual risk reduction -- at the population-level, by calculating the prevention percentages of cumulative cases compared to the counterfactual scenario without interventions. We performed sensitivity analyses with four parameters: case reporting fidelity, vaccine effectiveness, proportion of asymptomatic cases, and assortative mixing. Findings Model fitting revealed a basic reproduction number of 3.88 and 0.39 for the high-risk and low-risk populations, respectively, with 71.8% of mpox cases estimated from the high-risk population. A two-dose vaccination campaign, solely, could prevent 21.2% (10.2%-24.1%) of cases, while behaviour changes due to high-risk group awareness alone could prevent 15.4% (14.3%-20.6%). The combination of both measures were synergistic, with the model suggesting that 64.0% (43.8%-69.0%) of US cases were averted that would have otherwise occurred. Interpretation Our models suggest that the 2022-2023 mpox epidemic in the US was controlled by a combination of two-dose mpox vaccination campaign and high-risk group awareness and sexual risk reduction. Funding Taiwan Ministry of Education grant #NTU-112L9004, Taiwan National Science and Technology Council grant #MOST-109-2314-B-002-147-MY3 and grant #NSC-112-2314-B-002-216-MY3. SHV was supported, in part, by US National Institutes of Health grant #P30MH062294.
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Affiliation(s)
- Yin-Chien Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tzai-Hung Wen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Geography, National Taiwan University, Taiwan
| | - Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Infectious Diseases Research and Education Center, Ministry of Health and Welfare and National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital; and School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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15
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Andersen EW, Kulie P, Castel AD, Lucar J, Benator D, Greenberg AE, Monroe A. Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC. Pathogens 2024; 13:124. [PMID: 38392862 PMCID: PMC10891655 DOI: 10.3390/pathogens13020124] [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: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.
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Affiliation(s)
- Elisabeth W. Andersen
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Paige Kulie
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Jose Lucar
- Division of Infectious Diseases, The George Washington School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Debra Benator
- The Washington DC Veterans Affairs Administration, Washington, DC 20422, USA;
| | - Alan E. Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
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16
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Grov C, Zohra F, Mirzayi C, Stief M, D'Angelo AB, Dearolf M, Westmoreland DA, Carneiro P, Nash D, Carrico AW. Sexual and Gender Minorities' Vaccine Uptake and Behavioral Change in Response to the Mpox Outbreak in the United States: August 2022 Through November 2022. Clin Infect Dis 2024:ciad793. [PMID: 38262167 DOI: 10.1093/cid/ciad793] [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: 05/30/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND In the summer of 2022, the United States faced a nationwide outbreak of mpox, with cases concentrated in sexual and gender minorities who have sex with men. Understanding rates of mpox vaccine uptake and concomitant behavioral change is essential to guide the implementation of targeted public health responses to the potential reemergence of mpox. METHODS Between August 2022 and November 2022, 8551 individuals recruited via geosocial networking apps completed a brief survey that assessed mpox vaccine uptake, intentions to get a mpox vaccine, and behavioral change. RESULTS In August, 17.4% of participants reported having received at least 1 dose of the mpox vaccine. By November, this prevalence estimate was 35.0%. Black participants were significantly less likely to be vaccinated, and vaccine hesitancy increased among Black participants over time. Among those who had not yet received a vaccination, the intention to get vaccinated decreased over time. We observed trends that coincided with the evolving outbreak, such as decreased worry about mpox and less engagement in risk reduction behaviors over time. CONCLUSIONS Despite a 2-fold increase in mpox vaccine uptake between August 2022 and November 2022 in sexual and gender minorities who have sex with men, disparities in vaccine uptake were observed among Black participants. Findings will guide the implementation of public health responses to the potential reemergence of mpox and other viral infectious diseases (eg, meningitis) with a specific focus on optimizing vaccine uptake in Black communities.
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Affiliation(s)
- Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Fatima Zohra
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Chloe Mirzayi
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Matthew Stief
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Alexa B D'Angelo
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Michelle Dearolf
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Drew A Westmoreland
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Pedro Carneiro
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Florida International Univeristy, Miami, Florida, USA
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17
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Murayama H, Pearson CAB, Abbott S, Miura F, Jung SM, Fearon E, Funk S, Endo A. Accumulation of Immunity in Heavy-Tailed Sexual Contact Networks Shapes Mpox Outbreak Sizes. J Infect Dis 2024; 229:59-63. [PMID: 37402631 PMCID: PMC10786257 DOI: 10.1093/infdis/jiad254] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
Many countries affected by the global outbreak of mpox in 2022 have observed a decline in cases. Our mathematical model accounting for heavy-tailed sexual partnership distributions suggests that mpox epidemics can hit the infection-derived herd immunity threshold and begin to decline, with <1% of sexually active men who have sex with men infected regardless of interventions or behavioral changes. We consistently found that many countries and US states experienced an epidemic peak, with cumulative cases of around 0.1% to 0.5% among men who have sex with men. The observed decline in cases may not necessarily be attributable to interventions or behavioral changes primarily.
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Affiliation(s)
- Hiroaki Murayama
- School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Sam Abbott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fuminari Miura
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Center for Marine Environmental Studies, Ehime University, Ehime, Japan
| | - Sung-mok Jung
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth Fearon
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine
- Institute for Global Health, University College London, London, United Kingdom
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Akira Endo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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18
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Grabmeier-Pfistershammer K, Skorepa C, Breuer M, Masood M, Chromy D, Strassl R. No evidence of asymptomatic monkeypox infection in a highly sexually active MSM population in Austria. HIV Med 2024; 25:150-153. [PMID: 37652894 DOI: 10.1111/hiv.13535] [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] [Received: 06/19/2023] [Accepted: 08/06/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The 2022 outbreak of monkeypox virus (MPXV) revealed new transmission routes. Incidence declined sharply in September 2022, and it remains unclear whether MPXV is circulating in asymptomatic individuals because of increased immunity. OBJECTIVES Our study aimed to assesss the number of asymtomatic MPXV carriers in individuals at high risk for STI. METHODS We analysed anal samples from asymptomatic highly sexually active men who have sex with men for the presence of MPXV. RESULTS We detected a high number of concomitant sexually transmitted infections but did not find a single sample with MPXV. CONCLUSIONS Our results indicate that the general recommendation to implement screening for MPXV is not currently justified.
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Affiliation(s)
| | - Christopher Skorepa
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Monika Breuer
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Maheen Masood
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - David Chromy
- Department of Dermatology, Medical University Vienna, Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
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19
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Khan G, Perveen N. The 2022 monkeypox outbreak 1 year on: The 5 Ws. Rev Med Virol 2024; 34:e2489. [PMID: 37930054 DOI: 10.1002/rmv.2489] [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] [Received: 08/03/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
In May 2022, World Health Organization (WHO) reported an outbreak of Mpox in several European countries which were previously Mpox free. Mpox (formerly known as monkeypox) is a zoonotic viral disease endemic in Central and West Africa. The sudden emergence of Mpox outside Africa and its subsequent rapid spread lead the WHO to declare the outbreak as Public Health Emergency of International Concern. By 15 May 2023, a total of 87,704 confirmed cases and 140 deaths had been reported from 111 countries and territories worldwide. Looking back on this outbreak 1 year later, several important questions have arisen. Here, we address these questions using the classic 5 Ws: What, When, Where, Who and Why? We discuss these questions to understand how this outbreak emerged and how it was effectively managed. We outline what needs to be done to prevent, or at least minimise, outbreaks due to emerging and re-emerging viral infections.
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Affiliation(s)
- Gulfaraz Khan
- Department of Microbiology & Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Nighat Perveen
- Department of Biology, College of Science, United Arab Emirates University, Al-Ain, United Arab Emirates
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20
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Hong C. Mpox on Reddit: a Thematic Analysis of Online Posts on Mpox on a Social Media Platform among Key Populations. J Urban Health 2023; 100:1264-1273. [PMID: 37580545 PMCID: PMC10728031 DOI: 10.1007/s11524-023-00773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
The 2022-2023 mpox outbreak has disproportionately impacted gay, bisexual, and other men who have sex with men (GBMSM). The US CDC recommended individuals to explore safer sexual practices that minimize the potential risk of exposure and also strongly encouraged for eligible individuals to prioritize vaccination. This study aimed to analyze social media data related to mpox on Reddit since the mpox outbreak and identify themes associated with the impact on social behaviors and social processes among targeted population. Publicly available data were collected from the social media Reddit. We extracted the summarized mpox-related posts since the beginning of May 2022 from popular subreddits that were popular among GBMSM. We thematically analyzed the content to identify the overall themes related to the GBMSM's responses to the outbreak. There is an overall increase in the number of daily mpox-related posts, with three upticks in late May, late July, and early August 2022, which may correspond to the dates that the first mpox case was identified in the USA, the WHO declared a global public health emergency, and the US Department of Health and Human Services declared a public health emergency. Four themes were identified: (1) changes in sexual behaviors and social activities; (2) mpox vaccine attitude, uptake, and hesitancy; (3) perceived and experienced stigma and homophobia, and mental distress; and (4) online information-seeking and mutual aid and support. GBMSM changed their sexual behaviors and social activities to mitigate their exposure to the virus during this outbreak and actively sought and shared information about mpox vaccination in their respective settings, while some were hesitant due to concerns about side effects and potential effectiveness. Perceived and experienced stigma and discrimination on gay- and same sex-identify have impacted GBMSM's mental health. Interventions to promote the mpox vaccine must address the historical medical mistrust and vaccine hesitancy among GBMSM.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, 3250 Public Affairs Building, Los Angeles, CA, USA.
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21
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Krug C, Tarantola A, Chazelle E, Fougère E, Velter A, Guinard A, Souares Y, Mercier A, François C, Hamdad K, Tan-Lhernould L, Balestier A, Lahbib H, Etien N, Bernillon P, De Lauzun V, Durand J, Fayad M, De Valk H, Beck F, Che D, Coignard B, Lot F, Mailles A. Mpox outbreak in France: epidemiological characteristics and sexual behaviour of cases aged 15 years or older, 2022. Euro Surveill 2023; 28:2200923. [PMID: 38099346 PMCID: PMC10831416 DOI: 10.2807/1560-7917.es.2023.28.50.2200923] [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: 11/30/2022] [Accepted: 04/21/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundLocally-acquired mpox cases were rarely reported outside Africa until May 2022, when locally-acquired-mpox cases occurred in various European countries.AimWe describe the mpox epidemic in France, including demographic and behavioural changes among a subset of cases, during its course.MethodsData were retrieved from the enhanced national surveillance system until 30 September 2022. Laboratory-confirmed cases tested positive for monkeypox virus or orthopoxviruses by PCR; non-laboratory-confirmed cases had clinical symptoms and an epidemiological link to a laboratory-confirmed case. A subset of ≥ 15-year-old male cases, notified until 1 August, was interviewed for epidemiological, clinical and sexual behaviour information. Association of symptom-onset month with quantitative outcomes was evaluated by t- or Wilcoxon tests, and with binary outcomes, by Pearson's chi-squared or Fisher exact tests.ResultsA total of 4,856 mpox cases were notified, mostly in Île-de-France region (62%; 3,025/4,855). Cases aged ≥ 15 years were predominantly male (97%; 4,668/4,812), with 37 years (range: 15-81) as mean age. Between May and July, among the subset interviewed, mpox cases increased in regions other than Île-de-France, and mean age rose from 35 (range: 21-64) to 38 years (range: 16-75; p = 0.007). Proportions of cases attending men-who-have-sex-with-men (MSM) meeting venues declined from 60% (55/91) to 46% (164/359; p = 0.012); median number of sexual partners decreased from four (interquartile range (IQR): 1-10) to two (IQR: 1-4; p < 0.001).ConclusionChanges in cases' characteristics during the epidemic, could reflect virus spread from people who were more to less behaviourally vulnerable to mpox between May and July, or MSM reducing numbers of sexual partners as recommended.
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Affiliation(s)
- Catarina Krug
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- ECDC Fellowship Program, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
- These first authors contributed equally to this article
| | - Arnaud Tarantola
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Emilie Chazelle
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Erica Fougère
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Annie Velter
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Aix Marseille Univ, INSERM, IRD, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Marseille, France
| | - Anne Guinard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Yvan Souares
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Anna Mercier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Céline François
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Katia Hamdad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | | | - Anita Balestier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hana Lahbib
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Nicolas Etien
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Pascale Bernillon
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Virginie De Lauzun
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Julien Durand
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Myriam Fayad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Henriette De Valk
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - François Beck
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin (UVSQ), Villejuif, France
| | - Didier Che
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Bruno Coignard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Florence Lot
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
| | - Alexandra Mailles
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
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22
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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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23
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Wagner AL, Lacombe-Duncan A, Boulton ML. Acceptance of a Future Gonorrhea Vaccine in a Post-Coronavirus Disease 2019 World: Impact of Type of Recommendation and Changing Levels of Trust in Health Institutions and Authorities. Med Clin North Am 2023; 107:e19-e37. [PMID: 38609279 PMCID: PMC10261718 DOI: 10.1016/j.mcna.2023.06.010] [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: 04/14/2024]
Abstract
Widespread uptake of a future gonorrhea vaccine could decrease the burden of disease and limit the spread of antibiotic resistance. However, gonorrhea vaccination will occur in the backdrop of the roll-out of the coronavirus disease 2019 (COVID-19) vaccine, which could have influenced parental perceptions about other, non-COVID-19 vaccines. In an internet-based cross-sectional survey, 74% of parents would get a gonorrhea vaccine for their child, and this was higher among those whose trust in pharmaceutical companies increased since the start of the COVID-19 pandemic. About 60% of adults aged 18 to 45 would receive a vaccine for themselves.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Division of Infectious Disease, Department of Internal Medicine, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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24
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Musharbash M, DiLorenzo M, Genes N, Mukherjee V, Klinger A. Mpox in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2023; 7:210-214. [PMID: 38353186 PMCID: PMC10855293 DOI: 10.5811/cpcem.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1-August 1, 2022. Case Series We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2-16 hours, median 4 hours) and test turnaround time (range 1-11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat. Conclusion Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.
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Affiliation(s)
- Michael Musharbash
- New York University School of Medicine, Department of Emergency Medicine, New York
| | - Madeline DiLorenzo
- New York University School of Medicine, Department of Internal Medicine, New York
| | - Nicholas Genes
- New York University School of Medicine, Department of Emergency Medicine, New York
| | - Vikramjit Mukherjee
- New York University School of Medicine, Department of Internal Medicine, New York
| | - Amanda Klinger
- New York University School of Medicine, Department of Internal Medicine, New York
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25
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Fu J, Dai Z, Wang H, Si M, Chen X, Wu Y, Xiao W, Huang Y, Yu F, Mi G, Su X. Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey. PLoS One 2023; 18:e0293297. [PMID: 37856527 PMCID: PMC10586652 DOI: 10.1371/journal.pone.0293297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk of HIV acquisition. Long-acting injectable-pre-exposure prophylaxis (LAI-PrEP), requiring less frequent dosing, is being studied as an alternative method to daily oral HIV PrEP. With the addition of this potential new prevention method, it expands the scope for a wider user choice and is expected to increase the acceptability and uptake of HIV prevention measures. The aim of our study was to explore the willingness to use LAI-PrEP and associated influential factors. METHODS Participants were recruited from December 2020 to March 2021 through banner advertisements on web- and mobile app-based platforms on Blued, a large gay Chinese social media platform. MSM in our cross-sectional study was HIV-negative and currently lived in mainland China. Participants were asked about their willingness to use LAI-PrEP and reasons why they might be or not be willing to use LAI-PrEP. Multivariable logistic regression was used to analyze the factors associated with the willingness to use LAI-PrEP. RESULTS In total, 969 participants met the inclusion criteria and finished the survey. Nearly twenty percent (19.5%) of participants had never tested for HIV; 66.8% of MSM had multiple male partners; and 51.6% of MSM engaged in condomless sex with their partner. About three-fifths (66.3%) of MSM were aware of PrEP, and only 3.9% of MSM had used PrEP before. The willingness to use LAI-PrEP among MSM was 74.0% (95% CI: 71.4%-76.6%). MSM with higher education levels were less likely to show a willingness to use LAI-PrEP (AOR = 0.56, 95%CI: 0.38-0.84). Participants who had a history of HIV test (AOR = 1.68, 95%CI: 1.11-2.55), were willing to use daily oral PrEP (AOR = 10.64, 95%CI:7.43-15.21), had multiple male sexual partners (AOR = 1.33, 95%CI:0.93-1.90), who used rush popper(AOR = 1.49, 95%CI:1.05-2.13), and who were aware of PEP (AOR = 1.66, 95%CI: 1.02-2.70) were more likely to show willingness to use LAI-PrEP. CONCLUSIONS In our study, MSM had quite high awareness but low uptake of PrEP. As LAI-PrEP is expected to be approved for use in China in the future, our study of MSM highlights the need for key population-focused education programs about PrEP and healthy sexual behavior. This study also provides some evidence for LAI-PrEP use among the Chinese MSM population in the future.
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Affiliation(s)
- Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijin Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fei Yu
- Danlan Public Welfare, Beijing, China
| | | | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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26
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Cahill S. Lessons Learned from the U.S. Public Health Response to the 2022 mpox Outbreak. LGBT Health 2023; 10:489-495. [PMID: 37527421 DOI: 10.1089/lgbt.2022.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
In mid-2022, an mpox outbreak occurred in the United States and more than 100 countries, disproportionately affecting men who have sex with men (MSM). Initially, the U.S. public health system failed to deploy tests, treatment, and vaccines effectively. Key federal policy changes in August 2022, along with risk reduction among many MSM, led to a steady reduction in new diagnoses by December 2022. Mpox outbreaks occurred among MSM in Chicago and France in May 2023, and vaccination rates remain low. This perspective analyzes the U.S. response to the 2022 outbreak, and it identifies the lessons learned that may guide mpox management moving forward.
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Affiliation(s)
- Sean Cahill
- Health Policy Research, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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27
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Chow EPF, Samra RS, Bradshaw CS, Chen MY, Williamson DA, Towns JM, Maddaford K, Mercury F, Fairley CK. Mpox knowledge, vaccination and intention to reduce sexual risk practices among men who have sex with men and transgender people in response to the 2022 mpox outbreak: a cross-sectional study in Victoria, Australia. Sex Health 2023; 20:390-402. [PMID: 37423606 DOI: 10.1071/sh23075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The first mpox case was reported in May 2022 in Australia. Most cases have been diagnosed in men who have sex with men (MSM). This study aimed to examine community understanding of mpox, attitudes towards vaccination, and potential changes in sexual practices surrounding the mpox outbreak among MSM and transgender people in Victoria, Australia. METHODS Participants were recruited from sexual health clinics and communities in Victoria, Australia, in August-October 2022. Participants were asked about their understanding and knowledge of mpox, vaccination uptake and intentions to change sexual practices. Univariable and multivariable logistic regression was performed to examine the factors associated with mpox vaccine uptake. RESULTS Most participants (97.8%, 525/537) had heard about mpox and 10.5% (55/525) knew someone who had had mpox. Of the 12 mpox knowledge questions, the median score of correct answers was 10 (IQR=8-11) out of a maximum of 12. More than a third (36.6%, 191/522) had been vaccinated against mpox. MSM who had a good knowledge of mpox had the highest odds of receiving mpox vaccine compared with those who had poor knowledge (aOR=4.05; 95% CI: 1.54-10.61). To prevent mpox, half reported they would reduce having sex with casual partners, stop having chemsex (used drugs for the purpose of sex), stop attending sex-on-premises-venues, and stop having group sex. A quarter reported they would increase condom use for anal sex. CONCLUSIONS One-third of high-risk participants and a substantial proportion of participants intended to reduce or stop certain practices, which may explain the large reduction in mpox cases.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Ranjit S Samra
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Deborah A Williamson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia; and Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia; and Walter and Eliza Hall Institute, Melbourne, Vic., Australia
| | - Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Finn Mercury
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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28
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Jackson KJ, Buchholz M. Ecological study: MSM sex worker advertising amidst Monkeypox in three U.S. cities. Public Health Nurs 2023; 40:696-701. [PMID: 37254698 PMCID: PMC10645109 DOI: 10.1111/phn.13215] [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] [Received: 01/17/2023] [Revised: 04/16/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
The 2022 monkeypox (MPX) outbreak was a source of consternation and stress among men who have sex with men (MSM)-the population disproportionately affected by the recent MPX outbreak. Individuals at high-risk for MPX (e.g., MSM, sex workers) were prioritized for vaccination during early state and city health department vaccine initiatives across the U.S., but little is known about how the MSM sex work market was affected by the MPX outbreak in U.S. cities where MPX incidence was particularly high. To better characterize the potential relationship between MPX incidence and MSM sex worker advertising at the height of the U.S. MPX outbreak, we monitored advertising volume on an Internet advertising platform popular among MSM sex workers and compared these data to city and county health department MPX case reporting data during a 13-week period (July 2nd, 2022- September 24th, 2022) in three U.S. cities with peak MPX incidence: Chicago, New York City, and San Francisco. In each of these cities, we observed a decline in advertising during or immediately following study week(s) with the highest number of weekly MPX cases during the study period, recognizing that observed decreases in advertising could be attributed to transient increase(s) in advertising during large-scale LGBT festivals occurring during the study period.
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Affiliation(s)
- Kristopher J Jackson
- Postdoctoral Scholar, Center for AIDS Prevention Studies, University of California, San Francisco, California
| | - Michelle Buchholz
- Assistant Clinical Professor, Department of Family Health Care Nursing, University of California, San Francisco, California
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29
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Fernandes G, Maldonado V. Behavioral aspects and the transmission of Monkeypox: A novel approach to determine the probability of transmission for sexually transmissible diseases. Infect Dis Model 2023; 8:842-854. [PMID: 37502608 PMCID: PMC10369468 DOI: 10.1016/j.idm.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Motivated by the 2022 worldwide Monkeypox (MPox) outbreak, a compartmental model is proposed to predict the evolution of the disease. Numerous models have been proposed for infectious diseases so far, although the number of variables makes it difficult to establish causation relations between individual factors and transmission rates. In order to evaluate the reaction of susceptible people to avoid infection during the outbreak, the rate of transmission is modeled through a unique phenomenological probabilistic approach, allowing the expression of the rate of generation of new cases in terms of two characteristics of the susceptible group: the frequency of sexual encounters and the probability of transmission given that there is a sexual encounter. Transmission rates are obtained and compared for the U.S. and several other countries. Results show reductions of up to 71% in the transmissibility parameter, which may be combined with variations in the frequency of sexual encounters (obtained through behavioral research) to determine the changes in the probability of transmission during an outbreak in a much more convenient way than current alternatives. This framework presents a valuable tool to health authorities in the understanding of future sexually transmissible disease outbreaks.
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Saldana CS, Kelley CF, Aldred BM, Cantos VD. Mpox and HIV: a Narrative Review. Curr HIV/AIDS Rep 2023; 20:261-269. [PMID: 37178205 PMCID: PMC10182557 DOI: 10.1007/s11904-023-00661-1] [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] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE OF REVIEW We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH. RECENT FINDINGS During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.
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Affiliation(s)
- Carlos S Saldana
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA.
| | - Colleen F Kelley
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Bruce M Aldred
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
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Hong C, Holloway IW, Bednarczyk R, Javanbakht M, Shoptaw S, Gorbach PM. High Vaccine Confidence Is Associated with COVID-19 Vaccine Uptake in Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Substances. LGBT Health 2023; 10:480-485. [PMID: 36976808 PMCID: PMC10468549 DOI: 10.1089/lgbt.2022.0255] [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: 03/29/2023] Open
Abstract
Purpose: We examined associations between vaccine confidence and COVID-19 vaccine uptake among gay, bisexual, and other men who have sex with men (GBMSM). Methods: Computer-assisted self-interviews were conducted among 249 GBMSM participating in mSTUDY from May to October 2021-a cohort of GBMSM with a history of substance use in Los Angeles. Data were collected using a vaccine confidence index. The association between vaccine confidence and COVID-19 vaccine uptake was assessed using multivariable log-binomial regression. Results: Two-thirds (64.7%) of GBMSM reported receiving at least one dose of COVID-19 vaccine. Vaccine confidence was positively associated with COVID-19 vaccine uptake. Participants expressed neutral attitudes on government trust and vaccine safety. Perceived health benefit and vaccine effectiveness were statistically significantly associated with vaccine uptake (adjusted prevalence ratio [APR] = 1.59, 95% confidence interval [CI]: 1.20-2.16; APR = 1.51, 95% CI: 1.07-2.15). Conclusions: Public health programs should prioritize public benefit and vaccine effectiveness messaging to advance vaccination among GBMSM who use substances.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Ian W. Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Robert Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
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Torres TS, Silva MST, Coutinho C, Hoagland B, Jalil EM, Cardoso SW, Moreira J, Magalhaes MA, Luz PM, Veloso VG, Grinsztejn B. Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities. JMIR Public Health Surveill 2023; 9:e46489. [PMID: 37459174 PMCID: PMC10411424 DOI: 10.2196/46489] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. OBJECTIVE We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. METHODS A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. RESULTS We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that "LGBTQIA+ individuals are being discriminated and stigmatized due to mpox." Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). CONCLUSIONS Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Monica Avelar Magalhaes
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (ICICT-Fiocruz), Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Laurenson-Schafer H, Sklenovská N, Hoxha A, Kerr SM, Ndumbi P, Fitzner J, Almiron M, de Sousa LA, Briand S, Cenciarelli O, Colombe S, Doherty M, Fall IS, García-Calavaro C, Haussig JM, Kato M, Mahamud AR, Morgan OW, Nabeth P, Naiene JD, Navegantes WA, Ogundiran O, Okot C, Pebody R, Matsui T, Ramírez HLG, Smallwood C, Tasigchana RFP, Vaughan AM, Williams GS, Mala PO, Lewis RF, Pavlin BI, le Polain de Waroux O. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health 2023; 11:e1012-e1023. [PMID: 37349031 PMCID: PMC10281644 DOI: 10.1016/s2214-109x(23)00198-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4%] of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9%] of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7%] of 21 749). 3927 (7·3%) of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95% CI 1·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], p<0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], p<0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING WHO Contingency Fund for Emergencies. TRANSLATIONS For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | - Ana Hoxha
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Julia Fitzner
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | - Maria Almiron
- WHO Regional Office for the Americas, Washington, DC, USA
| | | | - Sylvie Briand
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Meg Doherty
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Joana M Haussig
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Masaya Kato
- WHO Regional Office for South-East Asia, Delhi, India
| | | | | | - Pierre Nabeth
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Opeayo Ogundiran
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Charles Okot
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Tamano Matsui
- WHO Regional Office for the Western Pacific, Manila, Philippines
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Deputy NP, Deckert J, Chard AN, Sandberg N, Moulia DL, Barkley E, Dalton AF, Sweet C, Cohn AC, Little DR, Cohen AL, Sandmann D, Payne DC, Gerhart JL, Feldstein LR. Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States. N Engl J Med 2023; 388:2434-2443. [PMID: 37199451 PMCID: PMC10962869 DOI: 10.1056/nejmoa2215201] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States, more than 30,000 cases of mpox (formerly known as monkeypox) had occurred as of March 1, 2023, in an outbreak disproportionately affecting transgender persons and gay, bisexual, and other men who have sex with men. In 2019, the JYNNEOS vaccine was approved for subcutaneous administration (0.5 ml per dose) to prevent mpox infection. On August 9, 2022, an emergency use authorization was issued for intradermal administration (0.1 ml per dose); however, real-world effectiveness data are limited for either route. METHODS We conducted a case-control study based on data from Cosmos, a nationwide Epic electronic health record (EHR) database, to assess the effectiveness of JYNNEOS vaccination in preventing medically attended mpox disease among adults. Case patients had an mpox diagnosis code or positive orthopoxvirus or mpox virus laboratory result, and control patients had an incident diagnosis of human immunodeficiency virus (HIV) infection or a new or refill order for preexposure prophylaxis against HIV infection between August 15, 2022, and November 19, 2022. Odds ratios and 95% confidence intervals were estimated from conditional logistic-regression models, adjusted for confounders; vaccine effectiveness was calculated as (1 - odds ratio for vaccination in case patients vs. controls) × 100. RESULTS Among 2193 case patients and 8319 control patients, 25 case patients and 335 control patients received two doses (full vaccination), among whom the estimated adjusted vaccine effectiveness was 66.0% (95% confidence interval [CI], 47.4 to 78.1), and 146 case patients and 1000 control patients received one dose (partial vaccination), among whom the estimated adjusted vaccine effectiveness was 35.8% (95% CI, 22.1 to 47.1). CONCLUSIONS In this study using nationwide EHR data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. (Funded by the Centers for Disease Control and Prevention and Epic Research.).
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Affiliation(s)
- Nicholas P Deputy
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Joseph Deckert
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Anna N Chard
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Neil Sandberg
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Danielle L Moulia
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Eric Barkley
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Alexandra F Dalton
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Cory Sweet
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Amanda C Cohn
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - David R Little
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Adam L Cohen
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Danessa Sandmann
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Daniel C Payne
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Jacqueline L Gerhart
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Leora R Feldstein
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
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Svartstein ASW, Knudsen AD, Heidari SL, Heftdal LD, Gelpi M, Benfield T, Nielsen SD. Mpox Incidence and Vaccine Uptake in Men Who Have Sex with Men and Are Living with HIV in Denmark. Vaccines (Basel) 2023; 11:1167. [PMID: 37514983 PMCID: PMC10385255 DOI: 10.3390/vaccines11071167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Here, we investigate the incidence of mpox and factors associated with vaccine uptake in mainly well-treated men who have sex with men and are living with HIV (MSMWH). (2) Methods: This study included 727 MSMWH from the Copenhagen co-morbidity in HIV infection (COCOMO) study from 1 May to 31 October 2022. Mpox infection and vaccination status were obtained from the Danish Microbiology Database and The Danish Vaccination Register. Vaccination willingness was assessed through an online survey. (3) Results: At a median follow-up of 180 days, 13 (1.8%) participants had laboratory-confirmed mpox infections. Furthermore, 238 (32.7%) had received the mpox vaccine. A sexually transmitted disease (STD) in the preceding two years was associated with a higher risk of mpox infection (hazard ratio 7.1; 95% confidence interval (CI) [1.9-26.9]) and with higher odds of vaccination (adjusted odds ratio 3.1; 95% CI [2.2-4.6]). 401 (55.2%) participants responded to the survey. 228 (57.0%) reported very high vaccination willingness. The self-perceived risk of infection was associated with vaccine uptake. (4) Conclusions: The incidence of mpox was low. A prior STD was associated with both a higher risk of mpox infection and higher odds of vaccination. Despite high-risk sexual behavior and high vaccination willingness, a sizable fraction of participants had not been vaccinated.
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Affiliation(s)
| | - Andreas Dehlbæk Knudsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Safura-Luise Heidari
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Line Dam Heftdal
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Marco Gelpi
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
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Montero Morales L, Barbas Del Buey JF, Alonso García M, Cenamor Largo N, Nieto Juliá A, Vázquez Torres MC, Jiménez Bueno S, Aragón Peña A, Gil Montalbán E, Íñigo Martínez J, Alonso Colón M, Arce Arnáez A. Post-exposure vaccine effectiveness and contact management in the mpox outbreak, Madrid, Spain, May to August 2022. Euro Surveill 2023; 28:2200883. [PMID: 37318762 PMCID: PMC10318941 DOI: 10.2807/1560-7917.es.2023.28.24.2200883] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/05/2023] [Indexed: 06/16/2023] Open
Abstract
BackgroundAppropriate vaccination strategies have been key to controlling the outbreak of mpox outside endemic areas in 2022, yet few studies have provided information on mpox vaccine effectiveness (VE).AimTo assess VE after one dose of a third-generation smallpox vaccine against mpox when given as post-exposure prophylaxis (PEP) within 14 days.MethodsA survival analysis in a prospective cohort of close contacts of laboratory-confirmed mpox cases was conducted from the beginning of the outbreak in the region of Madrid in May 2022. The study included contacts of cases in this region diagnosed between 17 May and 15 August 2022. Follow up was up to 49 days. A multivariate proportional hazard model was used to evaluate VE in the presence of confounding and interaction.ResultsInformation was obtained from 484 close contacts, of which 230 were vaccinated within 14 days of exposure. Of the close contacts, 57 became ill during follow-up, eight vaccinated and 49 unvaccinated. The adjusted effectiveness of the vaccine was 88.8% (95% CI: 76.0-94.7). Among sexual contacts, VE was 93.6% (95% CI: 72.1-98.5) for non-cohabitants and 88.6% (95% CI: 66.1-96.2) for cohabitants.ConclusionPost-exposure prophylaxis of close contacts of mpox cases is an effective measure that can contribute to reducing the number of cases and eventually the symptoms of breakthrough infections. The continued use of PEP together with pre-exposure prophylaxis by vaccination and other population-targeted prevention measures are key factors in controlling an mpox outbreak.
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Affiliation(s)
- Laura Montero Morales
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | | | - Marcos Alonso García
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Noelia Cenamor Largo
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Alba Nieto Juliá
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - María C Vázquez Torres
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Susana Jiménez Bueno
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Andrés Aragón Peña
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Elisa Gil Montalbán
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Jesús Íñigo Martínez
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - María Alonso Colón
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Araceli Arce Arnáez
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
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Bhat S, Saha S, Garg T, Sehrawat H, Chopade BA, Gupta V. Insights into the challenging multi-country outbreak of Mpox: a comprehensive review. J Med Microbiol 2023; 72. [PMID: 37378642 DOI: 10.1099/jmm.0.001725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Human monkeypox virus (hMpoxV) is of zoonotic origin and is closely related to the once-dreaded smallpox virus. It is largely endemic to the African continent but has moved out of the endemic regions as sporadic clusters in the past 20 years, raising concerns worldwide. Human Mpox is characterized by a mild to severe, self-limiting infection, with mortality ranging from less than 1% to up to 10% during different outbreaks caused by different clades of MpoxV. Bushmeat hunting is one of the primary reasons for its transmission from animals to humans. Various international and national health regulatory bodies are closely monitoring the disease and have laid down guidelines to manage and prevent hMpox cases. Emergency Use Status has been granted to Tecovirimat and Brincidofovir to treat severe cases and vaccination with the smallpox vaccine is recommended for high-risk group individuals. Strategies to repurpose and discover novel therapeutics and vaccines to control the outbreak are being researched. The current Mpox outbreak that has mainly affected men as approximately 96% of all cases are reported in men, is probably the result of a complex intersection of various factors. This necessitates a strong One Health response coordination involving human, animal and environmental health institutions. This review is an attempt to provide an all-inclusive overview of the biology, history, epidemiology, pathophysiology, diagnosis and management of hMpox in context to the recent 2022-2023 multi-country outbreak which is termed by WHO a 'Public Health Emergency of International Concern (PHEIC)'.
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Affiliation(s)
- Shreyas Bhat
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi, India
| | - Sumana Saha
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi, India
| | - Tanisha Garg
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi, India
| | | | - Balu Ananda Chopade
- Department of Microbiology, Savitribai Phule Pune University, Pune 411007, Maharashtra, India
| | - Vandana Gupta
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi, India
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McQuiston JH, Braden CR, Bowen MD, McCollum AM, McDonald R, Carnes N, Carter RJ, Christie A, Doty JB, Ellington S, Fehrenbach SN, Gundlapalli AV, Hutson CL, Kachur RE, Maitland A, Pearson CM, Prejean J, Quilter LAS, Rao AK, Yu Y, Mermin J. The CDC Domestic Mpox Response - United States, 2022-2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:547-552. [PMID: 37200231 DOI: 10.15585/mmwr.mm7220a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).
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Dalton AF, Diallo AO, Chard AN, Moulia DL, Deputy NP, Fothergill A, Kracalik I, Wegner CW, Markus TM, Pathela P, Still WL, Hawkins S, Mangla AT, Ravi N, Licherdell E, Britton A, Lynfield R, Sutton M, Hansen AP, Betancourt GS, Rowlands JV, Chai SJ, Fisher R, Danza P, Farley M, Zipprich J, Prahl G, Wendel KA, Niccolai L, Castilho JL, Payne DC, Cohn AC, Feldstein LR. Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:553-558. [PMID: 37200229 DOI: 10.15585/mmwr.mm7220a3] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions,† including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites,§ to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP),¶ regardless of administration route or immunocompromise status.
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Rosenberg ES, Dorabawila V, Hart-Malloy R, Anderson BJ, Miranda W, O'Donnell T, Gonzalez CJ, Abrego M, DelBarba C, Tice CJ, McGarry C, Mitchell EC, Boulais M, Backenson B, Kharfen M, McDonald J, Bauer UE. Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection - New York, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:559-563. [PMID: 37339074 DOI: 10.15585/mmwr.mm7220a4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
In 2022, an international Monkeypox virus outbreak, characterized by transmission primarily through sexual contact among gay, bisexual, and other men who have sex with men (MSM), resulted in 375 monkeypox (mpox) cases in the state of New York outside of New York City (NYC).*,† The JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), licensed by the U.S. Food and Drug Administration (FDA) against mpox as a 2-dose series, with doses administered 4 weeks apart,§ was deployed in a national vaccination campaign.¶ Before this outbreak, evidence to support vaccine effectiveness (VE) against mpox was based on human immunologic and animal challenge studies (1-3). New York State Department of Health (NYSDOH) conducted a case-control study to estimate JYNNEOS VE against diagnosed mpox in New York residents outside of NYC, using data from systematic surveillance reporting. A case-patient was defined as a man aged ≥18 years who received a diagnosis of mpox during July 24-October 31, 2022. Contemporaneous control patients were men aged ≥18 years with diagnosed rectal gonorrhea or primary syphilis and a history of male-to-male sexual contact, without mpox. Case-patients and control patients were matched to records in state immunization systems. JYNNEOS VE was estimated as 1 - odds ratio (OR) x 100, and JYNNEOS vaccination status (vaccinated versus unvaccinated) at the time of diagnosis was compared, using conditional logistic regression models that adjusted for week of diagnosis, region, patient age, and patient race and ethnicity. Among 252 eligible mpox case-patients and 255 control patients, the adjusted VE of 1 dose (received ≥14 days earlier) or 2 doses combined was 75.7% (95% CI = 48.5%-88.5%); the VE for 1 dose was 68.1% (95% CI = 24.9%-86.5%) and for 2 doses was 88.5% (95% CI = 44.1%-97.6%). These findings support recommended 2-dose JYNNEOS vaccination consistent with CDC and NYSDOH guidance.
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Ullah M, Li Y, Munib K, Zhang Z. Epidemiology, host range, and associated risk factors of monkeypox: an emerging global public health threat. Front Microbiol 2023; 14:1160984. [PMID: 37213509 PMCID: PMC10196482 DOI: 10.3389/fmicb.2023.1160984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 05/23/2023] Open
Abstract
Based on recent multiregional epidemiological investigations of Monkeypox (MPX), on 24 July 2022, the World Health Organization declared it a global public health threat. Retrospectively MPX was an ignored zoonotic endemic infection to tropical rainforest regions of Western and Central African rural communities until a worldwide epidemic in May 2022 verified the potential threat of monkeypox virus (MPXV) to be propagated across the contemporary world via transnational tourism and animal movements. During 2018-2022, different cases of MPX diagnosed in Nigerian travelers have been documented in Israel, the United Kingdom, Singapore, and the United States. More recently, on 27 September 2022, 66,000 MPX cases have been confirmed in more than 100 non-endemic countries, with fluctuating epidemiological footprinting from retrospective epidemics. Particular disease-associated risk factors fluctuate among different epidemics. The unpredicted appearance of MPX in non-endemic regions suggests some invisible transmission dynamic. Hence, broad-minded and vigilant epidemiological attention to the current MPX epidemic is mandatory. Therefore, this review was compiled to highlight the epidemiological dynamic, global host ranges, and associated risk factors of MPX, concentrating on its epidemic potential and global public health threat.
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Affiliation(s)
- Munib Ullah
- State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
- Department of Clinical Studies, Faculty of Veterinary and Animal Sciences, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan
| | - Yanmin Li
- College of Animal Husbandry and Veterinary Medicine, Southwest Minzu University, Chengdu, China
| | - Kainat Munib
- Department of Sociology, Allama Iqbal Open University Islamabad, Islamabad, Pakistan
| | - Zhidong Zhang
- College of Animal Husbandry and Veterinary Medicine, Southwest Minzu University, Chengdu, China
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Starks TJ, Scales D, Castiblanco J, Gorman J, Cain D. Correlates of Mpox Vaccination among Sexual Minority Men in the United States: Sexual Behavior, Substance Use, and Main Partner Relationships. JOURNAL OF SEX RESEARCH 2023; 60:634-644. [PMID: 36920105 PMCID: PMC10175215 DOI: 10.1080/00224499.2023.2188443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Sexual minority men (SMM) have accounted for the majority of infections during the 2022 outbreak of the orthopox virus known as mpox (previously "monkeypox") in the US. This study examined correlates of mpox vaccination. Between July 28 and September 22, 2022, adult cisgender SMM (n = 2,620) not previously diagnosed with mpox responded to recruitment advertisements on social networking applications and completed an online survey. Of these, 730 (27.9%) received at least one vaccine dose. Logistic regression indicated sex with a casual partner was positively associated with vaccination. Stimulant drug use was negatively associated with vaccination; meanwhile, the use of ecstasy, ketamine, gamma-hydroxybutyrate (GHB) or psychedelics was positively associated with vaccination. Among partnered SMM, non-monogamous sexual agreements, relationship length of ≥2 years, and relationship functioning were positively associated with vaccination. Even at low levels of relationship functioning, SMM in non-monogamous relationships of ≥2 years were more likely to be vaccinated than single SMM. At very high levels of relationship functioning, partnered SMM were more likely to be vaccinated than single SMM regardless of sexual agreement or relationship length. Findings are discussed in relation to prior research on HIV, other STI prevention, and theories of dyadic functioning and health in this population.
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Affiliation(s)
- Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA
| | - David Scales
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
- Critica, The Bronx, NY, USA
| | - Juan Castiblanco
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | | | - Demetria Cain
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
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Smallpox vaccine acceptability among French men having sex with men living with HIV in settings of monkeypox outbreak. AIDS 2023; 37:855-856. [PMID: 36919791 DOI: 10.1097/qad.0000000000003497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Vairo F, Leone S, Mazzotta V, Piselli P, De Carli G, Lanini S, Maggi F, Nicastri E, Gagliardini R, Vita S, Siddu A, Rezza G, Barca A, Vaia F, Antinori A, Girardi E. The possible effect of sociobehavioral factors and public health actions on the mpox epidemic slowdown. Int J Infect Dis 2023; 130:83-85. [PMID: 36906119 DOI: 10.1016/j.ijid.2023.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES A pre-exposure vaccination campaign to prevent the spread of the mpox virus was initiated in Italy in August 2022. We explore the possible factors affecting the trend of mpox cases in an Italian region (Lazio) with a rapid roll-out of the vaccination campaign. METHODS We estimated the impact of the communication and vaccination campaign by fitting a Poisson segmented regression model. Results By September 30, 2692, high-risk men who have sex with men had received at least one dose of vaccine, with a vaccination coverage of 37%. The analysis of surveillance data showed a significant decreasing trend in the number of mpox cases starting from the second week after vaccination (incidence rate ratio 0.452 [0.331-0.618]). CONCLUSION The reported trend in mpox cases is likely to result from a combination of multiple social and public health factors combined with a vaccination campaign.
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Affiliation(s)
- Francesco Vairo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Sara Leone
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Valentina Mazzotta
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy.
| | - Pierluca Piselli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Gabriella De Carli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Simone Lanini
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Fabrizio Maggi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Roberta Gagliardini
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Serena Vita
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Andrea Siddu
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Giovanni Rezza
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Alessandra Barca
- Unit of Health Promotion and Prevention, Directorate of Health and integration, Lazio Region, Italy
| | - Francesco Vaia
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
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Gilbert M, Ablona A, Chang HJ, Grennan T, Irvine MA, Sarai Racey C, Salway T, Naus M, Dawar M, Ogilvie G. Uptake of Mpox vaccination among transgender people and gay, bisexual and other men who have sex with men among sexually-transmitted infection clinic clients in Vancouver, British Columbia. Vaccine 2023; 41:2485-2494. [PMID: 36894397 PMCID: PMC9990897 DOI: 10.1016/j.vaccine.2023.02.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES As the primary public health strategy for controlling the 2022 Mpox outbreak, it is critical to evaluate the impact of Mpox vaccination campaigns for transgender people and gay, bisexual and other men who have sex with men (T/GBM). We measured vaccine uptake and associated factors among T/GBM clients of an urban STI clinic in British Columbia (BC). METHODS We conducted a cross-sectional online survey between August 8-22, 2022 of clients who had attended the STI clinic, 5-7 weeks following the first-dose Mpox vaccination campaign in BC. We drew on a systematic review of factors associated with vaccine uptake to develop survey questions, and measured vaccine uptake among vaccine-eligible T/GBM. RESULTS Overall, 51% of T/GBM had received the first dose of the vaccine. The sample (331 participants) was majority White and university educated, identified as a man and gay, 10% had trans experience, and 68% met eligibility criteria for vaccination. Among vaccine-eligible participants identifying as T/GBM, 66% had been vaccinated; being unvaccinated was more common among participants identifying as bisexual or heteroflexible/mostly straight, and who spent less time with other T/GBM. Eligible yet unvaccinated participants had lower perceived susceptibility, and reported fewer cues to action (e.g., fewer saw information promoting the vaccine), and increased constraints to vaccine access; vaccine barriers related to accessing clinics and privacy were common. The majority (85%) of those eligible and unvaccinated at time of survey were willing to receive the vaccine. CONCLUSION In this sample of STI clinic clients, vaccine uptake among eligible T/GBM was high in the initial weeks following a Mpox vaccination campaign. However, uptake was patterned on social gradients with lower uptake among T/GBM who may be less effectively engaged by available promotion channels. We recommend early, intentional and diverse engagement of T/GBM populations in Mpox and other targeted vaccination programs.
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Affiliation(s)
- Mark Gilbert
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Aidan Ablona
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Hsiu-Ju Chang
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Department of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - C Sarai Racey
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monika Naus
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meena Dawar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Kumar AM, Chen ST, Merola JF, Mostaghimi A, Zhou XA, Fett N, Smith GP, Saavedra AP, Noe MH, Rosenbach M. Monkeypox outbreak, vaccination, and treatment implications for the dermatologic patient: Review and interim guidance from the Medical Dermatology Society. J Am Acad Dermatol 2023; 88:623-631. [PMID: 36528266 PMCID: PMC9749826 DOI: 10.1016/j.jaad.2022.10.050] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/15/2022]
Abstract
Rapid human-to-human transmission of monkeypox has created a public health emergency requiring prompt, multidisciplinary attention. Dermatologists are at the forefront of diagnosis due to the disease-defining skin lesions. Moreover, patients with pre-existing skin disease and those who are on immunosuppressive medications for skin disease may be at increased risk of severe infection. In this review, a panel of authors with expertise in complex medical dermatology and managing patients on immunosuppression reviews the literature and provides initial guidance for diagnosis and management in dermatology practices. Though there are knowledge gaps due to a lack of controlled studies, we support use of replication-deficit vaccines in all dermatologic patients who meet qualifying risk or exposure criteria. We offer strategies to optimize vaccine efficacy in patients with immunosuppression. We discuss alternative post-exposure treatments and their safety profiles. Finally, we outline supportive care recommendations for cutaneous manifestations of monkeypox. Large scale epidemiologic investigations and clinical trials will ultimately revise and extend our guidance.
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Affiliation(s)
- Anusha M Kumar
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xiaolong A Zhou
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Gideon P Smith
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arturo P Saavedra
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Gravett RM, Marrazzo J. An Ulcer by Any Other Name. Infect Dis Clin North Am 2023; 37:369-380. [PMID: 37005160 DOI: 10.1016/j.idc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The myriad presentations of ulcerative sexually transmitted infections, other than genital herpes and syphilis, challenge even the most astute clinician given the considerable overlap in clinical presentation and lack of widely available diagnostic resources, such as nucleic acid testing, to confirm the diagnosis. Even so, case prevalence is relatively low, and incidence of chancroid and granuloma inguinale are declining. These diseases still cause substantial morbidity and increased chance for HIV acquisition, and with the recent advent of mpox as a cause, it remains imperative to identify and treat accurately.
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Affiliation(s)
- Ronnie M Gravett
- Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, THT 215, 1900 University Boulevard, Birmingham, AL 35294, USA.
| | - Jeanne Marrazzo
- Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, THT 215, 1900 University Boulevard, Birmingham, AL 35294, USA
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Ogunbajo A, Euceda A, Smith J, Ekundayo R, Wattree J, Brooks M, Hickson D. Demographics and Health Beliefs of Black Gay, Bisexual, and Other Sexual Minority Men Receiving a Mpox Vaccination in the United States. J Urban Health 2023; 100:204-211. [PMID: 36662397 PMCID: PMC9854406 DOI: 10.1007/s11524-022-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/21/2023]
Abstract
An outbreak of mpox virus (MPV) among humans in the United States (U.S.) was described in May 2022. This outbreak disproportionately affects Black and Hispanic sexual minority men (SMM) and these groups have lower rates of vaccination compared to Whites. Between July and August 2022, a partnership between a nonprofit and two local health departments successfully designed and implemented a community intervention to administer MPV vaccines to Black SMM in the Washington D.C. metropolitan area. We administered a quantitative survey to 178 respondents across four vaccinations clinics. We found that study participants had high socioeconomic status, high levels of anticipated MPV stigma, and were relatively skeptic about MPV. We demonstrated how a partnership between an urban nonprofit and government agency can facilitate quick and effective dissemination of a community intervention in a relatively low cost manner.
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Affiliation(s)
- Adedotun Ogunbajo
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA.
| | - Alexa Euceda
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
| | - Jamil Smith
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
| | - Raven Ekundayo
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
| | - Justise Wattree
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
| | - Mitchell Brooks
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
| | - DeMarc Hickson
- Us Helping Us, People into Living Inc, 3636 Georgia Avenue., Washington, DC, 20010, USA
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Chen Y, Li Y, Fu L, Zhou X, Wu X, Wang B, Peng X, Sun Y, Liu Q, Lin YF, Fan Y, Jiang H, Meng X, Zou H. Knowledge of Human Mpox (Monkeypox) and Attitude towards Mpox Vaccination among Male Sex Workers in China: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11020285. [PMID: 36851163 PMCID: PMC9966706 DOI: 10.3390/vaccines11020285] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Re-emerging human mpox (previously known as monkeypox) is spreading around the world. According to existing studies, the current mpox pandemic mainly affects men who have sex with men (MSM), including male sex workers (MSW). Our study aimed to assess mpox knowledge and attitude towards mpox vaccination among MSW in China. METHODS A web-based, cross-sectional survey was conducted in August 2022. We collected participants' socio-demographic characteristics and knowledge with 15 knowledge items related to mpox. Modified Bloom's cut-off points of 80% (total score > 12) was used to indicate good knowledge. Multivariable regression analysis was used to assess factors of mpox knowledge and attitude towards mpox vaccination. RESULTS A total of 154 MSW were recruited (age: median = 22, interquartile range, IQR = 12). Of the 154 MSW, 49.4% had good knowledge of mpox, and 63.0% were willing to be vaccinated against mpox. We found that good knowledge was associated with being single [adjusted odds ratio (AOR) = 2.46, 95% confident interval (CI) (1.22-4.87)], being unemployed [5.01, 1.21-20.70] and willingness to be vaccinated [2.51, 1.14-5.54]. Willingness to get vaccinated was related to age [1.06, 1.00-1.12], chronic diseases history [8.53, 1.01-71.68], and agreement with "priority for high-risk groups if mpox vaccine is in short supply" [2.57, 1.01-6.54]. CONCLUSIONS We found that MSW had suboptimal mpox knowledge and a high willingness to be vaccinated against mpox. MSW who are single and willing to be vaccinated may have good knowledge of mpox. These findings underscore the necessity of providing health education on mpox among MSW. When the mpox vaccine is in short supply, priority should be given to high-risk groups, such as MSW.
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Affiliation(s)
- Yuanyi Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Xin Peng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Qi Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
| | - Yinguang Fan
- School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Hongbo Jiang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi 214023, China
- Correspondence: (X.M.); (H.Z.); Tel.: +86-755-23260106 (H.Z.)
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 518107, China
- Correspondence: (X.M.); (H.Z.); Tel.: +86-755-23260106 (H.Z.)
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Bleichrodt A, Dahal S, Maloney K, Casanova L, Luo R, Chowell G. Real-time forecasting the trajectory of monkeypox outbreaks at the national and global levels, July-October 2022. BMC Med 2023; 21:19. [PMID: 36647108 PMCID: PMC9841951 DOI: 10.1186/s12916-022-02725-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Beginning May 7, 2022, multiple nations reported an unprecedented surge in monkeypox cases. Unlike past outbreaks, differences in affected populations, transmission mode, and clinical characteristics have been noted. With the existing uncertainties of the outbreak, real-time short-term forecasting can guide and evaluate the effectiveness of public health measures. METHODS We obtained publicly available data on confirmed weekly cases of monkeypox at the global level and for seven countries (with the highest burden of disease at the time this study was initiated) from the Our World in Data (OWID) GitHub repository and CDC website. We generated short-term forecasts of new cases of monkeypox across the study areas using an ensemble n-sub-epidemic modeling framework based on weekly cases using 10-week calibration periods. We report and assess the weekly forecasts with quantified uncertainty from the top-ranked, second-ranked, and ensemble sub-epidemic models. Overall, we conducted 324 weekly sequential 4-week ahead forecasts across the models from the week of July 28th, 2022, to the week of October 13th, 2022. RESULTS The last 10 of 12 forecasting periods (starting the week of August 11th, 2022) show either a plateauing or declining trend of monkeypox cases for all models and areas of study. According to our latest 4-week ahead forecast from the top-ranked model, a total of 6232 (95% PI 487.8, 12,468.0) cases could be added globally from the week of 10/20/2022 to the week of 11/10/2022. At the country level, the top-ranked model predicts that the USA will report the highest cumulative number of new cases for the 4-week forecasts (median based on OWID data: 1806 (95% PI 0.0, 5544.5)). The top-ranked and weighted ensemble models outperformed all other models in short-term forecasts. CONCLUSIONS Our top-ranked model consistently predicted a decreasing trend in monkeypox cases on the global and country-specific scale during the last ten sequential forecasting periods. Our findings reflect the potential impact of increased immunity, and behavioral modification among high-risk populations.
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Affiliation(s)
- Amanda Bleichrodt
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Sushma Dahal
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kevin Maloney
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lisa Casanova
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ruiyan Luo
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
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