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On August 26, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Transmission of Monkeypox virus (MPXV) during the 2022 multinational monkeypox outbreak has been associated with close contact, primarily sexual behavior, between men (1). Survey data suggest that gay, bisexual, and other men who have sex with men (MSM) have taken steps to protect themselves and their partners from monkeypox, including reducing one-time sexual partnerships (2). CDC simulated dynamic network models representing the sexual behavior between MSM. Men with more than one partner in the preceding 3 weeks had 1.8-6.9 times the risk for acquiring monkeypox as did men with only one partner. Although one-time partnerships represented <3% of the total daily partnerships and 16% of the sex between men on any given day, they accounted for approximately 50% of MPXV transmission. In this model, a 40% decrease in one-time partnerships yielded a 20%-31% reduction in the percentage of MSM infected and a delay in the spread of the outbreak. A decrease in one-time partnerships not only decreased the final percentage of MSM infected, but it also increased the number of days needed to reach a given level of infection in the population, allowing more time for vaccination efforts to reach susceptible persons. If decreasing one-time partnerships were combined with additional mitigation measures such as vaccination or shorter time from symptom onset to testing and treatment, this effect would be higher. Reductions in one-time partnerships, a change in behavior already being reported by MSM, might significantly reduce MPXV transmission.CDC adapted previously developed models of sexual infection transmission used to study HIV and gonorrhea transmission in the United States* (3,4); this framework has also been used to study MPXV spread in Belgium (5) (Supplementary Box 1; https://stacks.cdc.gov/view/cdc/120605). In this dynamic network modeling framework, men may have zero or one main partnership at a time, assumed to last 477 days on average, as well as zero, one, or two casual partnerships at a time, assumed to last 166 days on average. Men may also form one-time partnerships that last 1 day, meant to mimic a single sexual encounter that is not repeated. A man could possibly have main, casual, * Modeling code is available for download. https://github.com/CDCgov/ mpx_networkmodel_mmwr

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Assuming that 20% to 30% of the population would become ill, 1.7 to 3.5 billion respirators would be needed in the base case scenario, 2.6 to 4.3 billion in the intermediate demand scenario, and up to 7.3 billion in the maximum demand scenario (for all scenarios, between 0.1 and 0.4 billion surgical masks would be required for patients). For pandemics with a lower attack rate and fewer cases (eg, 2009-like pandemic), the number of respirators needed would be higher because the pandemic would have longer duration. Providing these numbers of respirators and surgical masks represents a logistic challenge for US public health agencies. Public health officials must urgently consider alternative use strategies for respirators and surgical masks during a pandemic that may vary from current practices.