Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil

Silva, Mayara Secco Torres; Coutinho, Carolina; Torres, Thiago Silva; Peixoto, Eduardo Mesquita; Ismério, Ronaldo; Lessa, Flávia; Nunes, Estêvão Portela; Hoagland, Brenda; Guevara, Amanda Dolores Echeverria; Bastos, Matheus Oliveira; Tavares, Isabel Cristina Ferreira; Ribeiro, Maria Pia Diniz; Ramos, Maíra Catharina; Andrade, Hugo Boechat; Santana, Ana Paula Lovetro; Santini-Oliveira, Marília; Netto, Juliana Barbosa Santos; Reges, Paula; Magalhães, Mônica Avelar Figueiredo Mafra; Rosadas, Leonardo Azevedo Silva; Nazer, Sandro; Velasque, Luciane; Cardoso, Sandra Wagner; Silva, Edson Elias da; Veloso, Valdiléa G.; Wakimoto, Mayumi Duarte; Grinsztejn, Beatriz; Japiassú, André Miguel; Trepow, Marcel; Ferreira, Italo Guariz; Villela, Larissa M.; Fraga, Rafael Teixeira; Pires, Mariah Castro de Souza; Escada, Rodrigo; Sousa, Leonardo Paiva de; Robleda, Gabriela Lisseth Umaña; Santos, Desirée Vieira; Camacho, Luiz Ricardo Siqueira; Amparo, Pedro; França, João Victor Jaegger de; Correa, Felipe de Oliveira Heluy; Sousa, Bruno Ivanovinsky Costa de; Valle, Bernardo Vicari do; Soares, João Paulo Bortot; Ferreira, Livia Cristina Fonseca; Martins, Pedro da Silva; Mesquita, Maira Braga; Coutinho, José Ricardo Hildebrant; Perlingeiro, Raissa de Moraes; Oliveira, Priscila de; Barbosa, Hugo Perazzo Pedroso; Accetta, André Figueiredo; Cunha, Marcelo; Eiras, Rosangela Vieira; Santos, Ticiana Martins dos; Silva, Wladmyr Davila da; Silveira, Monique do Vale; Brum, Tania de Souza; Calvet, Guilherme Amaral; Menezes, Rodrigo Caldas; Pereira, Sandro Antônio

doi:10.1016/j.lana.2022.100406

Cited by 23 publications

(43 citation statements)

References 55 publications

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“…An ecological study with 9729 confirmed mpox cases in Brazil until November 2022, described that 92.2% of positive diagnosis were in men, aged between 20 and 39 years (73.6%) and self‐identified as homosexual or bisexual (67.5%) 16 . Other studies, including non‐Brazilian populations, reported a similar profile, describing a high percentage of mpox in young MSM and people living with HIV 16‐21 . Overall, these findings illustrate a peculiar dynamic of recent mpox outbreaks, which differ from previous cases both in relation to transmission routes, in which animal−human transmission was suggested, and regarding age‐group, with a median age of 4−5 years (1970−1980), 10 years (2000−2009), and 21 years (2010−2019) 22 …”

Section: Discussionmentioning

confidence: 60%

Mpox in Northeast Brazil: Spatiotemporal analysis and predictors associated with confirmed diagnosis

Silva Júnior,

de Souza,

Flores

et al. 2023

Journal of Medical Virology

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The mpox outbreaks reported in several countries from May 2022 have shown an epidemiological profile different from that observed in previous years, raising a global public health alert. This issue is particularly important for Brazil, the second country with the highest number of mpox cases. Herein, we performed a retrospective cross‐sectional study on mpox cases notified in Pernambuco state, northeastern Brazil, between July 2022 and March 2023. Confirmed mpox cases were analyzed in a space‐time series and their social and clinical characteristics were compared with those of suspect‐negative cases, including a multivariate logistic regression to identify predictors associated with a positive diagnosis. A total of 1493 suspected mpox cases were reported, of which 362 cases (24.2%) were confirmed and distributed in 33 municipalities. Most mpox cases occurred between epidemiological weeks (EW) 33 and 39 of 2022, with the highest moving average in EW 34 and 35 (36 and 31.5, respectively). The most frequent clinical signs and symptoms were rash (87.3%), fever (60.2%), headache (45.3%), and genital/perianal lesions (40.3%). In the multivariate analysis, three variables showed considerable performance in predicting a positive mpox diagnosis (area under the ROC curve = 0.87; 95% CI: 0.84−0.90): sexual orientation (nonheterosexual; OR: 23.08; 95% CI: 13.97−38.15), male sex (OR: 2.05; 95% CI: 1.10−3.85), and multiple partnerships (OR: 1.95; 95% CI: 1.15−3.32). Overall, in addition to the detailed spatiotemporal description of mpox cases, which may contribute to appropriate public health measures, our study brings insights into mpox epidemiology by describing predictors associated with a positive diagnosis.

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Section: Discussionmentioning

confidence: 60%

Mpox in Northeast Brazil: Spatiotemporal analysis and predictors associated with confirmed diagnosis

Silva Júnior,

de Souza,

Flores

et al. 2023

Journal of Medical Virology

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“…Our findings align with those documented in the 2022 mpox outbreak in other countries and corroborate observations such as frequent uncertainty about the infection source 11,12,30,31 and a small proportion of confirmed cases with international travel history. 30,32 This suggests that a few cases are sufficient to establish regional and local transmission and highlights the need to maintain global surveillance.…”

Section: Discussionmentioning

confidence: 99%

Mpox outbreak in Rio de Janeiro, Brazil: A translational approach

Lira,

Ota,

Melo

et al. 2024

Journal of Medical Virology

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Mpox is a zoonotic disease historically reported in Africa. Since 2003, limited outbreaks have occurred outside Africa. In 2022, the global spread of cases with sustained interhuman transmission and unusual disease features raised public health concerns. We explore the mpox outbreak in Rio de Janeiro (RJ) state, Brazil, in an observational study of mpox‐suspected cases from June to December 2022. Data collection relied on a public healthcare notification form. Diagnosis was determined by MPXV‐PCR. In 46 confirmed cases, anti‐OPXV IgG was determined by ELISA, and seven MPXV genomes were sequenced. A total of 3095 cases were included, 816 (26.3%) with positive MPXV‐PCR results. Most positive cases were men in their 30 s and MSM. A total of 285 (34.9%) MPXV‐PCR+ patients live with HIV. Eight were coinfected with varicella‐zoster virus. Anogenital lesions and adenomegaly were associated with the diagnosis of mpox. Females and individuals under 18 represented 9.4% and 5.4% of all confirmed cases, respectively, showing higher PCR cycle threshold (Ct) values and fewer anogenital lesions compared to adult men. Anti‐OPXV IgG was detected in 29/46 (63.0%) patients. All analyzed sequences belonged to clade IIb. In RJ state, mpox presented a diverse clinical picture, represented mainly by mild cases with low complication rates and prominent genital involvement. The incidence in females and children was higher than usually reported. The observation of a bimodal distribution of Ct values, with few positive results, may suggest the need to review the diagnostic criteria in these groups.

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“…A meta-analysis comparing mpox outcomes in PWH and without HIV suggested that PWH had comparable anatomic distribution of mpox skin rash but higher odds of proctitis and diarrhea [98]. PWH with low CD4 þ cells counts (CD4 þ <350 cells/ml) or poorly controlled HIV have been at greater risk of disseminated disease [99], more severe clinical outcomes [3,31,[100][101][102][103], and higher mortality [104][105][106]. In an international case series of mpox patients with HIV and CD4 þ less than 350 cells/ml, Mitja `et al observed that the severity of mpox illness increased progressively with decreasing CD4 cell count [105].…”

Section: Mpox Among Pwhmentioning

confidence: 99%