An assessment of rates and covariates of mpox diagnosis and vaccination provides evidence to refine eligibility criteria for mpox vaccination among gay, bisexual and other men who have sex with men in the Netherlands

Adam, Philippe; Coul, Eline Op de; Zantkuijl, Paul; Bos, Hanna; Xiridou, Maria; Blom, C.; Ketsuwan, Itsada; Wierik, Margreet J.M. te; David, Silke; Wit, John de

doi:10.1101/2023.02.28.23286578

Cited by 4 publications

(5 citation statements)

References 15 publications

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“… a It was assumed that the number of casual partners of activity group i was

at the beginning of the outbreak (as estimated from the data; see Table 2 ) and was reduced to

after day

, with

sampled from the uniform distribution between 0 and 0.3. The maximum of 30% reduction was based on preliminary results from the survey “Monkeypox: a new challenge for your sex life” [ 9 , 26 , 27 ]and reports from club owners in Amsterdam who experienced reduced numbers of visitors in July 2022, with the reduction reaching its maximum at the end of July 2022 with approximately 30% fewer visitors (P. Zantkuijl, personal communication). b Change applied to both very low and fairly low activity groups.…”

Section: Methodsmentioning

confidence: 99%

The Fading of the Mpox Outbreak Among Men Who Have Sex With Men: A Mathematical Modelling Study

Xiridou,

Miura,

Adam

et al. 2023

The Journal of Infectious Diseases

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Background In the Netherlands, the number of mpox cases started declining before mpox vaccination was initiated. Most cases were men who have sex with men (MSM). We investigated whether the decline in mpox could be attributed to infection-induced immunity or behavioural adaptations. Methods We developed a transmission model and accounted for possible behavioural adaptations: less casual partners and shorter time until MSM with mpox refrain from sexual contacts. Results Without behavioural adaptations, the peak in modelled cases matched observations, but the decline was less steep than observed. With behavioural adaptations in the model, we found a decline of 16-18% in numbers of casual partners in June and 13-22% in July 2022. Model results showed a halving of the time before refraining from sex. When mpox vaccination started, 57% of MSM with very high sexual activity in the model had been infected. Model scenarios revealed that the outbreak could have waned by November 2022 even without vaccination. Conclusions The limited duration of the mpox outbreak in the Netherlands can be ascribed primarily to infection-induced immunity among MSM with high sexual activity levels. The decline was accelerated by behavioural adaptations. Immunity among those most sexually active is essential to impede mpox resurgence.

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“… a It was assumed that the number of casual partners of activity group i was

at the beginning of the outbreak (as estimated from the data; see Table 2 ) and was reduced to

after day

, with

Section: Methodsmentioning

confidence: 99%

The Fading of the Mpox Outbreak Among Men Who Have Sex With Men: A Mathematical Modelling Study

Xiridou,

Miura,

Adam

et al. 2023

The Journal of Infectious Diseases

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“…Given the importance of MPXV infection for public health and the influence of social/behavioral aspects on its epidemiology, we performed a space‐time analysis of mpox cases in Pernambuco state, northeastern Brazil, and identified predictors associated with its positive diagnosis as well. To the best of our knowledge, rare studies have performed multivariate analyses and identified mpox‐related predictors 12 . In this perspective, our findings contribute to the surveillance of mpox cases, as well as to the management and public health measures against the recent outbreaks.…”

Section: Introductionmentioning

confidence: 69%

“…To the best of our knowledge, rare studies have performed multivariate analyses and identified mpox-related predictors. 12 In this perspective, our findings contribute to the surveillance of mpox cases, as well as to the management and public health measures against the recent outbreaks.…”

mentioning

confidence: 75%

“…After logistic regression analysis, three characteristics showed considerable performance in predicting positive diagnosis of mpox: nonheterosexual orientation, male sex, and multiple partnerships. In a preprint by Adam et al, 12 some social/behavioral factors, such as HIV‐pre‐exposure prophylaxis (HIV‐PrEP) use and having 20 sex partners in the past 12 months, were also independently associated with the mpox diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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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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“…The vaccination programme in the Netherlands continued in 2023 and took newly identified risk factors, such as visiting sex venues, into account. 34,35 Continued vaccination programmes are needed to offer vaccination to new people meeting the criteria for vaccination or recently arrived migrant GBMSM. Surveillance of mpox and evaluation of the vaccination programmes, including assessment of VE, are of critical importance to inform future mpox prevention and control.…”

Section: Discussionmentioning

confidence: 99%

Factors that influenced the course of the mpox outbreak in the Netherlands, 2022-2023

Haverkate,

Willemstein,

van Ewijk

et al. 2023

Preprint

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BackgroundIn 2022-2023 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). We 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.MethodsObservational study. Data on notified cases, number of PPV invitations, and PPV doses administered were collected from public health services. PPV uptake and coverage were calculated. Monthly trends in behavioural data of GBMSM visiting Sexual Health Centres (SHC) were analysed for all consultations in 2022. VE was estimated using the screening method.FindingsA total of 1,266 mpox cases were reported until August 1, 2023. The outbreak peaked early July 2022 and sharply declined afterwards. PPV started July 25, 2023; in total 29,851 doses were administered. 45.8% received at least one dose, 35.4% was fully vaccinated. Estimated VE was 68.2% (95% CI 4.3%-89.5%). In our analyses of behavioural data, we did not observe an evident decrease in high-risk behaviour.InterpretationIt 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. We hypothesise that infection-induced immunity in high-risk groups contributed most to the decline.FundingDutch Ministry of Health, Welfare and Sport.

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An assessment of rates and covariates of mpox diagnosis and vaccination provides evidence to refine eligibility criteria for mpox vaccination among gay, bisexual and other men who have sex with men in the Netherlands

Cited by 4 publications

References 15 publications

The Fading of the Mpox Outbreak Among Men Who Have Sex With Men: A Mathematical Modelling Study

The Fading of the Mpox Outbreak Among Men Who Have Sex With Men: A Mathematical Modelling Study

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

Factors that influenced the course of the mpox outbreak in the Netherlands, 2022-2023

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