Monkeypox outbreak in the Netherlands in 2022: public health response, epidemiological and clinical characteristics of the first 1000 cases and protection of the first-generation smallpox vaccine

Ewijk, Catharina E. van; Miura, Fuminari; Rijckevorsel, Gini van; Vries, Henry J. C. de; Welkers, Matthijs R.A.; Berg, Oda E. van den; Friesema, Ingrid; Berg, Patrick van den; Dalhuisen, Thomas; Wallinga, Jacco; Brandwagt, Diederik; Cleef, Brigitte A. G. L. van; Vennema, Harry; Voordouw, Bettie; Eijk, Annemiek A. van der; Swaan, Corien; Wierik, Margreet J.M. te; Leenstra, Tjalling; Coul, Eline Op de; Franz, Eelco

doi:10.1101/2022.10.20.22281284

Cited by 16 publications

(34 citation statements)

References 12 publications

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“… Pooled frequency of genitalia involvement in post-2022 studies. Tarín-Vicente, 2022 [ 27 ], Angelo, 2022 [ 28 ], Betancort-Plata, 2022 [ 29 ], Caria, 2022 [ 30 ], Vanhamel 2022 [ 31 ], Girometti, 2022 [ 33 ], Orviz, 2022 [ 34 ], Hoffmann1, 2022 [ 35 ], Cobos, 2022 [ 36 ], Hoffmann2, 2022 [ 37 ], Van Ewijk, 2022 [ 38 ], Mailhe, 2022 [ 39 ], Nunez, 2022 [ 40 ], Catala, 2022 [ 41 ], Cassir, 2022 [ 42 ], Pascom, 2022 [ 70 ], Suner, 2022 [ 43 ], Maldonado, 2023 [ 44 ]. …”

Section: Figurementioning

confidence: 99%

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

et al. 2023

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(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0–95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77–41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3–25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4–49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7–59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.

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Section: Figurementioning

confidence: 99%

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

et al. 2023

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“…We used data on the daily numbers of mpox cases from the national surveillance system for notifiable infectious diseases [8]. The numbers of confirmed mpox cases were ordered according to date of symptom onset, throughout the analyses presented in this study.…”

Section: Datamentioning

confidence: 99%

“…6 By 31 December 2022, 1,259 cases had been notified. 7 On 25 July 2022, a vaccination programme was initiated, providing smallpox vaccination as pre-exposure prophylaxis to MSM at increased risk to get infected with MPXV. 7 Furthermore, in the second half of June 2022, health communication messages about mpox were disseminated via the media and sexual health intervention platforms for MSM.…”

Section: Introductionmentioning

confidence: 99%

“…7 On 25 July 2022, a vaccination programme was initiated, providing smallpox vaccination as pre-exposure prophylaxis to MSM at increased risk to get infected with MPXV. 7 Furthermore, in the second half of June 2022, health communication messages about mpox were disseminated via the media and sexual health intervention platforms for MSM. 7,8 On-site campaigns were also undertaken, providing information about mpox at venues, such as gay bars, sauna’s, sex clubs, and festivals.…”

Section: Introductionmentioning

confidence: 99%

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The fading of the mpox outbreak among men who have sex with men: a mathematical modelling study

Xiridou

Miura

Adam

et al. 2023

Preprint

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Background The mpox (monkeypox) outbreak in the Netherlands started winding down in July 2022, before the mpox vaccination programme was initiated. Most cases were men who have sex with men (MSM). We investigated whether the rapid decline in mpox could be attributed to depletion of susceptible MSM or to behavioural changes. Methods We developed a transmission model that was fitted to data on mpox cases in the Netherlands until 25 July 2022, when the mpox vaccination programme started. We included behavioural changes, namely less casual partners and shorter time until mpox cases abstain from sexual contacts. Results Without behavioural changes, the peak in modelled mpox cases matched observations, but the decline thereafter was less steep than observed. Allowing for behavioural changes in July 2022, we estimated a 13-24% decline in numbers of casual partners and halving of the infectious time until sexual abstinence. When the vaccination programme started, 64% of MSM with very high sexual activity in the model had been infected. Counterfactual model scenarios reveal that the outbreak could have waned by October 2022 even without the vaccination programme. Import of mpox cases at the end of 2022 could not result in major outbreaks. Conclusions The limited size of the mpox outbreak in the Netherlands can be ascribed to the depletion of susceptible MSM with high levels of sexual activity. The subsequent decline was accelerated by behavioural changes in July 2022. Immunity due to infection and vaccination among those most sexually active diminishes the risk of resurgence of mpox.

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“…The regional public health services that collected the data rated the reliability of self-reported symptom onset dates (into three categories: unreliable, plausible, or reliable), and assessed the likelihood of transmission between two cases (into three categories: unlikely; likely and the infectee selected an infector among several contacts; or likely and the infector is the only contact reported for the infectee). The reported symptom onset was defined for any symptom associated with monkeypox virus infection 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Time scales of human mpox transmission in the Netherlands

Miura

Backer

Rijckevorsel

et al. 2022

Preprint

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The global outbreak of monkeypox has spread to more than a hundred countries in non-endemic regions. One of the key determinants of the rapid growth is the serial interval, defined as the time interval between symptom onset in two successive cases. In this study, we estimated the serial interval by analyzing 109 pairs of laboratory-confirmed monkeypox in the Netherlands. After reviewing detailed exposure histories, we identified 34 pairs where the infectee reported a single potential infector. The mean serial interval for those 34 pairs was 10.1 days (95% CI: 6.6-14.7 days), suggesting a reproduction number between 1.3 and 1.6 during June 2022 in the Netherlands. Further investigation into pairs from one regional public health service revealed that pre-symptomatic transmission may have occurred in five out of eighteen pairs. These findings emphasize that precaution will remain key, regardless of the presence of recognizable symptoms, to anticipate possible resurgence of monkeypox.

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Monkeypox outbreak in the Netherlands in 2022: public health response, epidemiological and clinical characteristics of the first 1000 cases and protection of the first-generation smallpox vaccine

Cited by 16 publications

References 12 publications

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis

The fading of the mpox outbreak among men who have sex with men: a mathematical modelling study

Time scales of human mpox transmission in the Netherlands

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