Multiple introductions of monkeypox virus to Ireland during the international mpox outbreak, May 2022 to October 2023

Abstract

Background Mpox, caused by monkeypox virus (MPXV), was considered a rare zoonotic disease before May 2022, when a global epidemic of cases in non-endemic countries led to the declaration of a Public Health Emergency of International Concern. Cases of mpox in Ireland, a country without previous mpox reports, could reflect extended local transmission or multiple epidemiological introductions. Aim To elucidate the origins and molecular characteristics of MPXV circulating in Ireland between May 2022 and October 2023. Methods Whole genome sequencing of MPXV from 75% of all Irish mpox cases (182/242) was performed and compared to sequences retrieved from public databases (n = 3,362). Bayesian approaches were used to infer divergence time between sequences from different subclades and evaluate putative importation events from other countries. Results Of 242 detected mpox cases, 99% were males (median age: 35 years; range: 15–60). All 182 analysed genomes were assigned to Clade IIb and, presence of 12 distinguishable subclades suggests multiple introductions into Ireland. Estimation of time to divergence of subclades further supports the hypothesis for multiple importation events from numerous countries, indicative of extended and sustained international spread of mpox. Further analysis of sequences revealed that 92% of nucleotide mutations were from cytosine to thymine (or from guanine to adenine), leading to a high number of non-synonymous mutations across subclades; mutations associated with tecovirimat resistance were not observed. Conclusion We provide insights into the international transmission dynamics supporting multiple introductions of MPXV into Ireland. Such information supported the implementation of evidence-informed public health control measures.

Understanding sexual health service access for gay, bisexual and other men who have sex with men in Ireland during the COVID-19 crisis: Findings from the EMERGE survey

“…Capacity issues predate COVID-19 but were exacerbated by the pandemic and related government restrictions. These have likely also been worsened by the subsequent global mpox outbreak occurring primary among gbMSM and leading to substantial service difficulties in many settings [ 44 – 46 ]. Services must be appropriately resourced so that they can operate with sufficient capacity to respond to surges in testing demand and treatment needs while also expanding to cater for the substantial unmet demand which existed prior to the COVID-19 crisis.…”