Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex with Men to Prevent <i>Monkeypox virus</i> Transmission — United States, August 2022

Delaney, Kevin P.; Sanchez, Travis; Hannah, Marissa; Edwards, O. Winslow; Carpino, Thomas; Agnew-Brune, Christine; Renfro, Kaytlin J.; Kachur, Rachel; Carnes, Neal; DiNenno, Elizabeth; Lansky, Amy; Ethier, Kathleen A.; Sullivan, Patrick S.; Baral, Stefan; Oster, Alexandra M.

doi:10.15585/mmwr.mm7135e1

Cited by 119 publications

(135 citation statements)

References 7 publications

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“…These models show that personal decisions and public health interventions around one-time partnerships can have a substantial impact on reducing MPXV transmission. Changes in number of sex partners, and particularly changes in one-time partnerships, which are already being reported by MSM (2), have the potential to delay the spread of the outbreak. This could allow vaccination and implementation of other mitigation efforts to reach populations at high risk before they have been exposed to MPXV, and ultimately reduce MPXV transmission.…”

Section: Discussionmentioning

confidence: 99%

“…The model also summarized the proportion of MPXV transmission that occurred via each partnership type. Finally, the reduction in the final proportion of MSM infected was estimated at baseline and under a scenario in which MSM decreased their one-time partnering by 40% 2.5 months after MPXV entered the population, which is similar to recent survey results (2). All simulations were conducted in R (version 4.2.0; R Foundation) using the EpiModel package (8).…”

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confidence: 99%

“…On August 26, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).…”

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confidence: 99%

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Modeling the Impact of Sexual Networks in the Transmission of Monkeypox virus Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2022

Spicknall

Pollock

Clay

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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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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Section: Discussionmentioning

confidence: 99%

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confidence: 92%

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mentioning

confidence: 99%

“…On August 26, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).…”

mentioning

confidence: 99%

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Modeling the Impact of Sexual Networks in the Transmission of Monkeypox virus Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2022

Spicknall

Pollock

Clay

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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“…S5). Some of the countries with early introductions of cases including the UK have seen a slowdown in growth of cases as of 10 August 2022 ( 6 ); depletion of susceptibles and other factors such as vaccination and increased awareness ( 36 ) may have contributed to these trend changes. We did not consider the possibility of degree assortativity or clustering, which would lead to more densely clustered local subnetworks than those we modeled ( 37 ).…”

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confidence: 99%

Heavy-tailed sexual contact networks and monkeypox epidemiology in the global outbreak, 2022

Endo

Murayama

Abbott

et al. 2022

Science

133

121

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The outbreak of monkeypox across non-endemic regions confirmed in May 2022 shows epidemiological features distinct from previously imported outbreaks, most notably its observed growth and predominance amongst men who have sex with men (MSM). We use a transmission model fitted to empirical sexual partnership data to show that the heavy-tailed sexual partnership distribution, in which a handful of individuals have disproportionately many partners, can explain the sustained growth of monkeypox among MSM despite the absence of such patterns previously. We suggest that the basic reproduction number ( R 0 ) for monkeypox over the MSM sexual network may be substantially above 1, which poses challenges to outbreak containment. Ensuring support and tailored messaging to facilitate prevention and early detection among MSM with high numbers of partners is warranted.

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Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies

Titanji,

Hazra,

Zucker

2024

JAMA

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ImportanceA global outbreak of clade IIb Monkeypox virus (MPXV) infections spread rapidly across at least 118 countries resulting in a Public Health Emergency of International Concern (PHEIC) from July 2022 to May 2023. This outbreak affected more than 99 000 persons worldwide and caused more than 33 000 infections and 60 deaths in the US. In 2024, there have been approximately 200 new infections per month in the US. On August 14, 2024, the World Health Organization declared mpox a PHEIC for a second time due to a rapid increase in infections with clade I MPXV in Central Africa.ObservationsMpox is primarily acquired through direct skin to skin contact with MPXV. With clade IIb MPXV, infections are most commonly associated with sexual activity among individuals who are gay, bisexual, and other men who have sex with men. After a median incubation period of 7 to 10 days, prodromal symptoms include fever (62%-72%), lymphadenopathy (56%-86%), myalgias (31%-55%), malaise (23%-57%), and headache (25%-55%). Skin lesions progress through 4 well-defined stages (macules, papules, vesicles, and pustules) over 2 to 4 weeks. Clade IIb MPXV is typically a self-limited illness with a low mortality rate (&lt;0.2% in the US); however, severe illness and death may occur in immunocompromised individuals, especially those with advanced HIV (CD4 count &lt;200 cells/μL). Mpox should be suspected in patients with potential exposure to MPXV who have skin lesions, and the diagnosis is confirmed with polymerase chain reaction testing of lesions. Management is supportive and focuses on skin care and symptom relief with analgesics. While no antiviral treatments are currently approved for mpox by the US Food and Drug Administration, several therapeutics, such as tecovirimat, brincidofovir, and vaccinia immune globulin intravenous, are available through expanded access programs or clinical trials. Vaccination with the 2-dose Modified Vaccinia Ankara-Bavarian Nordic vaccine is recommended for high-incidence populations and has an efficacy of 66% to 86%.Conclusions and RelevanceMpox is a viral infection transmitted primarily through close skin to skin contact that typically causes a self-resolving illness but can result in severe illness and death in immunocompromised individuals. First-line therapy is supportive care, although patients with severe mpox infection may be treated with advanced therapeutics. Mpox vaccination is effective and, if available, should be offered to individuals at risk of exposure to mpox.

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Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex with Men to Prevent Monkeypox virus Transmission — United States, August 2022

Cited by 119 publications

References 7 publications

Modeling the Impact of Sexual Networks in the Transmission of Monkeypox virus Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2022

Modeling the Impact of Sexual Networks in the Transmission of Monkeypox virus Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2022

Heavy-tailed sexual contact networks and monkeypox epidemiology in the global outbreak, 2022

Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies

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