Dataset Information

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

ABSTRACT: Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

SUBMITTER: Borges V

PROVIDER: S-EPMC10579057 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Borges Vítor V Duque Mariana Perez MP Martins João Vieira JV Vasconcelos Paula P Ferreira Rita R Sobral Daniel D Pelerito Ana A de Carvalho Isabel Lopes IL Núncio Maria Sofia MS Borrego Maria José MJ Roemer Cornelius C Neher Richard A RA O'Driscoll Megan M Rocha Raquel R Lopo Sílvia S Neves Raquel R Palminha Paula P Coelho Luís L Nunes Alexandra A Isidro Joana J Pinto Miguel M Santos João Dourado JD Mixão Verónica V Santos Daniela D Duarte Silvia S Vieira Luís L Martins Fátima F Machado Jorge J Veríssimo Vítor Cabral VC Grau Berta B Peralta-Santos André A Neves José J Caldeira Margarida M Pestana Mafalda M Fernandes Cândida C Caria João J Pinto Raquel R Póvoas Diana D Maltez Fernando F Sá Ana Isabel AI Salvador Mafalda Brito MB Teófilo Eugénio E Rocha Miguel M Moneti Virginia V Duque Luis Miguel LM E Silva Francisco Ferreira FF Baptista Teresa T Vasconcelos Joana J Casanova Sara S Mansinho Kamal K Alves João Vaz JV Alves João J Silva António A Alpalhão Miguel M Brazão Cláudia C Sousa Diogo D Filipe Paulo P Pacheco Patrícia P Peruzzu Francesca F de Jesus Rita Patrocínio RP Ferreira Luís L Mendez Josefina J Jordão Sofia S Duarte Frederico F Gonçalves Maria João MJ Pena Eduarda E Silva Claúdio Nunes CN Guimarães André Rodrigues AR Tavares Margarida M Freitas Graça G Cordeiro Rita R Gomes João Paulo JP

Nature medicine 20230911 10

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence t ...[more]

PMID: 37696933

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Project description:IntroductionThe 2022-2023 mpox outbreak has been the largest in history. We aim to synthesise the key epidemiological parameters related to the dynamics, transmission, and severity of mpox (incubation period, serial interval, generation time, infectious period, basic (R0) and effective (R(t)) reproductive number, and case fatality rate (CFR)).MethodsSystematic review of observational studies in MEDLINE, EMBASE and other sources up to September 2023 (PROSPERO: CRD42023404503). Quality assessment using the Joanna Briggs Institute Critical Appraisal for case series, cross-sectional and cohort studies, and a designed quality assessment questionnaire for mathematical models. Meta-analysis was performed using a random effects model.ResultsFor transmissibility parameters, we estimated a pooled incubation period of 7.60 (95% CI 7.14 to 8.10) days and a pooled serial interval of 8.30 (95% CI 6.74 to 10.23) days. One study reported a generation time of 12.5 days (95% CI 7.5 to 17.3). Three studies reported presymptomatic transmission in 27-50% of paired cases investigated. R(t) varied between 1.16 and 3.74 and R0 varied between 0.006 and 7.84. The epidemic peaked between August and September 2022 in Europe and the Americas whereas transmission has continued in African countries. For severity parameters, we estimated a pooled CFR by continent: 0.19% (95% CI 0.09% to 0.37%) for the Americas and 0.33% (95% CI 0.15% to 0.7%) for Europe. For Africa, we found that the CFRs of countries associated with group I were higher (range 17-64%) than those associated with group IIb (range 0-6%).ConclusionPooled mpox serial interval was slightly larger than pooled incubation period, suggesting transmission occurs mostly postsymptom onset, although presymptomatic transmission can occur in an important proportion of cases. CFR estimates varied by geographical region and were higher in Africa, in countries linked with clade I. Our results contribute to a better understanding of mpox dynamics, and the development of mathematical models to assess the impact of current and future interventions.

Project description:In May 2022, the most widespread outbreak of sustained transmission of mpox outside of countries historically affected countries in Western and Central Africa occurred. We aimed to examine the personal and clinical experiences of international healthcare workers (HCWs) during this public health emergency. We conducted an international cross-sectional survey study between August and October 2022, examining the experiences and perceptions of HCWs clinically involved in the 2022 mpox response. Respondents were recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness; training and support at work; psychological well-being and vaccination. 725 multi-national healthcare workers across 41 countries were included in the analysis. 91% were physicians specialised in Sexual Health or Infectious Diseases; with 34% (n = 247) of all respondents involved in mpox policy. A substantial proportion of respondents (n = 296, 41%) reported working longer hours during the mpox outbreak, with no concomitant removal of other clinical responsibilities. 30% (n = 218) of respondents reported that they had never heard of mpox before the outbreak and over 25% of the respondents reported that they had misdiagnosed someone initially. This culminated in a high prevalence of moral distress at thirty percent. Less than 9% of HCWs in the region of the Caribbean, Central America and South America had been offered a vaccine as compared to almost one-third in the other regions. Where offered, there were high levels of uptake across all regions. The findings highlight a critical need for addressing the profound gaps in HCW knowledge about re-emerging diseases with pandemic potential. Strengthening the resilience of global health systems and prioritising internationally coordinated approaches to global vaccine deployment is imperative.

Dataset Information

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

Publications

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal.

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