Description of the first global outbreak of mpox: an analysis of global surveillance data

Henry Laurenson-Schafer; Nikola Sklenovská; Steven M. Kerr; Patricia Ndumbi; Julia Fitzner; Maria Almiron; Luis Alves de Sousa; Sylvie Briand; Orlando Cenciarelli; Soledad Colombe; Meg Doherty; Ibrahima Soce Fall; Christian García-Calavaro; Joana M. Haussig; Masaya Kato; Abdi Rahman Mahamud; Oliver W. Morgan; Pierre Nabeth; Jeremias Domingos Naiene; Wildo Araujo Navegantes; Opeayo Ogundiran; Charles Okot; Richard Pebody; Tamano Matsui; Hugo López-Gatell Ramírez; Catherine Smallwood; Raúl Francisco Pérez Tasigchana; Aisling M. Vaughan; George Sie Williams; WHO mpox Surveillance; Analytics team; Peter Omondi Mala; Rosamund F. Lewis; Boris I. Pavlin; Olivier le Polain de Waroux

doi:10.1016/S2214-109X(23)00198-5

Description of the first global outbreak of mpox: an analysis of global surveillance data

Henry Laurenson-Schafer, Nikola Sklenovská, Steven M. Kerr, Patricia Ndumbi, Julia Fitzner, Maria Almiron, Luis Alves de Sousa, Sylvie Briand, Orlando Cenciarelli, Soledad Colombe, Meg Doherty, Ibrahima Soce Fall, Christian García-Calavaro, Joana M. Haussig, Masaya Kato, Abdi Rahman Mahamud, Oliver W. Morgan, Pierre Nabeth, Jeremias Domingos Naiene, Wildo Araujo NavegantesOpeayo Ogundiran, Charles Okot, Richard Pebody, Tamano Matsui, Hugo López-Gatell Ramírez, Catherine Smallwood, Raúl Francisco Pérez Tasigchana, Aisling M. Vaughan, George Sie Williams, WHO mpox Surveillance, Analytics team, Peter Omondi Mala, Rosamund F. Lewis, Boris I. Pavlin, Olivier le Polain de Waroux

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4 of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9 of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7 of 21 749). 3927 (7·3 of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], ptextless0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], ptextless0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

Original language	English
Journal	Lancet Global Health
Volume	11
Issue number	7
Pages (from-to)	e1012-e1023
ISSN	2214-109X
DOIs	https://doi.org/10.1016/S2214-109X(23)00198-5
Publication status	Published - 1-Jul-2023
Externally published	Yes

Keywords

Disease Outbreaks
Female
Homosexuality
Male
Humans
Mpox (monkeypox)
Retrospective Studies
Sexual and Gender Minorities

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10.1016/S2214-109X(23)00198-5

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Laurenson-Schafer, H., Sklenovská, N., Kerr, S. M., Ndumbi, P., Fitzner, J., Almiron, M., de Sousa, L. A., Briand, S., Cenciarelli, O., Colombe, S., Doherty, M., Fall, I. S., García-Calavaro, C., Haussig, J. M., Kato, M., Mahamud, A. R., Morgan, O. W., Nabeth, P., Naiene, J. D., ... le Polain de Waroux, O. (2023). Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Global Health, 11(7), e1012-e1023. https://doi.org/10.1016/S2214-109X(23)00198-5

@article{4657061062354a16b72b73767e8dfac6,

title = "Description of the first global outbreak of mpox: an analysis of global surveillance data",

abstract = "BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4 of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9 of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7 of 21 749). 3927 (7·3 of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], ptextless0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], ptextless0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.",

keywords = "Disease Outbreaks, Female, Homosexuality, Male, Humans, Mpox (monkeypox), Retrospective Studies, Sexual and Gender Minorities",

author = "Henry Laurenson-Schafer and Nikola Sklenovsk{\'a} and Kerr, {Steven M.} and Patricia Ndumbi and Julia Fitzner and Maria Almiron and {de Sousa}, {Luis Alves} and Sylvie Briand and Orlando Cenciarelli and Soledad Colombe and Meg Doherty and Fall, {Ibrahima Soce} and Christian Garc{\'i}a-Calavaro and Haussig, {Joana M.} and Masaya Kato and Mahamud, {Abdi Rahman} and Morgan, {Oliver W.} and Pierre Nabeth and Naiene, {Jeremias Domingos} and Navegantes, {Wildo Araujo} and Opeayo Ogundiran and Charles Okot and Richard Pebody and Tamano Matsui and Ram{\'i}rez, {Hugo L{\'o}pez-Gatell} and Catherine Smallwood and Tasigchana, {Ra{\'u}l Francisco P{\'e}rez} and Vaughan, {Aisling M.} and Williams, {George Sie} and Surveillance, {WHO mpox} and Analytics team and Mala, {Peter Omondi} and Lewis, {Rosamund F.} and Pavlin, {Boris I.} and {le Polain de Waroux}, Olivier",

year = "2023",

month = jul,

day = "1",

doi = "10.1016/S2214-109X(23)00198-5",

language = "English",

volume = "11",

pages = "e1012--e1023",

journal = "Lancet Global Health",

issn = "2214-109X",

publisher = "Elsevier",

number = "7",

}

Laurenson-Schafer, H, Sklenovská, N, Kerr, SM, Ndumbi, P, Fitzner, J, Almiron, M, de Sousa, LA, Briand, S, Cenciarelli, O, Colombe, S, Doherty, M, Fall, IS, García-Calavaro, C, Haussig, JM, Kato, M, Mahamud, AR, Morgan, OW, Nabeth, P, Naiene, JD, Navegantes, WA, Ogundiran, O, Okot, C, Pebody, R, Matsui, T, Ramírez, HL-G, Smallwood, C, Tasigchana, RFP, Vaughan, AM, Williams, GS, Surveillance, WHOM, team, A, Mala, PO, Lewis, RF, Pavlin, BI & le Polain de Waroux, O 2023, 'Description of the first global outbreak of mpox: an analysis of global surveillance data', Lancet Global Health, vol. 11, no. 7, pp. e1012-e1023. https://doi.org/10.1016/S2214-109X(23)00198-5

TY - JOUR

T1 - Description of the first global outbreak of mpox: an analysis of global surveillance data

AU - Laurenson-Schafer, Henry

AU - Sklenovská, Nikola

AU - Kerr, Steven M.

AU - Ndumbi, Patricia

AU - Fitzner, Julia

AU - Almiron, Maria

AU - de Sousa, Luis Alves

AU - Briand, Sylvie

AU - Cenciarelli, Orlando

AU - Colombe, Soledad

AU - Doherty, Meg

AU - Fall, Ibrahima Soce

AU - García-Calavaro, Christian

AU - Haussig, Joana M.

AU - Kato, Masaya

AU - Mahamud, Abdi Rahman

AU - Morgan, Oliver W.

AU - Nabeth, Pierre

AU - Naiene, Jeremias Domingos

AU - Navegantes, Wildo Araujo

AU - Ogundiran, Opeayo

AU - Okot, Charles

AU - Pebody, Richard

AU - Matsui, Tamano

AU - Ramírez, Hugo López-Gatell

AU - Smallwood, Catherine

AU - Tasigchana, Raúl Francisco Pérez

AU - Vaughan, Aisling M.

AU - Williams, George Sie

AU - Surveillance, WHO mpox

AU - team, Analytics

AU - Mala, Peter Omondi

AU - Lewis, Rosamund F.

AU - Pavlin, Boris I.

AU - le Polain de Waroux, Olivier

PY - 2023/7/1

Y1 - 2023/7/1

N2 - BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4 of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9 of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7 of 21 749). 3927 (7·3 of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], ptextless0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], ptextless0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

AB - BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4 of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9 of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7 of 21 749). 3927 (7·3 of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], ptextless0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], ptextless0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

KW - Disease Outbreaks

KW - Female

KW - Homosexuality

KW - Male

KW - Humans

KW - Mpox (monkeypox)

KW - Retrospective Studies

KW - Sexual and Gender Minorities

U2 - 10.1016/S2214-109X(23)00198-5

DO - 10.1016/S2214-109X(23)00198-5

M3 - A1: Web of Science-article

SN - 2214-109X

VL - 11

SP - e1012-e1023

JO - Lancet Global Health

JF - Lancet Global Health

IS - 7

ER -

Description of the first global outbreak of mpox: an analysis of global surveillance data

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Keywords

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