Dynamic landscape of mpox importation risks driven by heavy-tailed sexual contact networks among men who have sex with men in 2022.

Abstract

During the 2022 global mpox outbreak, the cumulative number of countries reporting their first imported case quickly rose in the early phase, but the importation rate subsequently slowed down, leaving many countries reporting no cases by the 2022 year-end. We developed a mathematical model of international dissemination of mpox infections incorporating sexual networks and global mobility data. We used this model to characterize the mpox importation patterns observed in 2022 and to discuss the potential of further international spread. Our proposed model better explained the observed importation patterns than models not assuming heterogeneity in sexual contacts. Estimated importation hazards decreased in most countries, surpassing the global case count decline, suggesting a reduced per-case risk of importation. We assessed each country's potential to export mpox cases until the end of an epidemic, identifying countries capable of contributing to the future international spread. The accumulation of immunity among high-risk individuals over highly heterogeneous sexual networks may have contributed to the slowdown in the rate of mpox importations. Nevertheless, the existence of countries with the potential to contribute to the global spread of mpox highlights the importance of equitable resource access to prevent the global resurgence of mpox.