Multi-country Outbreak Research Articles

Characteristics of aircrew who flew while infectious with mpox during the 2022 multi-country mpox outbreak, United States, may 10-September 30, 2022.

Among aircrew identified as having flown while infectious with mpox and for whom information was available, most followed recommendations to mask and cover lesions. Clearer occupational health guidance and education for aircrew who contract mpox may be useful.

Therapeutic agents for the treatment of human mpox.

The aim of this study was to summarize the current knowledge of therapeutic options for mpox (formerly known as monkeypox) in the context of recent outbreaks and the ongoing evolution of the virus. Multiple therapeutic agents, including tecovirimat, cidofovir, brincidofovir, and vaccinia immune globulin, have been used during the multicountry outbreak of mpox caused by Clade 2b monkeypox virus that began in 2022. Tecovirimat has been most extensively used, based on efficacy against mpox lethal challenge in animal models, and human safety data. Real-world observational evidence has further supported safety with minimal adverse events in large cohorts and mixed reports of reductions in time to lesion resolution. Several prospective randomized controlled trials using tecovirimat are underway with headline results from a study in the Democratic Republic of the Congo showing no difference in lesion resolution compared to placebo. Other studies including in outpatient settings are underway in Europe and the Americas. Cidofovir and brincidofovir, limited by adverse event profiles, have been less extensively studied. Vaccinia immune globulin has been used predominantly in salvage therapy for severe mpox, with no large observational series available. The 2022 multicountry outbreak of mpox marked a public health emergency. Agents approved for smallpox management were widely used for mpox, supported by animal and in-vitro evidence, and human safety data. The large number of human cases has allowed retrospective observational study of these agents and facilitated recruitment in prospective trials. The ongoing evolution of the virus may pose challenges for therapeutic interventions, necessitating rigorous randomized controlled trials to guide clinical use.

Media Literacy and Its Potential Influence on Mpox-Related Perceptions and Prevention Intentions in China During the 2022 Multi-Country Outbreak of Mpox

ABSTRACT Media literacy plays an increasingly important role in health communication during public health emergencies. The present study aimed to investigate the level of media literacy and its association with disease perceptions and behavioral intentions of receiving vaccination services among young men who have sex with men (YMSM) in China during the 2022 multi-country mpox outbreak. The data were from a large-scale cross-sectional survey conducted among 2,493 YMSM aged 18–29 years in six provincial regions in China in September 2022. A total of 2,079 YMSM who had obtained mpox information from social media platforms were included in this study. Correlation analysis and path analysis were conducted. The mean age of the sample was 24.7. After controlling for background variables, significant positive correlations were found in several pairs between media literacy, mpox-related perceptions (including perceived susceptibility to mpox, perceived severity of mpox, perceived benefits of mpox vaccination, and self-efficacy of receiving mpox vaccination), and the behavioral intention of receiving mpox vaccination. The mpox-related perceptions played a significant mediation role in the association between media literacy and intention of receiving mpox vaccination (indirect effect = 0.165, p < .001, effect size = 82.1%). Media literacy is crucial for developing disease perceptions during public health emergencies and may further influence the adoption of preventive measures. As social media platforms have become the main battle field of health communication during disease outbreaks, improvement of media literacy is urgently warranted.

An Explainable Deep Learning Approach for Classifying Monkeypox Disease by Leveraging Skin Lesion Image Data

According to the World Health Organization's (WHO) external situation report on the multi-country outbreak of Monkeypox in 2023, from 11 countries in Southeast Asia Regions, Thailand recorded the highest reported cases, totaling 461. The ongoing Monkeypox outbreak has raised significant public health concerns due to its rapid spread across several nations. Early detection and diagnosis are imperative for effectively treating and controlling Monkeypox. Given this context, this study aimed to determine the most efficient model for detecting Monkeypox by employing interpretable deep learning techniques. This study utilizes deep learning techniques to diagnose Monkeypox based on images of skin lesions. We evaluate based on four models—convolutional neural network (CNN), gated recurrent unit (GRU), long short-term memory (LSTM), and bidirectional long short term memory (BiLSTM)—using a publicly available dataset. Additionally, we incorporate Local Interpretable Model-Agnostic Explanations (LIME) and techniques for explainable AI, facilitating visual interpretation of model predictions for healthcare practitioners. The CNN model's performance and LSTM model's performance have an accuracy of 100%, while the GRU model's performance and BiLSTM model's performance have an accuracy of 99.88% and 99.45%. Our findings demonstrate the effectiveness of deep learning models, including the suggested CNN model leveraging the pre-trained MobileNetV2 and LSTM. These models can play a pivotal role in combating the Monkeypox virus. Doi: 10.28991/ESJ-2024-08-05-013 Full Text: PDF

Mutated Adenovirus Attacks in West Bengal, India: Risk Evaluation of Multi-Country Outbreaks and Mitigation Strategies.

The human adenovirus (HAdV) is beginning to spread rapidly in children through human, surface and animal vectors. Around 12,000 cases were recognised in 2022 in West Bengal and a shocking number of cases arose throughout India and in other under-developed areas. This is going to be a big threat to public health since no vaccine, awareness or protocol policies were introduced. Early detection, immediate isolation and proper policy developments are the key factors in overcoming the situation. Therefore, we performed this rapid review and discussed probable mitigation strategies, updated research on vaccine development, and treatment strategies to control the outbreaks of mutated HAdV. This is a narrative review of publicly available information. Here, we extracted updated information and data using the terms HAdV outbreaks, mutations, species, risks and prevention from Google Scholar and PubMed. We considered relevant articles that have discussed prevention strategies, ongoing research, and antiviral drugs for managing HAdV outbreaks. Early detection from throat swabs, isolation and symptomatic treatments are required to minimise viral infections. A massive test needs to be performed to find the affected people. The cases should be immediately isolated. It is recommended to treat high-touch surfaces with heat- or bleach-containing cleaners to prevent the spread of infection. Oxygen support and many broad-spectrum antivirals have been used to treat HAdV. Several studies showed antibody neutralisation and interactions between the natural killer cell receptor KIR3DS1 and HLA-F in infected cells, indicating possible therapeutic options in the future. HAdV-4 and HAdV-7 vaccines have been limitedly approved for administration to military personnel. Isolation, certain safety measures, broad-spectrum antiviral drugs and further research on new vaccines could be useful to prevent this virus from producing a worldwide pandemic. Also, the authorities should ensure the proper therapeutic interventions and nursing care facilities for the infected children. Patient or public contribution was not relevant to our work.

RE: Prediction of potential public health risk of the recent multicountry monkeypox outbreak: An update after the end declaration of global public health emergency

RE: Prediction of potential public health risk of the recent multicountry monkeypox outbreak: An update after the end declaration of global public health emergency

First Data on WGS-Based Typing and Antimicrobial Resistance of Human Salmonella Enteritidis Isolates in Greece.

Salmonella enterica subsp. enterica serotype Enteritidis (S. Enteritidis) is one of the major causes of foodborne infections and is responsible for many national and multi-country foodborne outbreaks worldwide. In Greece, human salmonellosis is a mandatory notifiable disease, with laboratory surveillance being on a voluntary basis. This study aims to provide the first insights into the genetic characteristics and antimicrobial resistance profiles of 47 S. Enteritidis human isolates using whole-genome sequencing (WGS) technology. The S. Enteritidis population was mainly resistant to fluoroquinolones due to gyrA point mutations, whereas one isolate presented a multi-resistant plasmid-mediated phenotype. ST11 was the most frequent sequence type, and phylogenetic analysis through the cgMLST and SNP methods revealed considerable genetic diversity. Regarding virulence factors, 8 out of the 24 known SPIs and C63PI were detected. Due to the observed variability between countries, it is of utmost importance to record the circulating S. Enteritidis strains' structure and genomic epidemiology at the national level. WGS is a valuable tool that is revolutionizing our approach to Salmonella by providing a deeper understanding of these pathogens and their impact on human health.

Depressive symptoms and its multifaceted associated factors among young men who have sex with men facing the dual threats of COVID-19 and mpox in China

IntroductionThe COVID-19 pandemic has significantly impacted the mental health of human beings since 2020, especially the young people and the pre-existing marginalized groups such as men who have sex with men (MSM). During the COVID-19 pandemic, the multi-country outbreak of mpox in 2022 additionally posed a significant stress on the most-affected communities (i.e., MSM). This study investigated the level of depressive symptoms and its multifaceted associated factors among Chinese young men who have sex with men (YMSM) in this unique period. MethodsIn September 2022, a large-scale cross-sectional survey was conducted among YMSM aged 18–29 years across six representative provinces in China. Hierarchical regression analysis was performed to test the various types of associated factors of depressive symptoms. ResultsAmong the 2493 participants, 65.6 % (n = 1638) reported mild to severe depressive symptoms. The hierarchical regression analysis identified that depressive symptoms was significantly positively associated with unemployment, having substance use in the past 6 months, a higher level of MSM self-stigma, incompletion of COVID-19 vaccination, greater mpox risk perception, and presence of mpox related-like symptoms. LimitationsThis study used the facility-based sampling method to recruit the participants, which may lead to selection bias. ConclusionsChinese YMSM faced significant mental health challenges during the concurrent epidemics of COVID-19 and mpox, which was associated with their socio-economic status, risk behaviors, stigma, and multiple diseases-related variables. Proactive measures may hold promise as effective strategies for mitigating mental distress among marginalized groups during public health crises.

Prediction of potential public health risk of the recent multicountry monkeypox outbreak: An update after the end declaration of global public health emergency.

A double-stranded DNA virus called monkeypox virus (MPV) belonging to the Poxviridae family and Orthopoxvirus genus causes monkeypox (mpox) infection. This virus used to infect only Central, East, and West Africa. However, it has spread to an extent outside Africa recently. The range of MPV outbreaks was so high that on July 23, 2022, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern (PHEIC). About a year later, the WHO notified the end of a global public health emergency for mpox on May 11, 2023. Here, we aimed to assess the current pathogenicity and potential risk of MPV causing public health emergencies. We searched information from published articles available in PubMed, Scopus, and ScienceDirect. We used monkeypox, mpox, monkeypox outbreak, and monkeypox virus as keywords during the literature search. Many new variants of MPV have emerged throughout the world that created PHEIC for mpox. Considering the low lethality and transmission rate, mpox is no longer a global public health threat. In addition, the availability of therapeutic and preventive measures helped the healthcare authorities fight the mpox infection in an efficient manner. In this review, we have portrayed the history and evolution of mpox from past to present and an idea of its future outcomes. Also, we have discussed the symptoms related to mpox and approved antiviral treatment strategies to fight off the infection in this piece. This review also emphasized the preventive guidelines set by the WHO for patients, caregivers, and healthcare providers to control the outbreak of mpox infection. We believe this article would give an idea about the potential public health threats of the recent multi-country monkeypox outbreak to the healthcare authorities for taking measures accordingly.

Ongoing outbreak of hepatitis A associated with sexual transmission among men who have sex with men, Portugal, October 2023 to April 2024

An outbreak of hepatitis A is ongoing in Portugal, with 71 confirmed cases from 7 October 2023 to 24 April 2024. Most cases are male, aged 18–44 years, with many identifying as men who have sex with men (MSM) and reported as suspected sexual transmission. Phylogenetic analysis identified the subgenotype IA, VRD 521–2016 strain, last observed in an MSM-associated multi-country outbreak in 2016 to 2018. We wish to alert colleagues in other countries to investigate potential similar spread.

Development of a multiplex real-time PCR assay for the simultaneous detection of mpox virus and orthopoxvirus infections

Since May 2022, the multi-country outbreak of monkeypox (mpox) has raised a great concern worldwide. Early detection of mpox virus infection is recognized as an efficient way to prevent mpox transmission. Mpox specific detection methods reported up to now are based on the SNPs among mpox virus and other orthopoxviruses. We have therefore developed a real-time PCR based mpox detection method targeting mpox virus specific sequences (N3R and B18Rplus). We have also optimized an orthopoxvirus detection system which targets the highly conserved E9L and D6R genes. The mpox and orthopoxvirus real-time PCR assays have a high sensitivity (1 copy/reaction) and specificity. Mpox viral DNA and clinical samples from mpox patients are detected with the mpox detection system. Furthermore, we have established a multiplex real-time PCR detection system allowing simultaneous and efficient detection of mpox and orthopoxvirus infections.

Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022.

During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.

Ongoing outbreak of hepatitis A associated with sexual transmission among men who have sex with men, Portugal, October 2023 to April 2024.

An outbreak of hepatitis A is ongoing in Portugal, with 71 confirmed cases from 7 October 2023 to 24 April 2024. Most cases are male, aged 18-44 years, with many identifying as men who have sex with men (MSM) and reported as suspected sexual transmission. Phylogenetic analysis identified the subgenotype IA, VRD 521-2016 strain, last observed in an MSM-associated multi-country outbreak in 2016 to 2018. We wish to alert colleagues in other countries to investigate potential similar spread.

Mpox vaccination routes: prevalence, correlates and adverse effects of subcutaneous versus intradermal vaccination at a mass vaccination clinic in Sydney, Australia.

The Royal Prince Alfred Hospital Mpox Vaccination Clinic opened in response to the 2022 multicountry mpox outbreak. A total of 9500 vaccinations were administered intradermally and subcutaneously during the first 16 weeks of clinic operation. The rate of adverse events was 0.1%. Compared to people who received the vaccine intradermally, those who received it subcutaneously were more likely to be aged 30-39 years (P = 0.047), sexual partners of gay and bisexual men (P < 0.001), eligible for Medicare (P < 0.001) and born in the Philippines (P = 0.01) or Malaysia (P = 0.04).

The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study

BackgroundThe 2022–2023 mpox (monkeypox) outbreak has spread rapidly across multiple countries in the non-endemic region, mainly among men who have sex with men (MSM). In this study, we aimed to evaluate mpox’s importation risk, border screening effectiveness and the risk of local outbreak in Chinese mainland.MethodsWe estimated the risk of mpox importation in Chinese mainland from April 14 to September 11, 2022 using the number of reported mpox cases during this multi-country outbreak from Global.health and the international air-travel data from Official Aviation Guide. We constructed a probabilistic model to simulate the effectiveness of a border screening scenario during the mpox outbreak and a hypothetical scenario with less stringent quarantine requirement. And we further evaluated the mpox outbreak potential given that undetected mpox infections were introduced into men who have sex with men, considering different transmissibility, population immunity and population activity.ResultsWe found that the reduced international air-travel volume and stringent border entry policy decreased about 94% and 69% mpox importations respectively. Under the quarantine policy, 15–19% of imported infections would remain undetected. Once a case of mpox is introduced into active MSM population with almost no population immunity, the risk of triggering local transmission is estimated at 42%, and would rise to > 95% with over six cases.ConclusionsOur study demonstrates that the reduced international air-travel volume and stringent border entry policy during the COVID-19 pandemic reduced mpox importations prominently. However, the risk could be substantially higher with the recovery of air-travel volume to pre-pandemic level. Mpox could emerge as a public health threat for Chinese mainland given its large MSM community.Graphical

Concomitant Syndromic Diagnosis of Mpox and Other Vesicular Viruses in Patients with Skin and Genital Lesions.

The recent multi-country outbreak of the zoonotic monkeypox virus (MPXV) infection in humans without an epidemiological link with endemic areas has raised concerns about the route of transmission. Since the infection spread largely among men who have sex with men who, in most cases, presented primary lesions of the genital and oral mucosa, sexual transmission has been proposed. In the present study, we retrospectively evaluated specimens of vesicular lesions collected from the skin and genital tract of 35 patients (23 positive and 12 negative) presenting at our Institute for monkeypox (mpox) diagnosis by using a novel molecular syndromic vesicular virus panel (VVP) assay. All MPXV-positive samples but one was confirmed; however, the viral syndromic analysis revealed that 8.6% of them were coinfected with one or more viruses, and 17% had at least a virus different from the MPXV. The percentage of coinfections increased to more than 25% when nonviral pathogens, such as gonorrhea and syphilis, were also considered. These results show the usefulness of syndromic diagnosis in cases where MPXV is suspected (and vice versa) and at the same time highlight that the broader screening of sexually transmitted infections in the population with high-risk sexual behavior is critical to ensure a complete etiology and appropriate treatment.

Mpox reinfection: A rapid systematic review of case reports

BackgroundMpox re-emerged worldwide with the multi-country outbreaks that occurred in May 2022, threatening the public health of human beings. MethodsThis rapid systematic review summarized mpox reinfection cases documented. Electronic databases (PubMed, MedRxiv, and Social Science Research Network) were searched without time limitation, using the keywords “mpox,” “monkeypox,” & “reinfection,” “reoccur,” “reoccurrence,” “episode,” and “relapse”. All laboratory-confirmed cases of mpox reinfection published in the literature were included in this study. ResultsA total of seven publications (nine cases) from Africa, Europe, and South America were included. All mpox reinfection cases were male, with a median age of 36; 88.89% of cases had unprotected sexual behaviors with other males before each illness episode. The average onset interval between the two episodes was about 4 months. Perianal lesions and lymphadenopathy were major symptoms in both episodes, and no differences in clinical severity were reported between the two episodes. The mean duration of the two episodes was approximately 22 days and 13 days, respectively; which the mean duration of the second episode was shorter than the first infection (t = 2.17, p = 0.0487). Sexually transmitted infections were commonly concurrent among most cases, accounting for 55.6% and 77.8% in the two episodes, respectively. Full vaccination against mpox was rare among reinfection cases. ConclusionA second infection is possible even in a short period. Reinforcing monitoring, reducing high-risk behaviors, and heightening health education regarding mpox for high-risk populations are crucial to limit mpox spread, including persons with a history of mpox infection.

Immunoinformatic and molecular docking approaches: siRNA prediction to silence cell surface binding protein of monkeypox virus

BackgroundMonkeypox virus (MPV), an endemic pathogen in Africa, shares clinical similarities with smallpox. Recent reports indicate a concerning increase in the number of MPV cases detected outside its endemic region, highlighting the emergence of a multi-country outbreak. Given the importance of the cell surface-binding protein E8L in facilitating viral attachment to host cells, this study aimed to identify potential small interfering RNAs (siRNAs) capable of silencing E8L and thereby serving as a basis for therapeutic development.ResultssiRNAs have emerged as promising candidates for genetic therapies and antiviral and antibacterial treatments. In this investigation, we employed computational assays, including GC content analysis, binding free energy assessment, folding properties evaluation, melting temperature determination, and siRNA efficacy prediction. Our comprehensive analysis identified five siRNAs with high potential for effectively silencing the cell surface-binding protein of the monkeypox virus. Among these siRNAs, molecular docking revealed that “S8” (Guide-UUAUGGAUCCAAUCACUUGAU, Passenger-CAAGUGAUUGGAUCCAUAAUC) demonstrated the strongest affinity with the human argonaute-2 protein.ConclusionsThe siRNA “S8” represents a promising therapeutic target for developing treatments against monkeypox virus infection by specifically silencing the cell surface-binding protein E8L. Our research lays the foundation for future endeavors in genome-level therapies. It can potentially create chemically produced RNA molecules as effective antiviral drugs targeting Monkeypox virus infection. These findings contribute to advancing therapeutic strategies and offer new avenues for combating the spread of MPV, particularly in regions affected by the multi-country outbreak.

Epidemiological and Clinical Characteristics of Mpox in Cisgender and Transgender Women and Non-Binary Individuals Assigned to the Female Sex at Birth: A Comprehensive, Critical Global Perspective.

The 2022-2023 Mpox multi-country outbreak, identified in over 110 WHO Member States, revealed a predominant impact on cisgender men, particularly those engaging in sex with men, while less frequently affecting women. This disparity prompted a focused investigation into the gender-specific characteristics of Mpox infections, particularly among women, to address a notable knowledge gap. This review systematically gathers and analyzes the scientific literature and case reports concerning Mpox infections in women, covering a broad geographical spectrum including regions such as Argentina, Brazil, Colombia, Nigeria, Europe, Vietnam, and the United States. The analysis delves into various aspects of Mpox in women, including clinical features, epidemiology, psychological impacts, preparedness strategies, and case studies, with particular attention to pregnant women and those with underlying health conditions. Empirical data from multiple studies underscore the unique epidemiological and clinical patterns of Mpox in women. In the United States, a small percentage of Mpox cases were reported among cisgender women, with a notable portion involving non-Hispanic Black or African American, non-Hispanic White, and Hispanic or Latino ethnicities. The primary transmission route was identified as sexual or close intimate contact, with the virus predominantly manifesting on the legs, arms, and genital areas. Further, a study in Spain highlighted significant disparities in diagnosis delays, transmission modes, and clinical manifestations between genders, indicating a different risk profile and disease progression in women. Additionally, a case from Vietnam, linked to a new Mpox sub-lineage in women, emphasized the role of women in the transmission dynamics and the importance of genomic monitoring. This review emphasizes the necessity for inclusive surveillance and research to fully understand Mpox dynamics across diverse population groups, including women. Highlighting gender and sexual orientation in public health responses is crucial for an effective approach to managing the spread and impact of this disease. The findings advocate for a gender-diverse assessment in health services and further research to explore the nuances of Mpox transmission, behavior, and progression among different groups, thereby enhancing the global response to Mpox and similar public health challenges.

Genomic and transcriptomic analysis of the recent Mpox outbreak

The Mpox (formerly named Monkeypox) virus is the etiological cause of a recent multi-country outbreak, with thousands of distinct cases detected outside the endemic areas of Africa as of December 2023. In this article, we analyze the sequences of full genomes of Mpox virus from Europe and compare them with all available Mpox sequences of historical relevance, annotated by year and geographic origin, as well as related Cowpox and Variola (smallpox) virus sequences. Our results show that the recent outbreak is most likely originating from the West African clade of Mpox, with >99 % sequence identity with sequences derived from historical and recent cases, dating from 1971 to 2017. We analyze specific mutations occurring in viral proteins between the current outbreak, previous Mpox and Cowpox sequences, and the historical Variola virus. Genome-wide sequence analysis of the recent outbreak and other Mpox/Cowpox/Variola viruses shows a very high conservation, with 97.9 % (protein-based) and 97.8 % (nucleotide-based) sequence identity. We identified significant correlation in human transcriptional responses as well, with a conserved immune pathway response induced in human cell cultures by the three families of Pox virus. The similarities identified between the major strains of Pox viruses, as well as within the Mpox clades, both at the genomic and transcriptomic levels, provide a molecular basis for the observed efficacy of Variola vaccines in other Poxviruses.