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Current Epidemic of Mpox

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A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Epidemiology of Infectious Diseases".

Deadline for manuscript submissions: closed (15 January 2024) | Viewed by 11909

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Dr. Valentina Mazzotta

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Guest Editor

National Institute for Infectious Diseases “Lazzaro Spallanzani” (IRCCS), 00149 Rome, Italy
Interests: Mpox; SARS-CoV-2; HIV; therapies; vaccination

Special Issue Information

Dear Colleagues,

Since May 2022, we have been in the midst of a global outbreak of Mpox (formerly monkeypox) involving more than 110 countries around the world, which was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) in July 2022.

The current epidemic has already been described as different from previous cases reported mostly in Central and Western Africa; in particular, the transmission was predominantly through sexual contact, and the most involved population was self-defined gay and bisexual men who have sex with men (GBMSM).

Although progress in knowledge of the disease in this new context is increasing, there many poorly defined aspects, such as the predictors of worse outcomes, peculiar clinical presentation in specific subpopulations (e.g., immunosuppressed, HIV), virological characterization and evolution, entity and durability of the post-infection immune response, and effectiveness of currently approved treatments.

Post- and pre-exposure vaccination was recommended by the WHO, and vaccination campaigns started around the world. Clinical efficacy and immunological response to vaccination are partially known, and the correlates of protection need to be identified.

Dr. Valentina Mazzotta
Guest Editor

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Keywords

Mpox
immune response
clinical presentation
therapies
vaccination

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Published Papers (7 papers)

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18 pages, 626 KiB

Open AccessEditor’s ChoiceArticle

Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC

by Elisabeth W. Andersen, Paige Kulie, Amanda D. Castel, Jose Lucar, Debra Benator, Alan E. Greenberg and Anne Monroe

Pathogens 2024, 13(2), 124; https://doi.org/10.3390/pathogens13020124 - 28 Jan 2024

Cited by 2 | Viewed by 1657

Abstract

People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

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10 pages, 238 KiB

Open AccessArticle

Characterizing Indicators of Engagement in HIV-Associated Healthcare and Clinical Outcomes among People with HIV and Mpox in Washington, DC: A Nested Case-Control Study of the DC Cohort

by Lauren F. O’Connor, Morgan Byrne, Anuja Baskaran, Elisabeth W. Andersen, Michael A. Horberg, Debra A. Benator, Jose Lucar, Rachel V. Denyer, Rachel Lee, Amanda D. Castel and Anne K. Monroe

Pathogens 2024, 13(2), 117; https://doi.org/10.3390/pathogens13020117 - 27 Jan 2024

Cited by 1 | Viewed by 1362

Abstract

The high proportion of people with HIV (PWH) in the 2022–2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

12 pages, 2410 KiB

Open AccessArticle

Serosurvey of Immunity to Monkeypox (Mpox) Virus Antigens in People Living with HIV in South Florida

by Jonah Kupritz, Savita Pahwa and Suresh Pallikkuth

Pathogens 2023, 12(11), 1355; https://doi.org/10.3390/pathogens12111355 - 15 Nov 2023

Cited by 2 | Viewed by 2191

Abstract

Mpox is an infectious disease caused by the monkeypox virus (MPXV) belonging to the Orthopoxvirus (OPXV) genus, which includes smallpox and vaccinia virus (VACV). A global mpox outbreak which began in May 2022 has infected more than 88,000 people. VACV-based vaccines provide protection against mpox disease but complicate the use of serological assays for disease surveillance. We tested the reactivity of serum IgG from Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN)-vaccinated (n = 12) and convalescent mpox-infected (n = 5) individuals and uninfected, non-vaccinated controls (n = 32) to MPXV/VACV proteins A27, A29, A30, A35, B16, B21, C19, D6, E8, H3, I1, and L1. Using a subset of MPXV antigen-based assays (A35, B16, E8, H3, and I1), we conducted a mpox antibody survey of serum from 214 individuals, including 117 (54.7%) people with HIV (PWH) collected between June 2022 and January 2023, excluding individuals who reported recent mpox vaccination or infection, and 32 young, pre-pandemic controls. The convalescent sera reacted strongly to most tested antigens. Vaccine sera responses were limited to A35, E8, H3, and I1. IgG antibody to E8 was markedly elevated in all vaccinated individuals. B16 IgG showed high sensitivity (100% [95% CI: 56.55–100.0%]) and specificity (91.67% [64.61–99.57%]) for distinguishing infection from MVA-BN vaccination, while E8 IgG showed 100% [75.75–100] sensitivity and 100% [79.61–100] specificity for detecting and distinguishing vaccinated individuals from controls. We identified 11/214 (5.1%) recent serum samples and 1/32 (3.1%) young, pre-pandemic controls that were seropositive for ≥2 MPXV antibodies, including 6.8% of PWH. Seropositivity was 10/129 (7.8%) among males compared to 1/85 (1.2%) among females. Our findings provide insight into the humoral immune response to mpox and demonstrate the usefulness of inexpensive, antigen-based serosurveillance in identifying asymptomatic or unreported infections. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

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11 pages, 505 KiB

Open AccessArticle

Mpox Outbreak 2022: A Comparative Analysis of the Characteristics of Individuals Receiving MVA-BN Vaccination and People Diagnosed with Mpox Infection in Milan, Italy

by Flavia Passini, Angelo Roberto Raccagni, Sara Diotallevi, Riccardo Lolatto, Elena Bruzzesi, Caterina Candela, Costanza Bertoni, Benedetta Trentacapilli, Maria Francesca Lucente, Antonella Castagna and Silvia Nozza

Pathogens 2023, 12(9), 1079; https://doi.org/10.3390/pathogens12091079 - 24 Aug 2023

Cited by 1 | Viewed by 1347

Abstract

Mpox caused a worldwide outbreak in 2022, disproportionately affecting MSM reporting high-risk sexual behaviors. The aim of this study was to compare the characteristics of people receiving MVA-BN vaccination with those of individuals diagnosed with mpox to guide future vaccination policies. This was a retrospective study on people with mpox infection or vaccination at San Raffaele Scientific Institute, Milan, Italy, from May to November 2022. Characteristics were compared using Mann–Whitney or chi-square/Fisher’s exact tests; multivariable logistic regression and classification tree analysis were applied. Overall, 473 vaccinated individuals and 135 with mpox were included; 472/473 and 134/135 were MSM. People with mpox were more frequently living with HIV (48.9% vs. 22.4%, p < 0.001), had ≥1 previous STI (75.6% vs. 35.7%, p < 0.001), were chemsex users (37.8% vs. 6.34%, p < 0.001), were with a higher number of partners (23.0% vs. 1.69%, p < 0.001), and had engaged in group sex (55.6% vs. 24.1%, p < 0.001). At multivariable analysis, PLWH (aOR = 2.86, 95%CI = 1.59–5.19, p < 0.001), chemsex users (aOR = 2.96, 95%CI = 1.52–5.79, p = 0.001), those with previous syphilis (aOR = 4.11, 95%CI = 2.22–7.72, p < 0.001), and those with >10 partners (aOR = 11.56, 95%CI = 6.60–21.09, p < 0.001) had a higher risk of infection. This study underscores the importance of prioritizing MSM with prior STIs and multiple partners as well as chemsex users in vaccination policies to curb mpox spread. A destigmatized assessment of sexual history is vital for comprehensive sexual health strategies. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

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6 pages, 183 KiB

Open AccessBrief Report

Mpox Virus in the Pharynx of Men Having Sex with Men: A Case Series

by Silvia Limonta, Giuseppe Lapadula, Luca Mezzadri, Laura Corsico, Francesca Rovida, Alice Ranzani, Fausto Baldanti and Paolo Bonfanti

Pathogens 2024, 13(1), 92; https://doi.org/10.3390/pathogens13010092 - 20 Jan 2024

Cited by 1 | Viewed by 1523

Abstract

The recent Mpox virus (MPV) outbreak in Europe and North America, primarily among men who have sex with men (MSM), raised concerns about various transmission sources. We examined patients with Mpox from an urban STI center in Lombardy, Italy, between May and August 2022. Demographic, transmission, and clinical data were collected using a standardized form. Initial and subsequent tests were conducted using the RealStar Orthopoxvirus PCR Kit 1.0 (Altona Diagnostics, Hamburg, Germany) for skin lesions and oropharyngeal swabs. A total of 15 patients were recruited, all MSM, with 40% being HIV-positive. Almost all reported recent unprotected sexual activity. Oropharyngeal symptoms were observed in a minority, and oral cavity lesions were present in 20% of cases. MPV DNA was detected in skin lesions of 93% of patients and in oropharyngeal swabs of 87%. Skin samples exhibited a higher viral load than pharyngeal samples, with the latter persisting longer. Prospective follow-up of 11 individuals revealed an average pharyngeal persistence of 5.3 days beyond skin lesion clearance, reaching up to 80 days in an immunosuppressed case. Our findings indicate that MPV replication can persist in the pharynx asymptomatically and for an extended period. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

8 pages, 642 KiB

Open AccessCase Report

A Case of Severe Mpox Complicated with Streptococcus pyogenes Sepsis in a Patient with HIV Infection

by Silvia Di Bari, Annalisa Mondi, Carmela Pinnetti, Valentina Mazzotta, Fabrizio Carletti, Giulia Matusali, Donatella Vincenti, Roberta Gagliardini, Raffaele Santoro, Carla Fontana, Fabrizio Maggi, Enrico Girardi, Francesco Vaia and Andrea Antinori

Pathogens 2023, 12(9), 1073; https://doi.org/10.3390/pathogens12091073 - 23 Aug 2023

Cited by 1 | Viewed by 1322

Abstract

Since May 2022, a global outbreak of human Mpox has rapidly spread in non-endemic countries. We report a case of a 34-year-old man admitted to hospital for a six-day history of fever associated with vesiculo-pustular rash involving the face, limbs, trunk and perianal region, lymphadenopathy and severe proctitis and pharyngitis. He was HIV-positive and virologically suppressed by stable antiretroviral therapy. On admission, Mpox virus-specific RT-PCR was positive from multiple samples. Additionally, blood cultures yielded Streptococcus pyogenes, prompting a 14-day-course of penicillin G and clindamycin. Due to the worsening of proctitis along with right ocular mucosa involvement, tecovirimat treatment was started with a rapid improvement in both skin and mucosal involvement. The patient was discharged after 21 days of hospitalization and the complete clinical resolution occurred 38 days after symptom onset. This is a case of Mpox with extensive multi-mucosal (ocular, pharyngeal and rectal) and cutaneous extension and S. pyogenes bacteraemia probably related to bacterial translocation from the skin or oral cavity that was eased by Mpox lesions/inflammation. The HIVinfection, although well controlled by antiretroviral therapy, could have played a role in the severe course of Mpox, suggesting the importance of a prompt antiviral treatment in HIV-positive patients. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

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11 pages, 887 KiB

Open AccessBrief Report

Detection of Asymptomatic Mpox Carriers among High-Ri Men Who Have Sex with Men: A Prospective Analysis

by Roberto Rossotti, Daniele Calzavara, Massimo Cernuschi, Federico D’Amico, Anna De Bona, Roberto Repossi, Davide Moschese, Simona Bossolasco, Alessandro Tavelli, Camilla Muccini, Giovanni Mulé and Antonella d’Arminio Monforte

Pathogens 2023, 12(6), 798; https://doi.org/10.3390/pathogens12060798 - 3 Jun 2023

Cited by 7 | Viewed by 1560

Abstract

Mpox is traditionally considered a zoonotic disease with endemic circulation in Africa, but the 2022–2023 outbreak reached an unprecedented high number of cases in non-endemic countries, so that it was declared a public health emergency of international concern. The reasons for this extensive global spread, characterized by sexual transmission amongst men who have sex with men (MSM), have not been fully clarified. The existence of asymptomatic carriers with viable viral shedding might be an explanation and is under-debated after retrospective studies suggested that infection without symptoms might have a prevalence of 6.5%. We aimed to prospectively assess the presence of mpox infection in asymptomatic high-risk MSM using HIV pre-exposure prophylaxis and living with HIV. We selected individuals with no signs of active infection nor suggestive symptoms in the previous 21 days. Eligible individuals collected oral and anal swabs to undergo point-of-care testing for mpox and completed a 21-days follow-up. Seventy-two individuals were enrolled, and none tested positive for mpox infection nor developed symptoms during follow-up. We selected a high-risk population with a significant history of sexual exposure, but we failed to detect any asymptomatic infection. This observation might have important consequences in terms of contact management and epidemic control. Full article

(This article belongs to the Special Issue Current Epidemic of Mpox)

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