Viral genetics and transmission dynamics in the second wave of mpox outbreak in Portugal and forecasting public health scenarios
In 2023, a second wave of the global mpox epidemic, which is mainly affecting men who have sex with men (MSM), was observed in some countries. Herein, we benefited from a large viral sequence sampling (76/121; 63%) and vast epidemiological data to characterise the re-emergence and circulation of the <i>Monkeypox virus</i> (MPXV) in Portugal during 2023. We also modelled transmission and forecasted public health scenarios through a compartmental susceptible-exposed-infectious-recovered (SEIR) model. Our results suggest that the 2023 mpox wave in Portugal resulted from limited introduction(s) of MPXV belonging to C.1.1 sublineage, hypothetically from Asia, followed by sustained viral transmission and potential exportation to other countries. We estimated that the contribution of the MSM high sexual activity group to mpox transmission was 120 (95% CrI: 30-3553) times higher than that of the low sexual activity group. However, among the high sexual activity group, vaccinated individuals likely contributed approximately eight times less [0.123 (95% CrI: 0.068-0.208)] than the unvaccinated ones. Vaccination was also linked to potential reduced disease severity, with a Mpox Severity Score of 6.0 in the vaccinated group compared to 7.0 in unvaccinated individuals. Scenario analysis indicated that transmission is highly sensitive to sexual behaviour, projecting that a slight increase in the MSM sub-population with high sexual activity can trigger new mpox waves. This study strongly supports that continued vaccination, targeted awareness among risk groups and routine genomic epidemiology is needed to anticipate and respond to novel MPXV threats (e.g. global dissemination of clade I viruses).
Authors
- Luís Vieira
- Inês R. Correia (ORCID: https://orcid.org/0000-0002-3246-8965)
- Miguel Rocha (ORCID: https://orcid.org/0000-0003-1057-2419)
- Diogo de Sousa (ORCID: https://orcid.org/0000-0002-5415-887X)
- João Caria (ORCID: https://orcid.org/0000-0002-7798-7064)
- Raquel Pinto (ORCID: https://orcid.org/0000-0002-8168-4023)
- José Neves (ORCID: https://orcid.org/0000-0002-9014-2031)
- Rita Cordeiro (ORCID: https://orcid.org/0000-0001-5321-3657)
- Sónia Namorado (ORCID: https://orcid.org/0000-0002-7500-8811)
- Vítor Borges (ORCID: https://orcid.org/0000-0003-3767-2209)
- Isabel Lopes de Carvalho (ORCID: https://orcid.org/0000-0002-4693-3952)
- Miguel Alpalhão (ORCID: https://orcid.org/0000-0001-7672-0395)
- Ana Luísa João (ORCID: https://orcid.org/0000-0002-2489-0138)
- Ricardo Mexía (ORCID: https://orcid.org/0000-0002-0511-7940)
- Rita Patrocínio de Jesus (ORCID: https://orcid.org/0000-0001-5181-9305)
- Fernando Maltêz (ORCID: https://orcid.org/0000-0001-5828-7727)
- João Paulo Gomes (ORCID: https://orcid.org/0000-0002-2697-2399)
- Patrícia Pacheco (ORCID: https://orcid.org/0000-0003-4165-971X)
- Sara Casanova (ORCID: https://orcid.org/0000-0002-1651-583X)
- João Domingos (ORCID: https://orcid.org/0000-0002-8277-6288)
- Dinis Loyens
- Frederico Duarte (ORCID: https://orcid.org/0000-0001-6714-1594)
- Ana Pelerito (ORCID: https://orcid.org/0000-0003-4770-9079)
- Maria Sofia Núncio (ORCID: https://orcid.org/0000-0001-5182-6150)
- Luís Miguel Duque
- Daniel Sobral (ORCID: https://orcid.org/0000-0003-3955-0117)
- Cândida Fernandes (ORCID: https://orcid.org/0000-0003-2913-2536)
- Constantino Caetano (ORCID: https://orcid.org/0000-0002-6569-7772)
- Francesca Peruzzu
- Rita Ferreira (ORCID: https://orcid.org/0000-0002-0016-7543)
- Claúdia Brazão (ORCID: https://orcid.org/0000-0002-4485-7124)
- Luís Ferreira (ORCID: https://orcid.org/0000-0002-0292-8270)
- Maria João Gonçalves (ORCID: https://orcid.org/0000-0002-9742-4007)
- Luís Coelho (ORCID: https://orcid.org/0009-0007-0488-7912)
- J Mendez (ORCID: https://orcid.org/0000-0001-5786-3809)
- Joana Vasconcelos (ORCID: https://orcid.org/0000-0001-5444-4350)
- Teresa Baptista (ORCID: https://orcid.org/0009-0006-6191-6428)
- Paulo Filipe (ORCID: https://orcid.org/0000-0001-6917-527X)
- Diana Póvoas (ORCID: https://orcid.org/0000-0003-4531-2123)
- Sueila Martins
- Kamal Mansinho
- Mafalda Brito Salvador
- Marvin Silva Oliveira
- João Vaz Alves
- Daniela dos Santos (ORCID: https://orcid.org/0000-0002-9865-4883)
- Mafalda Andresen Guimarães
Institutions
- University of Lisbon (PT)
- University of Trás-os-Montes and Alto Douro (PT)
- Hospital Prof. Dr. Fernando Fonseca (PT)
- Hospital de Egas Moniz (PT)
- Hospital Pedro Hispano (PT)
- Administração Regional de Saúde de Lisboa e Vale do Tejo (PT)
- Centro Hospitalar do Tâmega e Sousa (PT)
- Centro Hospitalar de Lisboa Ocidental (PT)
- Hospital de Santo António (PT)
- Hospital Curry Cabral (PT)
- Check Point (Israel) (IL)
- National Institute of Health Dr. Ricardo Jorge (PT)
- Hospital Garcia de Orta (PT)
- Centro Hospitalar do Porto (PT)
- Instituto Gulbenkian de Ciência (PT)
- Altice Portugal (Portugal) (PT)
- Universidade Lusófona (PT)
Publication Details
- Journal
- Emerging Microbes & Infections
- Published
- 2024-10-03
- DOI
- https://doi.org/10.1080/22221751.2024.2412635
- Citations
- 6
- Primary Topic
- Poxvirus research and outbreaks
- Type
- article
- Field-Weighted Citation Impact
- 1.76
Funders
- European Commission