Behavior changes influence mpox transmission in the United States, 2022–2023: Insights from homogeneous and heterogeneous models

In 2022, an unprecedented mpox epidemic rapidly swept the globe, primarily transmitted through sexual contact among men who have sex with men (MSM). However, our understanding of how changes in human behavior influence this outbreak remains incomplete. In this study, we introduce a two-layer network model to investigate the impact of human behavior on mpox transmission within the United States during 2022-2023, leveraging surveillance data. We theoretically explore mpox transmission under behavioral changes using homogeneous and heterogeneous mean-field approximations. While the heterogeneous model captures differences in individual behavior, its variations do not significantly affect the overall spread, validating the feasibility of using only homogeneous models to study behavioral changes. Utilizing infection data, we exhibit the influence of behavior changes across varying transmission levels of mpox, emphasize the significant role of sexual behavior among MSM, and recommend enhancing surveillance of nonsexual cases to enable timely control of spread. Utilizing vaccination data, we demonstrate the critical impact of behavior changes on the transmission capacity of mpox virus, contrasting the limited effectiveness of vaccine campaigns. This study highlights the importance of human behavior in controlling the spread of future outbreaks, offering valuable insights for the strategic development of public health interventions aimed at mitigating such occurrences.