Emerging Microbes and Infections (Oct 2024)
Viral genetics and transmission dynamics in the second wave of mpox outbreak in Portugal and forecasting public health scenarios
- Rita Cordeiro,
- Constantino P. Caetano,
- Daniel Sobral,
- Rita Ferreira,
- Luís Coelho,
- Ana Pelerito,
- Isabel Lopes de Carvalho,
- Sónia Namorado,
- Dinis B. Loyens,
- Ricardo Mexia,
- Cândida Fernandes,
- José Miguel Neves,
- Ana Luísa João,
- Miguel Rocha,
- Luís Miguel Duque,
- Inês Correia,
- Teresa Baptista,
- Cláudia Brazão,
- Diogo Sousa,
- Paulo Filipe,
- Miguel Alpalhão,
- Fernando Maltez,
- Diana Póvoas,
- Raquel Pinto,
- João Caria,
- Rita Patrocínio de Jesus,
- Patrícia Pacheco,
- Francesca Peruzzu,
- Josefina Méndez,
- Luís Ferreira,
- Kamal Mansinho,
- João Vaz Alves,
- Joana Vasconcelos,
- João Domingos,
- Sara Casanova,
- Frederico Duarte,
- Maria João Gonçalves,
- Mafalda Brito Salvador,
- Mafalda Andresen Guimarães,
- Sueila Martins,
- Marvin Silva Oliveira,
- Daniela Santos,
- Luís Vieira,
- Maria Sofia Núncio,
- Vítor Borges,
- João Paulo Gomes
Affiliations
- Rita Cordeiro
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Constantino P. Caetano
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Daniel Sobral
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Rita Ferreira
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Luís Coelho
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Ana Pelerito
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Isabel Lopes de Carvalho
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Sónia Namorado
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Dinis B. Loyens
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Ricardo Mexia
- Department of Epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Cândida Fernandes
- Serviço de Dermatovenereologia, Consulta de DST, Unidade Local de Saúde de São José, Lisbon, Portugal.
- José Miguel Neves
- Serviço de Dermatovenereologia, Consulta de DST, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Ana Luísa João
- Serviço de Dermatovenereologia, Consulta de DST, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Miguel Rocha
- GAT - Grupo de Ativistas em Tratamentos, GAT-CheckpointLX, Lisbon, Portugal.
- Luís Miguel Duque
- GAT - Grupo de Ativistas em Tratamentos, GAT-CheckpointLX, Lisbon, Portugal.
- Inês Correia
- GAT - Grupo de Ativistas em Tratamentos, GAT-Intendente, Lisbon, Portugal.
- Teresa Baptista
- GAT - Grupo de Ativistas em Tratamentos, GAT-Intendente, Lisbon, Portugal.
- Cláudia Brazão
- Dermatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
- Diogo Sousa
- Dermatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
- Paulo Filipe
- Dermatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
- Miguel Alpalhão
- Dermatology Department, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
- Fernando Maltez
- Institute of Environmental Health, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
- Diana Póvoas
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Raquel Pinto
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Unidade Local de Saúde de São José, Lisbon, Portugal.
- João Caria
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Rita Patrocínio de Jesus
- Serviço de Infeciologia, Hospital Professor Doutor Fernando Fonseca, Unidade Local de Saúde Amadora/Sintra, Amadora, Portugal.
- Patrícia Pacheco
- Serviço de Infeciologia, Hospital Professor Doutor Fernando Fonseca, Unidade Local de Saúde Amadora/Sintra, Amadora, Portugal.
- Francesca Peruzzu
- Serviço de Infeciologia, Hospital Professor Doutor Fernando Fonseca, Unidade Local de Saúde Amadora/Sintra, Amadora, Portugal.
- Josefina Méndez
- Serviço de Doenças Infecciosas, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
- Luís Ferreira
- Serviço de Doenças Infecciosas, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
- Kamal Mansinho
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital de Egas Moniz, Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal.
- João Vaz Alves
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital de Egas Moniz, Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal.
- Joana Vasconcelos
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- João Domingos
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital de Egas Moniz, Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal.
- Sara Casanova
- Serviço de Doenças Infecciosas e Medicina Tropical, Hospital de Egas Moniz, Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal.
- Frederico Duarte
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
- Maria João Gonçalves
- Serviço de Doenças Infeciosas, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
- Mafalda Brito Salvador
- Unidade de Doenças Sexualmente Transmissíveis, Unidade de Cuidados de Saúde Personalizados da Lapa, Unidade Local de Saúde de São José, Lisbon, Portugal.
- Mafalda Andresen Guimarães
- PPCIRA, Unidade de Tratamento de Imunodeficiência, Hospital de Cascais, Lisboa, Portugal.
- Sueila Martins
- UL-PPCIRA, Unidade Local de Saúde Trás-os-Montes e Alto Douro, Vila Real, Portugal.
- Marvin Silva Oliveira
- Serviço de Patologia Clínica, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal.
- Daniela Santos
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Luís Vieira
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Maria Sofia Núncio
- Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- Vítor Borges
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
- João Paulo Gomes
- Genomics and Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
Abstract
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 Monkeypox virus (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).
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