The Lancet Regional Health. Americas (Jan 2023)

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from BrazilResearch in context

  • Mayara Secco Torres Silva,
  • Carolina Coutinho,
  • Thiago Silva Torres,
  • Eduardo Peixoto,
  • Ronaldo Ismério,
  • Flavia Lessa,
  • Estevão Portela Nunes,
  • Brenda Hoagland,
  • Amanda Dolores Echeverria Guevara,
  • Matheus Oliveira Bastos,
  • Isabel Cristina Ferreira Tavares,
  • Maria Pia Diniz Ribeiro,
  • Maria Roberta Meneguetti Seravalli Ramos,
  • Hugo Boechat Andrade,
  • Ana Paula Lovetro Santana,
  • Marilia Santini-Oliveira,
  • Juliana Barbosa Santos Netto,
  • Paula Reges,
  • Monica Avelar Magalhães,
  • Leonardo Azevedo Silva Rosadas,
  • Sandro Nazer,
  • Luciane Velasque,
  • Sandra Wagner Cardoso,
  • Edson Elias da Silva,
  • Valdilea Gonçalves Veloso,
  • Mayumi Duarte Wakimoto,
  • Beatriz Grinsztejn,
  • André Miguel Japiassu,
  • Marcel Trepow,
  • Italo Guariz Ferreira,
  • Larissa Villela,
  • Rafael Teixeira Fraga,
  • Mariah Castro de Souza Pires,
  • Rodrigo Otavio da Silva Escada,
  • Leonardo Paiva de Sousa,
  • Gabriela Lisseth Umaña Robleda,
  • Desirée Vieira Santos,
  • Luiz Ricardo Siqueira Camacho,
  • Pedro Amparo,
  • João Victor Jaegger de França,
  • Felipe de Oliveira Heluy Correa,
  • Bruno Ivanovinsky Costa de Sousa,
  • Bernardo Vicari do Valle,
  • João Paulo Bortot Soares,
  • Livia Cristina Fonseca Ferreira,
  • Pedro da Silva Martins,
  • Maira Braga Mesquita,
  • José Ricardo Hildebrant Coutinho,
  • Raissa de Moraes Perlingeiro,
  • Priscila Peixoto de Castro Oliveira,
  • Hugo Perazzo Pedroso Barbosa,
  • André Figueiredo Accetta,
  • Marcelo Cunha,
  • Rosangela Vieira Eiras,
  • Ticiana Martins dos Santos,
  • Wladmyr Davila da Silva,
  • Monique do Vale Silveira,
  • Tania de Souza Brum,
  • Guilherme Amaral Calvet,
  • Rodrigo Caldas Menezes,
  • Sandro Antônio Pereira

Journal volume & issue
Vol. 17
p. 100406

Abstract

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Summary: Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).

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