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A genomic and epidemiologic analysis of data from the 2022 mpox outbreak estimates that 1.3% of men who have sex with men (MSM) in Portugal were infected. 

Led by researchers from Portugal’s national institute of health, the study involved the sequencing of 54.2% of the country’s 495 confirmed mpox cases. Viral samples were obtained from May 4 to September 16, 2022.

Among the 447 patients with demographic data, 99.1% were men, 96.5% were MSM, 44.1% were aged 30 to 39 years, 28.4% were aged 20 to 29, and 20.4% were 40 to 49. A total of 42.9% of the patients with HIV information (168 of 392) were HIV-positive.

Sex networks, saunas fed mpox spread

Portugal was one of the first countries to report mpox cases in 2022. An estimated 62% of the country’s cases were reported, and 1.3% of MSM were infected. Sexual networks and superspreader gatherings such as at saunas played a critical role in mpox spread.

In April, the R_t (expected number of infections caused by an infected person in a population in which some people might be immune) was 2.25, peaking at 2.70 in May. In total, 182 genetic subclusters were identified globally, with 78.3% including at least two Portuguese sequences, which made up 66.6% of sequences from Portugal. There was a link between travel-related countries and those with a high percentage of sequences in Portuguese subclusters.

Our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Of the 399 cases with information on probable transmission routes, 95.2% identified sexual contact, 3.3% cited nonsexual contact, and 0.5% reported healthcare-associated spread.

“Our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population,” the study authors wrote.

The global mpox outbreak began in May 2022, with 88,600 confirmed infections and 152 deaths reported in 113 countries across all world regions by August 2, 2023. As of January 10, 2023, 951 mpox cases had been confirmed in Portugal.