1887
Outbreaks Open Access
Like 0

Abstract

In early May 2022, a global outbreak of mpox started among persons without travel history to regions known to be enzootic for monkeypox virus (MPXV). On 8 August 2022, the Netherlands reported its 1,000th mpox case, representing a cumulative incidence of 55 per million population, one of the highest cumulative incidences worldwide. We describe characteristics of the first 1,000 mpox cases in the Netherlands, reported between 20 May and 8 August 2022, within the context of the public health response. These cases were predominantly men who have sex with men aged 31–45 years. The vast majority of infections were acquired through sexual contact with casual partners in private or recreational settings including LGBTQIA+ venues in the Netherlands. This indicates that, although some larger upsurges occurred from point-source and/or travel-related events, the outbreak was mainly characterised by sustained transmission within the Netherlands. In addition, we estimated the protective effect of first-generation smallpox vaccine against moderate/severe mpox and found a vaccine effectiveness of 58% (95% CI: 17–78%), suggesting moderate protection against moderate/severe mpox symptoms on top of any possible protection by this vaccine against MPXV infection and disease. Communication with and supporting the at-risk population in following mitigation measures remains essential.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.12.2200772
2023-03-23
2024-02-29
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.12.2200772
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/12/eurosurv-28-12-4.html?itemId=/content/10.2807/1560-7917.ES.2023.28.12.2200772&mimeType=html&fmt=ahah

References

  1. Vivancos R, Anderson C, Blomquist P, Balasegaram S, Bell A, Bishop L, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill. 2022;27(22):2200422.  https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200422  PMID: 35656834 
  2. World Health Organization (WHO). Multi-country monkeypox outbreak in non-endemic countries: Update. Geneva: WHO; 2022. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388
  3. European Centre for Disease Prevention and Control (ECDC). Risk assessment. Monkeypox multi-country outbreak. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/risk-assessment-monkeypox-multi-country-outbreak
  4. Vaughan AM, Cenciarelli O, Colombe S, Alves de Sousa L, Fischer N, Gossner CM, et al. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill. 2022;27(36):2200620.  https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620  PMID: 36082686 
  5. Mathieu E, Spooner F, Dattani S, Ritchie H, Roser M. Mpox (monkeypox). OurWorldInData.org. [Accessed: 24 Aug 2022]. Available from: https://ourworldindata.org/monkeypox
  6. Statistics Netherlands (CBS). Leeftijdsverdeling. Hoe ziet de leeftijdsopbouw van de Nederlandse bevolking eruit? [Age distribution – What is the age structure of the Dutch population?]. The Hague: CBS. [Accessed: 9 Jan 2023]. Dutch. Available from: https://www.cbs.nl/nl-nl/visualisaties/dashboard-bevolking/leeftijd/bevolking
  7. Dutch National Institute of Public Health and the Evironment (RIVM). Pokken. [Smallpox]. Bilthoven: RIVM; 2020. Dutch. Available from: https://www.rivm.nl/pokken
  8. World Health Organisation (WHO). History of smallpox vaccination. Geneva: WHO. [Accessed: 9 Jan 2023]. Available from: https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-smallpox-vaccination
  9. Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID. Smallpox and its eradication. Geneva: World Health Organisation; 1988. 1460 p. Available from: https://apps.who.int/iris/handle/10665/39485
  10. Zaeck LM, Lamers MM, Verstrepen BE, Bestebroer TM, van Royen ME, Götz H, et al. Low levels of monkeypox virus-neutralizing antibodies after MVA-BN vaccination in healthy individuals. Nat Med. 2023;29(1):270-8.  https://doi.org/10.1038/s41591-022-02090-w  PMID: 36257333 
  11. Li Y, Zhao H, Wilkins K, Hughes C, Damon IK. Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA. J Virol Methods. 2010;169(1):223-7.  https://doi.org/10.1016/j.jviromet.2010.07.012  PMID: 20643162 
  12. Maksyutov RA, Gavrilova EV, Shchelkunov SN. Species-specific differentiation of variola, monkeypox, and varicella-zoster viruses by multiplex real-time PCR assay. J Virol Methods. 2016;236:215-20.  https://doi.org/10.1016/j.jviromet.2016.07.024  PMID: 27477914 
  13. Schroeder K, Nitsche A. Multicolour, multiplex real-time PCR assay for the detection of human-pathogenic poxviruses. Mol Cell Probes. 2010;24(2):110-3.  https://doi.org/10.1016/j.mcp.2009.10.008  PMID: 19879351 
  14. Statistics Netherlands (CBS). Migratieachtergrond. [Migration background]. The Hague: CBS. [Accessed: 9 Jan 2023]. Dutch. Available from: https://www.cbs.nl/nl-nl/onze-diensten/methoden/begrippen/migratieachtergrond
  15. van de Kassteele J, Eilers PHC, Wallinga J. Nowcasting the number of new symptomatic cases during infectious disease outbreaks using constrained P-spline smoothing. Epidemiology. 2019;30(5):737-45.  https://doi.org/10.1097/EDE.0000000000001050  PMID: 31205290 
  16. Tutu van Furth AM, van der Kuip M, van Els AL, Fievez LCR, van Rijckevorsel GGC, van den Ouden A, et al. Paediatric monkeypox patient with unknown source of infection, the Netherlands, June 2022. Euro Surveill. 2022;27(29):2200552.  https://doi.org/10.2807/1560-7917.ES.2022.27.29.2200552  PMID: 35866435 
  17. Dutch National Institute of Public Health and the Evironment (RIVM). Welke infectieziekten zijn meldingsplichtig? [Which infectious diseases are notifiable?]. Bilthoven: RIVM. [Accessed: 19 Aug 2022]. Dutch. Available from: https://www.rivm.nl/meldingsplicht-infectieziekten/welke-infectieziekten-zijn-meldingsplichtig
  18. Dutch Ministry of Health, Welfare and Sport. Kamerbrief over stand van zaken apenpokkenvirus. [Letter to the parliament on the current situation of monkeypox]. The Hague: Rijksoverheid; 2022. Dutch. Available from: https://www.rijksoverheid.nl/documenten/kamerstukken/2022/07/07/kamerbrief-over-stand-van-zaken-apenpokken
  19. Dutch National Institute of Public Health and the Evironment (RIVM). Infacts en Labinfact. [Direct messaging services]. Bilthoven: RIVM. [Accessed: 26 Sep 2022]. Dutch. Available from: https://www.rivm.nl/surveillance-van-infectieziekten/signalering-infectieziekten/infact-en-labinfact
  20. Dutch National Institute of Public Health and the Evironment (RIVM). Signaleringsoverleg Infectieziekten. [Early Warning Meeting]. Bilthoven: RIVM. [Accessed: 26 Sep 2022]. Dutch. Available from: https://www.rivm.nl/surveillance-van-infectieziekten/signalering-infectieziekten/signaleringsoverleg
  21. Dutch National Institute of Public Health and the Evironment (RIVM). Mpox Richtlijn. [Mpox directive]. Bilthoven: RIVM. [Accessed: 29 Sep 2022]. Dutch. Available from: https://lci.rivm.nl/richtlijnen/monkeypox-apenpokken
  22. SOA AIDS Nederland. Uitbreiding voorlichtingscampagne monkeypox. [Spread of mpox information campaign]. Ansterdam: Soa Aids Nederland; 2022. Dutch. Available from: https://www.soaaids.nl/nl/professionals/nieuws-en-standpunten/nieuwsbericht/uitbreiding-voorlichtingscampagne-monkeypox
  23. Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022;22(8):1153-62.  https://doi.org/10.1016/S1473-3099(22)00228-6  PMID: 35623380 
  24. Selb R, Werber D, Falkenhorst G, Steffen G, Lachmann R, Ruscher C, et al. A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022. Euro Surveill. 2022;27(27):2200499.  https://doi.org/10.2807/1560-7917.ES.2022.27.27.2200499  PMID: 35801518 
  25. Perez Duque M, Ribeiro S, Martins JV, Casaca P, Leite PP, Tavares M, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill. 2022;27(22):2200424.  https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200424  PMID: 35656830 
  26. de Vries HJ, Götz HM, Bruisten S, van der Eijk AA, Prins M, Oude Munnink BB, et al. Human Monkeypox Virus outbreak among Men who have Sex with Men in Amsterdam and Rotterdam, the Netherlands: no evidence for undetected transmission prior to May 2022 in a retrospective study. medRxiv. 2022:2022.11.19.22282179 . https://doi.org/10.1101/2022.11.19.22282179 
  27. World Health Organisation (WHO). Monkeypox. Geneva: WHO; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/monkeypox
  28. European Centre for Disease Prevention and Control (ECDC). Factsheet for health professionals on mpox (monkeypox). Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals
  29. European Centre for Disease Prevention and Control (ECDC)/World Health Organisation Regional Office for Europe (WHO/Europe). Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin. Stockholm/Copenhagen: ECDC/WHO/Europe; 2022. Available from: https://monkeypoxreport.ecdc.europa.eu
  30. Centers for Disease Control and Prevention (CDC). ACAM2000 Vaccine. Atlanta: CDC; 2022. Available from: https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/acam2000-vaccine.html
  31. Jezek Z, Grab B, Szczeniowski MV, Paluku KM, Mutombo M. Human monkeypox: secondary attack rates. Bull World Health Organ. 1988;66(4):465-70. PMID: 2844429 
  32. Pittman PR, Hahn M, Lee HS, Koca C, Samy N, Schmidt D, et al. Phase 3 efficacy trial of modified vaccinia Ankara as a vaccine against smallpox. N Engl J Med. 2019;381(20):1897-908.  https://doi.org/10.1056/NEJMoa1817307  PMID: 31722150 
  33. De Baetselier I, Van Dijck C, Kenyon C, Coppens J, Michiels J, de Block T, et al. Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium. Nat Med. 2022;28(11):2288-92.  https://doi.org/10.1038/s41591-022-02004-w  PMID: 35961373 
/content/10.2807/1560-7917.ES.2023.28.12.2200772
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error