Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study

Alvaro Furtado Costa; Simone Queiroz Rocha; Mylva Fonsi; Roberta Schiavon Nogueira; Artur Olhovetchi Kalichman; José Valdez Ramalho Madruga; Maria Clara Gianna; Rosa de Alencar Souza; Rosangela Rodrigues; Angela Tayra; Lucas Rocker Ramos; Roberto José Carvalho da Silva; Ana Marli Christovam Sartori; Walkiria Delnero Almeida Prado; Adriano Abbud; Mariza Vono Tancredi; Mpox-CRT working group

doi:10.1016/j.ijregi.2023.11.017

Clinical and epidemiological features of mpox in a Brazilian reference center for HIV and sexually transmitted infections: A cross-sectional study

IJID Reg. 2023 Nov 27:10:114-122. doi: 10.1016/j.ijregi.2023.11.017. eCollection 2024 Mar.

Authors

Alvaro Furtado Costa¹, Simone Queiroz Rocha¹, Mylva Fonsi¹, Roberta Schiavon Nogueira¹, Artur Olhovetchi Kalichman¹, José Valdez Ramalho Madruga¹, Maria Clara Gianna¹, Rosa de Alencar Souza¹, Rosangela Rodrigues¹, Angela Tayra¹, Lucas Rocker Ramos¹, Roberto José Carvalho da Silva¹, Ana Marli Christovam Sartori², Walkiria Delnero Almeida Prado³, Adriano Abbud⁴, Mariza Vono Tancredi¹; Mpox-CRT working group

Affiliations

¹ Centro de Referência e Treinamento DTS/Aids, São Paulo (SP), Brazil.
² Departamento de Moléstias Infecciosas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil.
³ Centro de Informações Estratégicas em Vigilância em Saúde do Centro de Vigilância Epidemiológica de São Paulo, São Paulo (SP), Brazil.
⁴ Instituto Adolfo Lutz, São Paulo (SP), Brazil.

Abstract

Background: The 2022 mpox outbreak has affected disproportionately people living with HIV (PLWH) and pre-exposure prophylaxis (PrEP) users.

Methods: We conducted a cross-sectional study to evaluate factors associated with laboratory diagnosis of mpox among suspected cases, and access differences between PrEP users and PLWH with confirmed diagnostic.

Results: 394 mpox suspected cases were analyzed, 309 (78.4%) confirmed. Most patients with mpox were PLWH (54.4%) and 99 (32%) PrEP users. Mpox cases were likely to be between 25 and 39 years old (aOR=2.8; p=0.042), men who have sex with men/bisexual or transgender women (aOR=17.2; p< 0.001) and to have fever (aOR=4.7; p< 0.001), adenomegaly (aOR=7.2; p< 0.001) and multiple vesicular lesions (aOR=4.2; p< 0.001). Comparing PrEP users to PLWH with confirmed mpox, PrEP users had lesions predominantly with exclusive genital involvement (p=0.016); while PLWH had higher extragenital involvement (p=0.018).

Conclusions: PrEP users and PLWHA were the main epidemiological groups in our cohort. Recognizing the differences between vulnerable populations can contribute to the development public policies to control mpox in settings with reduced access to vaccines.