Public understanding and awareness of and response to monkeypox virus outbreak: A cross‐sectional survey of the most affected communities in the United Kingdom during the 2022 public health emergency

Informed, but uncertain: managing transmission risk and isolation in the 2022 mpox outbreak among gay and bisexual men in Australia

In 2022, a global outbreak of mpox (formerly 'monkeypox') emerged in non-endemic countries, including Australia, predominantly affecting gay, bisexual and other men who have sex with men. Public health advice on transmission and isolation emerged rapidly from different sources, sometimes conflicting and producing uncertainty. Using the concept of 'counterpublic health', which acknowledges the incorporation of official science and experiences of affected communities into embodied practice, this paper investigates how people affected by mpox in Australia managed risk of transmission and navigated self-isolation. In-depth interviews were conducted with 16 people: 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay and bisexual men living in Australia. Participants thought critically about public health advice, often finding it restrictive and unresponsive to the needs of people with mpox. Participants' decisions about reducing mpox risk and isolating often drew on experiences with other infections (i.e. HIV; COVID-19) and were made collaboratively with the people closest to them (e.g. partners, friends, family) to sustain relationships. Future public health responses to infectious disease outbreaks would benefit from identifying more opportunities to formalise and embed mechanisms to obtain feedback from affected communities so as to inform responses.

Dating apps as health allies? Examining the opportunities and challenges of dating apps as partners in public health

In recent years, dating apps have become important allies in public health. In this paper, we explore the implications of partnering with dating apps for health promotion. We consider the opportunities and challenges inherent in these collaborations, paying special attention to privacy, trust, and user care in a digital environment.Despite their potential as targeted health promotion tools, dating apps raise significant ethical concerns, including the commodification of user data and privacy breaches, which highlight the complexities of blending healthcare initiatives with for-profit digital platforms. Furthermore, the paper delves into issues of discrimination, harassment and unequal access within these apps, factors which can undermine public health efforts.We develop a nuanced framework, emphasising the development of transparent data policies, the decoupling of content moderation from health initiatives and a commitment to combat discrimination. We underscore the importance of embedding app-based health initiatives within broader care pathways, ensuring comprehensive support beyond the digital domain. This essay offers vital insights for public health practitioners, app developers and policymakers navigating the intersection of digital innovation and healthcare.

Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022

During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.

The 5 C model and Mpox vaccination behavior in Germany: a cross-sectional survey

BACKGROUND

Due to the authorization of the Mpox vaccines, we aimed to identify determinants of the intention to get vaccinated, actively trying to receive vaccination, and for successfully receiving a vaccination in Germany employing the 5 C model of vaccination readiness.

METHODS

Data stem from a cross-sectional online survey that was available online from August 13, 2022 to August 31, 2022. To assess the influence of the 5 C Model on vaccination behavior, we conducted a multinomial logistic regression.

RESULTS

3,338 participants responded to the survey, with 487 already vaccinated and 2,066 intending to receive a vaccination. Confidence and collective responsibility were positively associated with intention to get vaccinated, while complacency was negatively correlated. A higher score on the calculation scale increased the odds of intention to receive vaccination but not with actively having tried to receive a vaccination. Fewer perceived constraints were associated with higher odds to be vaccinated. Patients in practices that focus on HIV treatment were more likely to intend to get vaccinated, to have tried to get vaccinated and to be vaccinated, regardless of indication. While level of education had no impact, having an indication to get vaccinated was a strong predictor of vaccination behavior in all groups.

CONCLUSION

Future vaccination campaigns should aim to reduce specific constraints of the target group and make vaccines widely available in primary care institutions beyond HIV-focused practices.

Evaluation of the public policy impacts on Monkeypox in Brazil

Brazil ranked third in the number of Monkeypox infected worldwide in early September 2022 and eighth in multiple deaths. Brazilian Ministry of Health prepared a public policy to face the smallpox outbreak. This paper aims to analyze the governmental public policy' impacts on Monkeypox using survival analysis. The information in the database was collected from epidemiological bulletins on the official websites of the Brazilian Ministry of Health and the World Health Organization (WHO). The survival analysis with parametric statistical analysis, semiparametric with Cox regression, and nonparametric analysis were used. The inference of causality was perceived by the impact caused by the national public policy with the proportional reduction in the number of cases in the treatment group (Chi-sq = 117.783, p < 0.001), contrary to what was perceived in the control group, as well as survival about the time of the states that elaborated their plans based on what was made available by the government. The need to evaluate government projects should be within the scope of project management in Brazilian states and provide for more assertive decision-making in the fight against smallpox.

Mpox Illness Narratives: Stigmatising Care and Recovery During and After an Emergency Outbreak

In May 2022, a global outbreak of mpox (formerly monkeypox virus) affected thousands of mainly gay and bisexual men. Mpox is usually a time-limited illness that can involve fever, pain, and skin lesions, but may require hospitalisation. There is scant research into the firsthand experiences of people affected by mpox, including experiences of symptoms, healthcare, and recovery. This study considers the different illness narratives of people who experienced mpox in Australia in 2022. In-depth interviews and 6-month follow-up interviews were conducted with 16 people, including 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay or bisexual men living in Australia. Participants' accounts described minor to severe periods of sickness, negative and stigmatising experiences engaging with healthcare, and some participants experienced long-term effects on their sexual well-being and complications from mpox. The emergency outbreak context meant that mpox was highly distressing, making it difficult to manage and producing varying forms of disruption to everyday life. Mpox was narrated as disruptive in different ways: as a minor interruption to holiday plans, a prolonged period of poor health, or a biographically disruptive event prompting a re-evaluation of sexual values and health. This analysis demonstrates that an unfamiliar emergent disease outbreak related to sexual practices and sociality can reconfigure personal life and sexual well-being, suggesting a need to focus on providing quality patient care in outbreaks of mpox and other infectious diseases.

Behavioral intentions of self-isolation and informing close contacts after developing mpox-related symptoms among young men who have sex with men in China

The 2022 multi-country mpox outbreak raised public concern globally. Self-isolation and informing close contacts after developing mpox-related symptoms are critical measures in controlling the outbreak. This study investigated behavioral intentions of self-isolation and informing close contacts after developing mpox-related symptoms and associated factors among young men who have sex with men (YMSM) aged 18-29 years in China. The cross-sectional study was conducted among 2493 YMSM in six provincial regions in China from September 10th to 30th, 2022. Descriptive and logistic analyses were applied, using the intentions of self-isolation and informing close contacts after developing mpox-related symptoms as binary outcomes. The mean age of the participants was 24.6 (SD = 2.9) years. The prevalence of having intentions of self-isolation and informing close contacts after developing mpox-related symptoms was 88.6% (95% CI: 87.3%-89.9%) and 84.9% (95% CI: 83.5%-86.3%). Participants who were employed (adjusted odds ratio (AOR) = 1.474, 95% CI: 1.035-2.097; AOR = 1.371, 95% CI:1.002, 1.876), had higher mpox knowledge scores (AOR = 1.474, 95% CI: 1.035-2.097; AOR = 1.371, 95% CI: 1.002-1.876), and had higher perceived threats of mpox (AOR = 1.079, 95% CI: 1.030-1.130; AOR = 1.045, 95% CI: 1.002-1.090) were more likely to intend to self-isolate and inform close contacts. Participants who had MSM in-person gatherings in the past 6 months were more likely to intend to self-isolate (AOR = 1.392, 95% CI: 1.066-1.208). Participants with higher depression scores (AOR = 0.968, 95% CI: 0.948-0.989) and self-stigma (AOR = 0.975, 95% CI: 0.954-0.997) were less likely to intend to self-isolate and inform close contacts, respectively. Self-isolation and informing close contacts when developing disease-related symptoms are acceptable measures in response to mpox in China. Strengthening targeted risk communication and self-efficacy, raising disease knowledge, providing mental support, and reducing stigma toward the affected community are warranted.

Mpox: The Reemergence of an Old Disease and Inequities

Mpox, previously known as monkeypox, is caused by an Orthopoxvirus related to the variola virus that causes smallpox. Prior to 2022, mpox was considered a zoonotic disease endemic to central and west Africa. Since May 2022, more than 86,000 cases of mpox from 110 countries have been identified across the world, predominantly in men who have sex with men, most often acquired through close physical contact or during sexual activity. The classical clinical presentation of mpox is a prodrome including fever, lethargy, and lymphadenopathy followed by a characteristic vesiculopustular rash. The recent 2022 outbreak included novel presentations of mpox with a predominance of anogenital lesions, mucosal lesions, and other features such as anorectal pain, proctitis, oropharyngeal lesions, tonsillitis, and multiphasic skin lesions. We describe the demographics and clinical spectrum of classical and novel mpox, outlining the potential complications and management.

Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC

People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.

Cross-sectional survey of sexual health professionals' experiences and perceptions of the 2022 mpox outbreak in the UK

OBJECTIVE

To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK.

DESIGN

Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data.

PARTICIPANTS

Participants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis. The survey was completed between 11 August and 31 October 2022 by 139 respondents, the majority of whom were doctors (72.7%), cis-female (70.5%) and White (78.4%).

RESULTS

70.3% reported that they were required to respond to mpox in addition to their existing clinical responsibilities, with 46.8% working longer hours as a result. In the open-text data, respondents highlighted that workload pressures were exacerbated by a lack of additional funding for mpox, pre-existing pressures on sexual health services, and unrealistic expectations around capacity. 67.6% of respondents reported experiencing negative emotional impact due to their mpox work, with stress (59.0%), fatigue (43.2%) and anxiety (36.0%) being the most common symptoms. 35.8% stated that they were less likely to remain in their profession because of their experiences during the mpox outbreak. In the open-text data, these feelings were ascribed to post-COVID exhaustion, understaffing and frustration among some participants at the handling of the mpox response.

CONCLUSIONS

These findings indicate that sexual health services require increased funding and resources, along with evidence-based well-being interventions, to support sexual health professionals' outbreak preparedness and recovery.

How news reporting exacerbated the monkeypox pandemic in Spain and the US: A corpus-based news values analysis

Media reporting greatly influences the civilians' mentality, which further exacerbates or mitigates outbreaks of infectious diseases, prolongs or shortens the pandemic process. Adopting corpus linguistic methods and Discursive news values analysis (DNVA) framework, this study examined the news values through key words, naming strategies and photographs in monkeypox-themed news reporting in Spanish and the US media, to analyse how they constructed the monkeypox pandemic in their news reporting, sold it to the public and exacerbated the pandemic in the two societies. The results show that the Spanish media constructed the monkeypox pandemic predominantly as an international medical event, distancing the monkeypox pandemic from the Spanish indigenous context and depriving the domestic audiences from the sense of urgency to take prevention actions. On the other hand, the US media mainly packaged the monkeypox pandemic as a political event which isolated this public health crisis from the life of the common people and hindered the US citizens' understanding of the requisite medical information about the monkeypox virus. It is concluded that the lack of indigenous focus of the Spanish media, and the excessively politicised focus of the US media are important factors that lead to the exacerbation of the monkeypox epidemic.

Attitudes towards Receiving Monkeypox Vaccination: A Systematic Review and Meta-Analysis

BACKGROUND

The public's attitude towards Mpox vaccination is a critical factor in the success of immunisation programmes. Understanding the factors contributing to vaccine acceptance or hesitancy is critical for developing effective health communication strategies. This systematic review and meta-analysis aims to bring together evidence from observational studies on attitudes towards Mpox vaccination, including willingness and rejection.

METHODS

From this review's inception until June 2023, a comprehensive search was conducted across four major electronic databases: PubMed, Web of Science, Scopus, and EBSCO. The inclusion criteria included studies investigating public attitudes towards Mpox vaccination, as defined by acceptance and willingness to be vaccinated versus rejection and unwillingness.

RESULTS

Thirty studies met the inclusion criteria among the screened literature. An analysis of 27 studies involving 81,792 participants revealed that 45,926 (56.14%) were willing to receive the Mpox vaccination. In contrast, ten studies involving 7448 participants revealed that 2156 people (28.94%) were unwilling to receive the Mpox vaccination. Females were less willing to receive the vaccine than males, with an odds ratio (OR) of 0.61 (95% CI, 0.43-0.86). Furthermore, homosexuals were found to be more willing than heterosexuals, with an OR of 1.44 (95% CI, 1.14-1.80).

CONCLUSION

Vaccination is emerging as a critical strategy for preventing Mpox infection and fostering herd immunity against potential outbreaks. Improving public awareness and acceptance of vaccination is critical to avoiding a situation similar to the COVID-19 pandemic. Targeted educational and outreach programmes could explain the benefits of vaccination, bridging the information gap and encouraging a proactive public health approach to emerging infectious diseases.

Fear of a new pandemic: perception and prediction of monkeypox among the middle east general population

Background

Monkeypox is a zoonotic disease caused by the monkeypox virus, an Orthopox virus. The 2022 monkeypox outbreak provoked fear among the public. Public awareness about the disease could be an important factor in its control. The authors conducted this study to assess the perception and prediction of monkeypox among the Middle East public.

Methods

This cross-sectional study was conducted in August 2022. Data were conveniently collected from eight Middle Eastern countries using an online self-administered questionnaire distributed through educational and social media platforms. Statistical analysis was conducted using R software.

Results

Approximately 11 016 individuals participated in this study. The participants' overall knowledge score indicated poor knowledge about monkeypox. Most of the participants knew the causative organism (66.7%). However, numerous participants were not aware of the disease mode of transmission, symptoms, complications, and vaccination. Participants' awareness was mostly gained from social media (61.8%). The majority predicted acquiring monkeypox when protective measures are not taken (72.7%), progression to a pandemic with economic consequences (50.8 and 52%, respectively), and the ability of the Ministry of Health to control the epidemic (51.5%).

Conclusion

In the Middle East, public knowledge about monkeypox is poor. Raising awareness about monkeypox would be of benefit in controlling the epidemic. This study constitutes evidence upon which health education programs could be designed.

Willingness to receive and recommend hypothetical mpox vaccination and associated factors in Chinese adults: a community-based survey in Shenzhen, China

OBJECTIVES

China may face new threats to public health due to the increased risk of imported mpox (monkeypox) cases. However, research gaps exist in the acceptance of mpox vaccination and potential associated factors in the Chinese population.

STUDY DESIGN

We conducted a cross-sectional study targeting community residents in Shenzhen, China, from August 5 to September 7 2022.

METHODS

A self-administered questionnaire was used to collect information about demographic and health characteristics, mpox-related perceptions, and attitudes towards mpox vaccination. Multivariable logistic regression models were applied to detect the factors associated with willingness to receive and recommend mpox vaccination.

RESULTS

A total of 2293 community residents were included in the analyses (average age: 34.03, female: 72.6%). Among the participants, 76.9% were aware of mpox, 62.1% were aware of the global mpox outbreak, but only 53.6% had a high knowledge level of mpox. Males had a higher proportion of high knowledge (56.9% vs 52.3%, P＜0.05) and a lower proportion of high worry (30.2% vs 45.4%, P＜0.05) than females. Approximately 69.1% of the participants were willing to vaccinate against mpox, and 69.6% were willing to recommend mpox vaccination to people around them, in which no gender difference was found. The obstacle reported most among people hesitant to receive vaccination was concerning the safety and side-effects, whereas it changed to be concerning the suitability due to individual health differences among people hesitant to recommend mpox vaccines. Factors associated with the willingness to receive and recommend mpox vaccination included having a history of influenza vaccination, having a history of COVID-19 vaccination, being aware of the global mpox outbreak, having a high knowledge level of mpox, and having a high level of mpox-related worry.

CONCLUSIONS

This study identified a moderate willingness to receive and recommend mpox vaccination among Chinese adults. Without gender differences, willingness to receive and recommend mpox vaccination was significantly associated with mpox-related perceptions, such as awareness, knowledge, and worry. Authoritative and up-to-date information is needed to help the general population improve public confidence in mpox vaccines in China.

Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in the UK: a qualitative study to inform public health guidance and messaging

BACKGROUND

The 2022-23 mpox epidemic is the first-time sustained community transmission had been reported in countries without epidemiological links to endemic areas. During that period, the outbreak almost exclusively affected sexual networks of gay, bisexual, or other men who have sex with men (GBMSM) and people living with HIV. In efforts to control transmission, multiple public health measures were implemented, including vaccination, contact tracing and isolation. This study examines knowledge, attitudes, and perceptions of mpox among a sample of GBMSM during the 2022-23 outbreak in the UK, including facilitators for and barriers to the uptake of public health measures.

METHODS

Interviews were conducted with 44 GBMSM between May and December 2022. Data were analysed using reflexive thematic analysis. Positive and negative comments pertaining to public health measures were collated in a modified version of a 'table of changes' to inform optimisations to public health messages and guidance.

RESULTS

Most interviewees were well informed about mpox transmission mechanisms and were either willing to or currently adhering to public health measures, despite low perceptions of mpox severity. Measures that aligned with existing sexual health practices and norms were considered most acceptable. Connections to GBMSM networks and social media channels were found to increase exposure to sexual health information and norms influencing protective behaviours. Those excluded or marginalized from these networks found some measures challenging to perform or adhere to. Although social media was a key mode of information sharing, there were preferences for timely information from official sources to dispel exaggerated or misleading information.

CONCLUSIONS

There are differential needs, preferences, and experiences of GBMSM that limit the acceptability of some mitigation and prevention measures. Future public health interventions and campaigns should be co-designed in consultation with key groups and communities to ensure greater acceptability and credibility in different contexts and communities.

Did mpox knowledge, attitudes and beliefs affect intended behaviour in the general population and men who are gay, bisexual and who have sex with men? An online cross-sectional survey in the UK

OBJECTIVES

To investigate rates of mpox beliefs, knowledge and intended behaviours in the general population and in gay, bisexual or other men who have sex with men (GBMSM), and factors associated with intended behaviours. To test the impact of motivational messages (vs a factual control) on intended behaviours.

DESIGN

Cross-sectional online survey including a nested randomised controlled trial.

SETTING

Data collected from 5 September 2022 to 6 October 2022.

PARTICIPANTS

Participants were aged 18 years or over and lived in the UK (general population). In addition, GBMSM were male, and gay, bisexual or had sex with men. The general population sample was recruited through a market research company. GBMSM were recruited through a market research company, the dating app Grindr and targeted adverts on Meta (Facebook and Instagram).

MAIN OUTCOME MEASURES

Intention to self-isolate, seek medical help, stop all sexual contact, share details of recent sexual contacts and accept vaccination.

RESULTS

Sociodemographic characteristics differed by sample. There was no effect of very brief motivational messaging on behavioural intentions. Respondents from Grindr and Meta were more likely to intend to seek help immediately, completely stop sexual behaviour and be vaccinated or intend to be vaccinated, but being less likely to intend to self-isolate (ps<0.001). In the general population sample, intending to carry out protective behaviours was generally associated with being female, older, having less financial hardship, greater worry, higher perceived risk to others and higher perceived susceptibility to and severity of mpox (ps<0.001). There were fewer associations with behaviours in the Grindr sample, possibly due to reduced power.

CONCLUSIONS

GBMSM were more likely to intend to enact protective behaviours, except for self-isolation. This may reflect targeted public health efforts and engagement with this group. Associations with socioeconomic factors suggest that providing financial support may encourage people to engage with protective behaviours.

Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: results of a national cross-sectional survey

BACKGROUND

In mid-2022, a global mpox (formerly 'monkeypox') outbreak affecting predominantly gay and bisexual men emerged in non-endemic countries. Australia had never previously recorded mpox cases and there was no prior research on knowledge or attitudes to mpox among gay and bisexual men across Australia.

METHODS

We conducted a national, online cross-sectional survey between August 2022 and September 2022. Participants were recruited through community organisation promotions, online advertising, and direct email invitations. Eligible participants were gay, bisexual or queer; identified as male (cisgender or transgender) or non-binary; aged 16years or older; and lived in Australia. The main outcome measures were: knowledge and concern about mpox; recognition of mpox symptoms and transmission routes; vaccination history; acceptability of behavioural changes to reduce mpox risk, and willingness to be vaccinated.

RESULTS

Of 2287 participants, most participants were male (2189/2287; 95.7%) and gay (1894/2287; 82.8%). Nearly all had heard about mpox (2255/2287; 98.6%), and the majority were concerned about acquiring it (1461/2287; 64.4%). Most of the 2268 participants not previously diagnosed with mpox correctly identified skin lesions (2087; 92%), rash (1977; 87.2%), and fever (1647; 72.6%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire mpox (2124, 93.7%; and 1860, 82%, respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494; 65.9%) and sex-on-premises venues (1503; 66.4%), and having fewer sexual partners (1466; 64.6%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733; 84.1%).

CONCLUSIONS

People at risk of mpox should be supported to adopt acceptable risk reduction strategies during outbreaks and to seek vaccination.

Mpox vaccine acceptability among people experiencing homelessness in San Francisco - October-November 2022

Mpox has affected many communities in the United States (U.S.), including people experiencing homelessness (PEH). Mpox vaccination has been an important tool to disrupt transmission and protect communities at risk of infection. To better understand mpox vaccine knowledge and attitudes, we surveyed 273 PEH and people accessing homeless service sites in San Francisco. Among 64 participants previously offered mpox vaccination, 38 (59 %) had received the vaccine. Among 209 participants not previously offered mpox vaccination, 108 (52 %) reported they would receive the vaccine. Vaccine acceptance was higher among transgender female participants and among male participants who reported male sex partner preference (MSM). Half of participants who declined vaccination identified that perception of personal risk and vaccine education may increase their likelihood of receiving an mpox vaccine. Leveraging trusted information sources to provide risk communication and vaccine education may increase vaccine uptake among PEH.

Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities

BACKGROUND

The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America.

OBJECTIVE

We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis.

METHODS

A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables.

RESULTS

We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that "LGBTQIA+ individuals are being discriminated and stigmatized due to mpox." Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001).

CONCLUSIONS

Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.

Barriers and facilitators to HIV pre-exposure prophylaxis for cisgender and transgender women in the UK

Uptake of oral HIV pre-exposure prophylaxis (PrEP) among cisgender and transgender women in the UK has been low. In this Review, we explore the barriers and facilitators to PrEP access for these groups, with a focus on health equity. We included 20 studies, including seven abstracts presented at conferences. The study samples were disparate, with minimal overlap between papers. We identified barriers at the individual, interpersonal, and structural levels, including poor awareness and acceptability; stigma, race, and ethnicity; restricted access to PrEP; and exclusion from clinical trials. We found hidden subpopulations of women who could potentially benefit from PrEP, of whom little is known about their PrEP knowledge, preferences, and access due to a lack of UK research. These subpopulations include non-Black African women, transgender women, sex workers, migrant women, women experiencing intimate partner violence, incarcerated women, and women who inject drugs. We highlight opportunities to address these obstacles. Research on the use of PrEP by women in the UK is scarce, and existing research has poor granularity. Without a better understanding of the needs and preferences of the full spectrum of women who could benefit from PrEP, the UK will not reach zero transmissions by 2030.

Sexual orientation was associated with intention to be vaccinated with a smallpox vaccine against mpox: A cross-sectional preliminary survey in Japan

This survey aimed to assess the prevalence of intention to receive smallpox vaccine against mpox and its relationship with sexual orientation in Japan. A cross-sectional online survey was conducted in September-October 2022, with 12,900 assigned males and 13,413 assigned females participating. Modified Poisson regression analyses were performed to determine the relationship between vaccine willingness and sexual orientation, adjusting for socioeconomics, trust in government, COVID-19 vaccination status, and frequency of brothel visits. Vaccine willingness was higher in homosexual respondents than heterosexual counterparts, with proportions of 23.1 % among assigned males and 13.4 % among assigned females. Homosexual orientation was significantly associated with vaccine willingness, with prevalence ratios of 1.37 (95 % CI: 1.23-1.54) among assigned males and 1.34 (95 % CI: 1.13-1.59) among assigned females. These findings highlight the need for targeted vaccine promotion campaigns and ongoing monitoring of attitudes towards mpox and vaccine compliance in high-risk groups.

Efficacy of the modified vaccinia Ankara virus vaccine and the replication-competent vaccine ACAM2000 in monkeypox prevention

BACKGROUND

Recently, there has been an uptick in reported cases of monkeypox (Mpox) in Africa and across the globe. This prompted us to investigate the efficacy of the two vaccines that can prevent Mpox, the modified vaccinia Ankara virus (MVA) vaccine and ACAM2000 vaccine. We analyzed them to determine their rates of humoral cell responses, adverse events, and rash reactions and used these factors as the primary indicators.

METHODS

This study adapted primary data obtained from the Medline, Google Scholar, and Cochrane Library databases. We included a total of eight studies, three of which explored the ACAM2000 vaccine and five of which explored the JYNNEOS MVA vaccine.

RESULTS

There were significant differences in the rates of humoral responses after inoculation by the two vaccines. JYNNEOS MVA vaccine immunization resulted in a statistically significant increased humoral immune response with an effect size of 81.00 (42.80, 119.21) at a 95% CI and a rash reaction with an effect size of 96.50 (42.09, 235.09.21) at a 95% CI. ACAM2000 resulted in a lesser increase in neutralizing antibodies than JYNNEOS MVA vaccine. Similar findings were identified for the rates of adverse reactions, but the difference was not statistically significant. The differences in rash reaction rates in the two vaccination groups were also not statistically significant.

CONCLUSION

ACAM2000 and JYNNEOS vaccines have proven to be efficient in preventing Mpox even though variations exist in their modes of action and associated significant effects. The nonreplicating nature of JYNNEOS prevents the occurrence of the adverse effects seen with other vaccines.