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Abstract

Background

In 2022 and 2023, a global outbreak of mpox affected mostly gay, bisexual and other men having sex with men (GBMSM). Outbreak control in the Netherlands included isolation, quarantine, post-exposure prophylaxis vaccination and primary preventive vaccination (PPV).

Aim

We describe the course of the outbreak, the vaccination programme, vaccine effectiveness (VE) of full vaccination against symptomatic disease, and trends in behaviour to generate hypotheses about factors that influenced the outbreak’s decline.

Methods

In this observational study, we collected data from public health services on notified cases, number of PPV invitations and PPV doses administered. We calculated PPV uptake and coverage. Trends in behavioural data of GBMSM visiting sexual health centres were analysed for all consultations in 2022. We estimated VE using the screening method.

Results

Until 31 December 2023, 1,294 mpox cases were reported. The outbreak peaked in early July 2022 and then declined sharply. PPV started on 25 July 2022; in total 29,851 doses were administered, 45.8% received at least one dose, 35.4% were fully vaccinated. The estimated VE was 68.2% (95% CI 4.3–89.5%). We did not observe an evident decrease in high-risk behaviour.

Discussion

It is unlikely that PPV was a driver of the outbreak’s decline, as incidence started to decline well before the start of the PPV programme. The possible impact of behavioural change could not be demonstrated with the available indicators, however, the data had limitations, hampering interpretation. We hypothesise that infection-induced immunity in high-risk groups was an important factor explaining the decline.

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2024-05-23
2024-12-26
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References

  1. Angelo KM, Smith T, Camprubí-Ferrer D, Balerdi-Sarasola L, Díaz Menéndez M, Servera-Negre G, et al. Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study. Lancet Infect Dis. 2023;23(2):196-206.  https://doi.org/10.1016/S1473-3099(22)00651-X  PMID: 36216018 
  2. McCollum AM, Shelus V, Hill A, Traore T, Onoja B, Nakazawa Y, et al. Epidemiology of human Mpox - worldwide, 2018-2021. MMWR Morb Mortal Wkly Rep. 2023;72(3):68-72.  https://doi.org/10.15585/mmwr.mm7203a4  PMID: 36656790 
  3. Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis. Lancet Infect Dis. 2004;4(1):15-25.  https://doi.org/10.1016/S1473-3099(03)00856-9  PMID: 14720564 
  4. Centers for Disease Control and Prevention (CDC). Multistate outbreak of monkeypox--Illinois, Indiana, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep. 2003;52(23):537-40. PMID: 12803191 
  5. Gross E. Update on emerging infections: news from the Centers for Disease Control and prevention. Update: Multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. Ann Emerg Med. 2003;42(5):660-2, discussion 662-4.  https://doi.org/10.1016/S0196-0644(03)00819-9  PMID: 14581919 
  6. 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 
  7. Laurenson-Schafer H, Sklenovská N, Hoxha A, Kerr SM, Ndumbi P, Fitzner J, et al. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health. 2023;11(7):e1012-23.  https://doi.org/10.1016/S2214-109X(23)00198-5  PMID: 37349031 
  8. World Health Organization (WHO). 2022-23 Mpox (monkeypox) outbreak: global trends. Geneva: WHO: 2024. Available from: https://worldhealthorg.shinyapps.io/mpx_global
  9. van Ewijk CE, Miura F, van Rijckevorsel G, de Vries HJC, Welkers MRA, van den Berg OE, et al. Mpox outbreak in the Netherlands, 2022: public health response, characteristics of the first 1,000 cases and protection of the first-generation smallpox vaccine. Euro Surveill. 2023;28(12):2200772.  https://doi.org/10.2807/1560-7917.ES.2023.28.12.2200772  PMID: 36951783 
  10. European Medicines Agency (EMA). Imvanex smallpox and monkeypox vaccine (Live Modified Vaccinia Virus Ankara). Amsterdam: EMA. [Accessed: 1 Aug 2023]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/imvanex
  11. Dutch National Institute for Public Health and the Environment (RIVM). Mpoxvaccinatie Uitvoeringsrichtlijn. [Mpox vaccination practice guideline]. Bilthoven: RIVM. [Accessed: 1 October 2022]. Dutch. Available from: https://lci.rivm.nl/richtlijnen/monkeypoxvaccinatie
  12. Ministry of Health, Welfare and Sport. Factsheet Pokken. [Factsheet Smallpox]. Version 25. The Hague: Government of the Netherlands; 2003. Dutch.
  13. Taube JC, Rest EC, Lloyd-Smith JO, Bansal S. The global landscape of smallpox vaccination history and implications for current and future orthopoxvirus susceptibility: a modelling study. Lancet Infect Dis. 2023;23(4):454-62.  https://doi.org/10.1016/S1473-3099(22)00664-8  PMID: 36455590 
  14. Soa Aids Nederland. Uitbreiding voorlichtingscampagne mpox. [Expansion of mpox awareness campaign]. Amsterdam: Soa Aids Nederland; 2022. Dutch. Available from: https://www.soaaids.nl/nl/professionals/actueel/nieuwsbericht/uitbreiding-voorlichtingscampagne-mpox
  15. Ministry of Health, Welfare and Sport. Regeling apenpokken. [Monkeypox regulation]. The Hague: Government of the Netherlands. [Accessed: 1 Oct 2022]. Dutch. Available from: https://wetten.overheid.nl/BWBR0046692/2022-05-21/0/informatie
  16. Farrington CP. Estimation of vaccine effectiveness using the screening method. Int J Epidemiol. 2023;52(1):14-21.  https://doi.org/10.1093/ije/dyac207  PMID: 36326585 
  17. Flannery B, Andrews N, Feikin D, Patel MK. Commentary: estimation of vaccine effectiveness using the screening method. Int J Epidemiol. 2023;52(1):19-21.  https://doi.org/10.1093/ije/dyac013  PMID: 35138384 
  18. Bertran M, Andrews N, Davison C, Dugbazah B, Boateng J, Lunt R, et al. Effectiveness of one dose of MVA-BN smallpox vaccine against mpox in England using the case-coverage method: an observational study. Lancet Infect Dis. 2023;23(7):828-35.  https://doi.org/10.1016/S1473-3099(23)00057-9  PMID: 36924787 
  19. Wolff Sagy Y, Zucker R, Hammerman A, Markovits H, Arieh NG, Abu Ahmad W, et al. Real-world effectiveness of a single dose of mpox vaccine in males. Nat Med. 2023;29(3):748-52.  https://doi.org/10.1038/s41591-023-02229-3  PMID: 36720271 
  20. Deputy NP, Deckert J, Chard AN, Sandberg N, Moulia DL, Barkley E, et al. Vaccine effectiveness of JYNNEOS against mpox disease in the United States. N Engl J Med. 2023;388(26):2434-43.  https://doi.org/10.1056/NEJMoa2215201  PMID: 37199451 
  21. Dalton AF, Diallo AO, Chard AN, Moulia DL, Deputy NP, Fothergill A, et al. Estimated effectiveness of JYNNEOS vaccine in preventing mpox: a multijurisdictional case-control study - United States, August 19, 2022-March 31, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(20):553-8.  https://doi.org/10.15585/mmwr.mm7220a3  PMID: 37200229 
  22. Rosenberg ES, Dorabawila V, Hart-Malloy R, Anderson BJ, Miranda W, O’Donnell T, et al. Effectiveness of JYNNEOS vaccine against diagnosed mpox infection - New York, 2022. MMWR Morb Mortal Wkly Rep. 2023;72(20):559-63.  https://doi.org/10.15585/mmwr.mm7220a4  PMID: 37339074 
  23. 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 
  24. Miura F, van Ewijk CE, Backer JA, Xiridou M, Franz E, Op de Coul E, et al. Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022. Euro Surveill. 2022;27(24):2200448.  https://doi.org/10.2807/1560-7917.ES.2022.27.24.2200448  PMID: 35713026 
  25. McFarland SE, Marcus U, Hemmers L, Miura F, Iñigo Martínez J, Martínez FM, et al. Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022. Euro Surveill. 2023;28(27):2200806.  https://doi.org/10.2807/1560-7917.ES.2023.28.27.2200806  PMID: 37410383 
  26. Zhang XS, Mandal S, Mohammed H, Turner C, Florence I, Walker J, et al. Transmission dynamics and effect of control measures on the 2022 outbreak of mpox among gay, bisexual, and other men who have sex with men in England: a mathematical modelling study. Lancet Infect Dis. 2024;24(1):65-74.  https://doi.org/10.1016/S1473-3099(23)00451-6  PMID: 37708908 
  27. Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, et al. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a population at high risk of mpox: a Spanish cohort study. Clin Infect Dis. 2024;78(2):476-83.  https://doi.org/10.1093/cid/ciad645  PMID: 37864849 
  28. Clay PA, Asher JM, Carnes N, Copen CE, Delaney KP, Payne DC, et al. Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the USA during the 2022 outbreak. Sex Transm Infect. 2024;100(2):70-6.  https://doi.org/10.1136/sextrans-2023-055922  PMID: 38050171 
  29. van Ewijk CE, Smit C, Bavalia R, Ainslie K, Vollaard A, van Rijckevorsel G, et al. Acceptance and timeliness of post-exposure vaccination against mpox in high-risk contacts, Amsterdam, the Netherlands, May-July 2022. Vaccine. 2023;41(47):6952-9.  https://doi.org/10.1016/j.vaccine.2023.10.013  PMID: 37838481 
  30. Adam PCG, Op de Coul ELM, Zantkuijl P, Xiridou M, Bos H, Blom C, et al. A survey-based assessment of rates and covariates of mpox diagnosis and vaccination provides evidence to refine eligibility criteria for mpox vaccination among gay, bisexual and other men who have sex with men in the Netherlands. Front Public Health. 2024;12:1194844.  https://doi.org/10.3389/fpubh.2024.1194844  PMID: 38351958 
  31. Delaney KP, Sanchez T, Hannah M, Edwards OW, Carpino T, Agnew-Brune C, et al. Strategies adopted by gay, bisexual, and other men who have sex with men to prevent monkeypox virus transmission - United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022;71(35):1126-30.  https://doi.org/10.15585/mmwr.mm7135e1  PMID: 36048582 
  32. Brand SPC, Cavallaro M, Cumming F, Turner C, Florence I, Blomquist P, et al. The role of vaccination and public awareness in forecasts of Mpox incidence in the United Kingdom. Nat Commun. 2023;14(1):4100.  https://doi.org/10.1038/s41467-023-38816-8  PMID: 37433797 
  33. Murayama H, Pearson CAB, Abbott S, Miura F, Jung S, Fearon E, et al. Accumulation of immunity in heavy-tailed sexual contact networks shapes mpox outbreak sizes. J Infect Dis. 2023;229(1):59-63. PMID: 37402631 
  34. Xiridou M, Miura F, Adam P, Op de Coul E, de Wit J, Wallinga J. The fading of the mpox outbreak among men who have sex with men: a mathematical modelling study. J Infect Dis. 2023;jiad414.  https://doi.org/10.1093/infdis/jiad414  PMID: 37740556 
  35. Wang H, d’Abreu de Paulo KJI, Gültzow T, Zimmermann HML, Jonas KJ. Monkeypox self-diagnosis abilities, determinants of vaccination and self-isolation intention after diagnosis among MSM, the Netherlands, July 2022. Euro Surveill. 2022;27(33):2200603.  https://doi.org/10.2807/1560-7917.ES.2022.27.33.2200603  PMID: 35983772 
  36. Dukers-Muijrers NHTM, Evers Y, Widdershoven V, Davidovich U, Adam PCG, Op de Coul ELM, et al. Mpox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch Mpox-survey). Front Public Health. 2023;10:1058807.  https://doi.org/10.3389/fpubh.2022.1058807  PMID: 36684959 
  37. Vairo F, Leone S, Mazzotta V, Piselli P, De Carli G, Lanini S, et al. The possible effect of sociobehavioral factors and public health actions on the mpox epidemic slowdown. Int J Infect Dis. 2023;130:83-5.  https://doi.org/10.1016/j.ijid.2023.03.005  PMID: 36906119 
  38. Dutch National Institute for Public Health and the Environment (RIVM). Mpoxvaccinatie Uitvoeringsrichtlijn. [Mpox vaccination practice guideline]. Bilthoven: RIVM. [Accessed: 1 October 2022]. Dutch. Available from: https://lci.rivm.nl/richtlijnen/monkeypoxvaccinatie
Factors potentially contributing to the decline of the mpox outbreak in the Netherlands, 2022 and 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Manon+R+Haverkate&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haverkate Manon R</a>, <a href="/search?value1=Inge+JM+Willemstein&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Willemstein Inge JM</a>, <a href="/search?value1=Catharina+E+van+Ewijk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Ewijk Catharina E</a>, <a href="/search?value1=Philippe+CG+Adam&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Adam Philippe CG</a>, <a href="/search?value1=Susan+J+Lanooij&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lanooij Susan J</a>, <a href="/search?value1=Petra+Jonker-Jorna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jonker-Jorna Petra</a>, <a href="/search?value1=Colette+van+Bokhoven&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Bokhoven Colette</a>, <a href="/search?value1=Gini+GC+van+Rijckevorsel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Rijckevorsel Gini GC</a>, <a href="/search?value1=Elske+Hoornenborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoornenborg Elske</a>, <a href="/search?value1=Silke+David&option1=author&noRedirect=true" class="nonDisambigAuthorLink">David Silke</a>, <a href="/search?value1=Liesbeth+Mollema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mollema Liesbeth</a>, <a href="/search?value1=Margreet+J+te+Wierik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">te Wierik Margreet J</a>, <a href="/search?value1=Jente+Lange&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lange Jente</a>, <a href="/search?value1=Eelco+Franz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Franz Eelco</a>, <a href="/search?value1=Hester+E+de+Melker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Melker Hester E</a>, <a href="/search?value1=Eline+LM+Op+de+Coul&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Op de Coul Eline LM</a>, <a href="/search?value1=Susan+JM+Hahn%C3%A9&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hahné Susan JM</a></span>. Factors potentially contributing to the decline of the mpox outbreak in the Netherlands, 2022 and 2023. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(21):pii=2300608. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.21.2300608" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.21.2300608</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 03 Nov 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Mar 2024 </span> </p>
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