Evaluating the Impact of Targeted Mpox Vaccination Scenarios stratified by HIV Status and Sexual Risk Behaviors: A Compartmental Modeling Approach
DOI:
https://doi.org/10.64891/jome.18Keywords:
Mpox, vaccination, SVEIR model, HIV, sexual risk behaviorsAbstract
Objectives: Models of mpox outbreaks have not fully accounted for epidemiologic heterogeneity by HIV status and sexual risk behaviors. Therefore, our objectives were to develop an innovative compartmental model that accounts for these heterogeneities and to evaluate the impact of targeted vaccination scenarios in a theoretical outbreak of mpox in Washington, DC. Methods: We developed a Susceptible-Vaccinated-Exposed-Infectious-Recovered (SVEIR) compartmental model with six different risk strata accounting for sexual risk behaviors, HIV status, and CD4. We then evaluated a theoretical 6-month outbreak of mpox in Washington, DC under various targeted vaccination scenarios. From each vaccination scenario, we chose an optimal set of vaccination rates based on the number of mpox cases, severe cases, deaths, and effective reproduction number (Reff). Results: We found that vaccinating 25% of individuals with high sexual risk behaviors was optimal. If vaccination is introduced immediately, this scenario resulted in only 316 mpox cases, no deaths, an Reff of 1.69 at the end of the 6-month period, and only required vaccinating 9,090 individuals. Conclusions: In order to control future mpox outbreaks, vaccination campaigns should target individuals with high sexual risk behaviors and be implemented in tandem with isolation protocols and partner reduction.
References
[1] A. M. McCollum et al., Epidemiology of Human Mpox - Worldwide, 2018-2021, MMWR Morb. Mortal. Wkly. Rep.,
72(3), (2023), 68-72. https://doi.org/10.15585/mmwr.mm7203a4
[2] D. Philpott et al., Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July
22, 2022, MMWR Morb. Mortal. Wkly. Rep., 71(32), (2022), 1018–1022. https://doi.org/10.15585/mmwr.
mm7132e3
[3] O. Mitj`a et al., Mpox in people with advanced HIV infection: a global case series, Lancet, 401(10380), (2023),
939–949. https://doi.org/10.1016/S0140-6736(23)00273-8
[4] FDA, Fact Sheet for Healthcare Providers Administering Vaccine: Emergency Use Authorization of Jynneos (Smallpox
and Monkeypox Vaccine, Live, Non-Replicating) for Prevention of Monkeypox Disease in Individuals Determined to be
at High Risk for Monkeypox Infection. Available from: https://www.fda.gov/media/160774/download [Accessed
Feb. 09, 2025]
[5] E. S. Rosenberg et al., Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection — New York, 2022,
MMWR Morb. Mortal. Wkly. Rep., 72(20), (2023), 559–563. https://doi.org/10.15585/mmwr.mm7220a4
[6] N. P. Deputy et al., Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States, N. Engl. J. Med.,
388(26), (2023), 2434–2443.https://doi.org/10.1056/NEJMoa2215201
[7] A. F. Dalton 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., 72(20),
(2023), 553–558. https://doi.org/10.15585/mmwr.mm7220a3
[8] K. E. Nelson and C. M. Williams, Infectious Disease Epidemiology: Theory and Practice, 3rd ed. Jones & Bartlett
Learning, (2013).
[9] T. Spath et al., Modeling the protective effect of previous compulsory smallpox vaccination against human monkeypox
infection: from hypothesis to a worst-case scenario, Int. J. Infect. Dis., 124, (2022), 107–112. https://doi.org/
10.1016/j.ijid.2022.09.022
[10] J. Molla, I. Sekkak, A. Mundo Ortiz, I. Moyles, and B. Nasri, Mathematical modeling of mpox: A scoping review,
One Health, 16, (2023), 100540. https://doi.org/10.1016/j.onehlt.2023.100540
[11] S. V. Bankuru, S. Kossol, W. Hou, P. Mahmoudi, J. Rycht´aˇr, and D. Taylor, A game-theoretic model of Monkeypox
to assess vaccination strategies, PeerJ., 8, e9272. https://doi.org/10.7717/peerj.9272
[12] I. B. Augsburger, G. K. Galanthay, J. H. Tarosky, J. Rycht´aˇr, and D. Taylor, Voluntary vaccination may not stop
monkeypox outbreak: A game-theoretic model, PLoS Negl. Trop. Dis., 16(12), (2020), e0010970. https://doi.
org/10.1371/journal.pntd.0010970
[13] HIV.gov, Pre-Exposure Prophylaxis (PrEP). Available from: https://www.hiv.gov/hiv-basics/
hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis [Accessed Mar.
11, 2026]
[14] A. E. Greenberg et al., Development of a large urban longitudinal HIV clinical cohort using a web-based platform to
merge electronically and manually abstracted data from disparate medical record systems: technical challenges and
innovative solutions, J. Am. Med. Inform. Assoc., 23(3), (2016), 635–643. https://doi.org/10.1093/jamia/
ocv176
[15] DC Health, Mpox Data — doh. Available from: https://dchealth.dc.gov/node/1611066 [Accessed Dec. 20,
2022]
[16] L. E. Owens, JYNNEOS Vaccination Coverage Among Persons at Risk for Mpox — United States, May 22, 2022–January
31, 2023, MMWR Morb. Mortal. Wkly. Rep., 72(13), (2023), 342-347. https://doi.org/10.15585/mmwr.
mm7213a4
[17] R Core Team, RA language and environment for statistical computing. R Foundation for Statistical, Computing,
(2020), Vienna, Austria.
[18] X. -S. Zhang 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.,
24(1), (2024), 65–74. https://doi.org/10.1016/%20%20S1473-3099(23)00451-6
[19] F. Branda, M. Pierini, and S. Mazzoli, Monkeypox: Early estimation of basic reproduction number R0 in Europe, J.
Med. Virol., 95(1), (2023), e28270. https://doi.org/10.1002/jmv.28270
[20] C. D´ıaz-Brochero and Z. M. Cucunub´a, Epidemiological findings, estimates of the instantaneous reproduction number,
and control strategies of the first Mpox outbreak in Latin America, Travel. Med. Infect. Dis., 59, (2024), 102701.
https://doi.org/10.1016/j.tmaid.2024.102701
[21] N. L. Bragazzi, S. A. Iyaniwura, Q. Han, W. A. Woldegerima, and J. D. Kong, Quantifying the basic reproduction
number and underestimated fraction of Mpox cases worldwide at the onset of the outbreak, J. R. Soc. Interface.,
21(216), (2024), 20230637. https://doi.org/10.1098/rsif.2023.0637
[22] DC Health, DC Health Announces Launch of Pre-registration System for
Monkeypox Vaccine, Available from: https://dchealth.dc.gov/release/
dc-health-announces-launch-pre-registration-system-monkeypox-vaccine [Accessed Jan. 09, 2025]
[23] Government of the District of Columbia Muriel Bowser, DC Health to Provide Limited Walk-up
Monkeypox Vaccinations on Fridays for Eligible Residents, Available from: https://mayor.dc.gov/
release/dc-health-provide-limited-walk-monkeypox-vaccinations-fridays-eligible-residents [Accessed
Jan. 09, 2025]
[24] P. A. Clay et al., Modelling the impact of vaccination and sexual behaviour adaptations on mpox cases in the
USA during the 2022 outbreak, Sex. Transm. Infect., 100(2), (2024), 70–76. https://doi.org/10.1136/
sextrans-2023-055922
[25] G. Guzzetta et al., Early Estimates of Monkeypox Incubation Period, Generation Time, and Reproduction Number,
Italy, May–June 2022, Emerg. Infect. Dis., 28(10), (2022), 2078–2081. https://doi.org/10.3201/eid2810.
221126
[26] A. Omame et al., Understanding the impact of HIV on mpox transmission in the MSM population: A mathematical
modeling study, Infect. Dis. Model., 9(4), (2024), 1117–1137. https://doi.org/10.1016/j.idm.2024.05.008
[27] E. Vynnycky and R. G. White, An Introduction to Infectious Disease Modelling, 1st ed., Oxford University Press,
(2010). Avalable from: https://anintroductiontoinfectiousdiseasemodelling.com/ [Accessed Feb. 10,
2024]
[28] E. W.Andersen et al., pox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington,
DC, Pathogens, 13(2), (2024), 124. https://doi.org/10.3390/pathogens13020124
[29] C. Grov et al., Sexual and Gender Minorities’ Vaccine Uptake and Behavioral Change in Response to the Mpox
Outbreak in the United States: August 2022 Through November 2022, Clin. Infect. Dis., (2024), ciad793. https:
//doi.org/10.1093/cid/ciad793
[30] J. MacGibbon et al., Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination:
results of a national cross-sectional survey, Sex. Health., 20(5), (2023), 403–410. https://doi.org/10.1071/
SH23047
[31] H. Yellin, S. Bornstein, M. Balachandran, M. Siegel, and M. Magnus, Psychosocial and Behavioral Impacts of the
Mpox Outbreak among People with and without HIV in the United States, AIDS Behav., (2024). https://doi.org/
10.1007/s10461-024-04603-9
[32] Centers for Disease Control and Prevention, Vaccine for Mpox Prevention in the United States. Available from:
https://www.cdc.gov/mpox/hcp/vaccine-considerations/index.html [Accessed Jan. 09, 2025]
[33] M. G. Curtis et al., Predictors of Mpox vaccine uptake among sexual and gender minority young adults living in
Illinois: Unvaccinated vs. double vs. single dose vaccine recipients, Vaccine, 41(27), (2023), 4002–4008. https:
//doi.org/10.1016/j.vaccine.2023.05.043
[34] A. Klee, Impact of MPOX on Behavior Changes and Vaccine Uptake Among MSM, Radford University, Radford, VA,
(2023). Available from: https://wagner.radford.edu/1083/ [Accessed Dec. 15, 2024]
[35] Centers for Disease Control and Prevention, CDC Safer Sex, Social Gatherings, and Mpox. Available from: https:
//www.cdc.gov/poxvirus/mpox/prevention/sexual-health.html [Accessed Apr. 26, 2023]
[36] A. N. Chard et al., Risk of Clade II Mpox Associated with Intimate and Nonintimate Close Contact Among Men Who
Have Sex with Men and Transgender Adults — United States, August 2022–July 2023, MMWR Morb. Mortal. Wkly.
Rep., 73(40), (2024), 896–902. https://doi.org/10.15585/mmwr.mm7340a2
[37] Centers for Disease Control and Prevention, Mpox in the United States and Around the World: Current Situation.
Available from: https://www.cdc.gov/mpox/situation-summary/index.html [Accessed Dec. 15, 2024]
[38] J. L. Americo, P. L. Earl, and B. Moss, Virulence differences of mpox (monkeypox) virus clades I, IIa, and IIb.1 in
a small animal model, Proc. Natl. Acad. Sci. USA, 120(8), (2023), e2220415120. https://doi.org/10.1073/
pnas.2220415120
[39] Center for Health Security Johns Hopkins University, Mpox Virus: Clade I and Clade II Situation Update October
30, 2024. Available from: https://publichealth.jhu.edu/sites/default/files/2024-10/Mpox-SU-10.30.
24.pdf [Accessed Dec. 15, 2024]
[40] F. Branda, G. Ceccarelli, M. Ciccozzi, and F. Scarpa, First cases of mpox Clade I outside of Africa: genetic insights
on its evolution, Infect. Dis., 56(11), (2024), 1003–1005. https://doi.org/10.1080/23744235.2024.2399776
[41] Milken Institute School of Public Health, DC Cohort Longitudinal HIV Study, Milken Institute School of Public
Health, The George Washington University. Availabel from: https://publichealth.gwu.edu/projects/
dc-cohort-longitudinal-hiv-study [Accessed Jan. 12, 2024]
[42] DC Health, DC HIV Behavior Study Series 2. Available from: https://dchealth.dc.gov/sites/default/
files/dc/sites/doh/publication/attachments/MSM%20Behavioral%20Study%20Final.pdf [Accessed Oct.
15, 2024]
[43] L. Bates, A. Honeycutt, S. Bass, T. A. Green, and P. G. Farnham, Updated Estimates of the Number of Men Who
Have Sex With Men (MSM) With Indications for HIV Pre-exposure Prophylaxis, J. Acquir. Immune. Defic. Syndr.,
88(4), (2021), e28–e30. https://doi.org/10.1097/QAI.0000000000002791
[44] C. Chandra et al., Comparing Sexual Network Mean Active Degree Measurement Metrics Among Men Who Have Sex
With Men, Sex. Transm. Dis., 49(12), (2022), 808–814. https://doi.org/10.1097/OLQ.0000000000001708
[45] Government of the District of Columbia Muriel Bowser, 2023 Census Data Highlights Continued
Population Growth in Washington, DC. Available from: https://mayor.dc.gov/release/
2023-census-data-highlights-continued-population-growth-washington-dc [Accessed Oct. 15, 2024]
[46] M. I. Betti, L. Farrell, and J. Heffernan, A pair formation model with recovery: Application to mpox, Epidemics, 44,
(2023), 100693. https://doi.org/10.1016/j.epidem.2023.100693
[47] H. Ajmal, E. Hunter, J. Duggan, C. Timoney, and C. Walsh, Agent-Based Modelling of Mpox Infection Dynamics:
Simulating Disease Transmission and Control Strategies, JASSS, 27(2), (2024), 6.
[48] R. Harpaz, R. M. Dahl, and K. L. Dooling, Prevalence of Immunosuppression Among US Adults, 2013, JAMA,
316(23), (2016), 2547–2548. https://doi.org/10.1001/jama.2016.16477
[49] M. Font´an-Vela et al., Reduction in the risk of mpox infection after MVA-BN vaccination in individuals on HIV
pre-exposure prophylaxis: a Spanish cohort study, medRxiv, (2023). https://doi.org/10.1101/2023.05.30.
23290712
[50] M. Monta˜no et al., Mpox in People With Human Immunodeficiency Virus: Predictors of Diagnosis, Outcomes, and
Vaccine Effectiveness in a Multisite Cohort, Clin. Infect. Dis., (2024), ciae464. https://doi.org/10.1093/cid/
ciae464
[51] M. Banuet-Martinez et al., Monkeypox: a review of epidemiological modelling studies and how modelling has led to
mechanistic insight, Epidemiol. Infect., 151, (2023), e121. https://doi.org/10.1017/S0950268823000791
[52] Centers for Disease Control and Prevention, Signs and Symptoms of Mpox. Available from: https://www.cdc.
gov/mpox/signs-symptoms/index.html [Accessed Nov. 01, 2024]
[53] L. Ponce et al., Incubation Period and Serial Interval of Mpox in 2022 Global Outbreak Compared with Historical
Estimates, Emerg. Infect. Dis., 30(6), (2024), 1173–1181. https://doi.org/10.3201/eid3006.231095
[54] J. Kowalski, I. Cielniak, E. Garbacz-Łago˙zna, G. Cholewi´nska-Szyma´nska, and M. Parczewski, Comparison of
clinical course of Mpox among HIV-negative and HIV-positive patients: A 2022 cohort of hospitalized patients in
Central Europe, J. Med. Virol., 95(10), (2023), e29172. https://doi.org/10.1002/jmv.29172
[55] Z. J. Madewell et al., Serial interval and incubation period estimates of monkeypox virus infection in 12 U.S. jurisdictions,
May – August 2022, Epidemiology, (2022), preprint. https://doi.org/10.1101/2022.10.26.22281516
[56] J. L. Farrar, Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of
JYNNEOS Vaccine and in Unvaccinated Persons—29 U.S. Jurisdictions, May 22–September 3, 2022,” MMWR Morb.
Mortal. Wkly. Rep., 71(5152), (2022), 1610–1615. https://doi.org/10.15585/mmwr.mm715152a2
[57] H. Yon et al., Clinical manifestations of human Mpox infection: A systematic review and meta-analysis, Rev. Med.
Virol., 33(4), (2023), e2446. https://doi.org/10.1002/rmv.2446
[58] G. R. Olivencia, M. M. V. Garc´ıa, M. V. Arribas, J. Casabona, M. J. Mart´ınez, and F. J. M. D. Novales, Hospitalization
determinants in patients with Mpox disease: The CEME-22 Project, Heliyon, 10(9), (2024), e30564.
https://doi.org/10.1016/j.heliyon.2024.e30564
[59] W. M. Garneau et al., Risk Factors for Hospitalization and Effect of Immunosuppression on Clinical Outcomes Among
an Urban Cohort of Patients With Mpox, Open Forum Infectious Diseases, 10(12), (2023), ofad533. https:
//doi.org/10.1093/ofid/ofad533
[60] Q. Liu et al., Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis,
Pathogens, 12(1), (2023), 146. https://doi.org/10.3390/pathogens12010146
[61] P. C. Eustaquio, L. A. T. Salmon-Trejo, McGuire, and S. Ellington, Epidemiologic and Clinical Features of Mpox
in Adults Aged ¿50 Years — United States, May 2022–May 2023, MMWR Morb. Mortal. Wkly. Rep., 72, (2023).
https://doi.org/10.15585/mmwr.mm7233a3
[62] Centers for Disease Control and Prevention, Mpox Infection Prevention and Control in Healthcare Settings. Available
from: https://www.cdc.gov/mpox/hcp/infection-control/healthcare-settings.html [Accessed Oct.
15, 2024]
[63] S. T. Kr¨oger et al., Mpox outbreak 2022: an overview of all cases reported to the Cologne Health Department,
Infection, 51(5), (2023), 1369–1381. https://doi.org/10.1007/s15010-023-01997-x
[64] D. Ogoina, I. Damon, and E. Nakoune, Clinical review of human mpox, Clin. Microbiol. Infect., 29(12), (2023),
1493–1501. https://doi.org/10.1016/j.cmi.2023.09.004
[65] Centers for Disease Control and Prevention, Clinical Features of Mpox. Available from: https://www.cdc.gov/
mpox/hcp/clinical-signs/ [Accessed Mar. 25, 2024]
[66] World Health Organization, Mpox. Available from: https://www.who.int/news-room/fact-sheets/detail/
monkeypox [Accessed Feb. 11, 2025]
[67] V. Mazzotta et al., Poor evidence for an effect of tecovirimat in shortening recovery time in hospitalized mpox cases
from real-world data, medRxiv, (2023). https://doi.org/10.1101/2023.02.07.23285617
[68] V. Mazzotta et al., Effect of tecovirimat on healing time and viral clearance by emulation of a target trial in patients
hospitalized for mpox, J. Med. Virol., 95(6), (2023), e28868. https://doi.org/10.1002/jmv.28868
[69] L. Hermanussen et al., Tecovirimat for the treatment of severe Mpox in Germany, Infection, 51(5), (2023),
1563–1568. https://doi.org/10.1007/s15010-023-02049-0
[70] A. P. Riser et al., Epidemiologic and Clinical Features of Mpox-Associated Deaths — United States, May 10,
2022–March 7, 2023, MMWR Morb. Mortal. Wkly. Rep., 72(15), (2023), 404–410. https://doi.org/10.15585/
mmwr.mm7215a5
[71] Centers for Disease Control and Prevention, Provisional COVID-19 Mortality Surveillance. Available from: https:
//www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm [Accessed Oct. 15, 2024]
[72] U.S. Census Bureau, QuickFacts: District of Columbia. Available from: https://www.census.gov/quickfacts/
fact/table/DC/PST040221 [Accessed Oct. 15, 2024]
[73] DC Health, HAHSTA Annual Epidemiology & Surveillance Report 2022. Available from: https://dchealth.dc.
gov/node/1643226 [Accessed Mar. 13, 2024]
[74] Centers for Disease Control and Prevention, Preventing Mpox. Available from: https://www.cdc.gov/mpox/
prevention/index.html [Accessed Feb. 11, 2025]
[75] J. H. McQuiston et al., U.S. Preparedness and Response to Increasing Clade I Mpox Cases in the Democratic Republic
of the Congo — United States, 2024, MMWR Morb. Mortal. Wkly. Rep., 73(19), (2024), 435–440. https://doi.
org/10.15585/mmwr.mm7319a3
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