Lin Yin-Chien, Wen Tzai-Hung, Shih Wei-Liang, Vermund Sten H, Fang Chi-Tai
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Geography, National Taiwan University, Taiwan.
EClinicalMedicine. 2024 Jan 5;68:102407. doi: 10.1016/j.eclinm.2023.102407. eCollection 2024 Feb.
The unprecedented global outbreak of mpox in 2022 posed a public health challenge. In addition to the mpox vaccine campaign in the United States (US), community organisations and public health agencies initiated educational efforts to promote sexual risk reduction. This modelling study estimated the impact of the two-dose vaccination campaign and sexual behaviour changes coincident with high-risk group awareness on the mpox epidemic in the US.
We fitted a deterministic, risk-structured SEIARV model to the epidemic curve of reported mpox cases in the US between May 22, 2022 and December 22, 2022. We evaluated the putative effects of the two preventive responses in the US -- vaccination and sexual risk reduction -- at the population-level, by calculating the prevention percentages of cumulative cases compared to the counterfactual scenario without interventions. We performed sensitivity analyses with four parameters: case reporting fidelity, vaccine effectiveness, proportion of asymptomatic cases, and assortative mixing.
Model fitting revealed a basic reproduction number of 3.88 and 0.39 for the high-risk and low-risk populations, respectively, with 71.8% of mpox cases estimated from the high-risk population. A two-dose vaccination campaign, solely, could prevent 21.2% (10.2%-24.1%) of cases, while behaviour changes due to high-risk group awareness alone could prevent 15.4% (14.3%-20.6%). The combination of both measures were synergistic, with the model suggesting that 64.0% (43.8%-69.0%) of US cases were averted that would have otherwise occurred.
Our models suggest that the 2022-2023 mpox epidemic in the US was controlled by a combination of two-dose mpox vaccination campaign and high-risk group awareness and sexual risk reduction.
Taiwan Ministry of Education grant #NTU-112L9004, Taiwan National Science and Technology Council grant #MOST-109-2314-B-002-147-MY3 and grant #NSC-112-2314-B-002-216-MY3. SHV was supported, in part, by US National Institutes of Health grant #P30MH062294.
2022年全球范围内史无前例的猴痘疫情爆发带来了公共卫生挑战。除了美国开展的猴痘疫苗接种活动外，社区组织和公共卫生机构还发起了教育活动以促进降低性传播风险。这项建模研究估计了两剂次疫苗接种活动以及与高危人群意识相关的性行为变化对美国猴痘疫情的影响。
我们将一个确定性的、按风险分层的SEIARV模型拟合到2022年5月22日至2022年12月22日美国报告的猴痘病例流行曲线。我们通过计算与无干预的反事实情景相比累计病例的预防百分比，在人群层面评估了美国两种预防措施——疫苗接种和降低性传播风险——的假定效果。我们对四个参数进行了敏感性分析：病例报告保真度、疫苗效力、无症状病例比例和分类混合。
模型拟合显示高危人群和低危人群的基本再生数分别为3.88和0.39，估计71.8%的猴痘病例来自高危人群。仅两剂次疫苗接种活动可预防21.2%（10.2%-24.1%）的病例，而仅因高危人群意识导致的行为变化可预防15.4%（由14.3%-20.6%）。两种措施相结合具有协同作用，模型表明可避免64.0%（43.8%-69.0%）本会发生的美国病例。
我们的模型表明，美国2022-2023年的猴痘疫情是通过两剂次猴痘疫苗接种活动以及高危人群意识和降低性传播风险的结合得以控制的。
台湾教育部资助项目#NTU-112L9004、台湾国家科学技术委员会资助项目#MOST-109-2314-B-002-147-MY3和资助项目#NSC-112-2314-B-002-216-MY3。SHV部分得到了美国国立卫生研究院资助项目#P30MH062294的支持。
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