Literature review on mathematical and phylodynamic modelling of mpox outbreaks in men who have sex with men populations

Abstract

Background: Mpox, previously known as 'monkeypox' poses a significant concern for public health, especially among men who have sex with men (MSM) communities. This was emphasized by the 2022-2023 international mpox outbreak, in which >98% of cases globally were MSM. Given the status of MSM as a high-risk group for mpox transmission, targeted interventions are necessary. Objective: We aimed to conduct a literature review and evidence synthesis of studies describing mathematical modeling of mpox outbreaks in MSM populations and phylodynamic analyses of mpox. Our aim was to identify the most effective interventions for limiting outbreak spread and to locate potential gaps in the literature. Methods: After conducting a systematic and thorough search of the available literature, 35 studies that fulfilled the search criteria were selected. We extracted data about the types of models and analyses used, sources of data, and the principal results of the studies and which interventions the authors recommended. Results: We found that despite the variety in model types, phylodynamic analyses methods, data sources and techniques used, there was a distinct trend in recommended interventions. Most studies recommended vaccination (especially targeted towards high-risk groups), behavior changes (such as condom use and reduction in sexual contacts), enhanced genomic surveillance to track viral evolution, and surveillance and timely detection of cases via contact tracing. We identified several gaps in the literature pertaining to studies focusing only on MPXV clade IIb. This limits the generalizability of their results, especially in the wake of the August 2024 outbreak which was caused by clade I.b. Conclusion: Mpox has transitioned from a zoonotic to a human-to-human transmitted disease. Our study highlights the importance of MSM being included in public health strategies against mpox. Such strategies should include interventions such as the ones mentioned above to control the outbreak. The gaps we identified should be addressed by future research to improve knowledge of mpox transmission dynamics and assure outbreak preparedness.