Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study)

• Published in: Open forum infectious diseases Vol. 11; no. 3; p. ofae105
• Main Authors: Ramírez-Olivencia, G, Velasco Arribas, M, Vera García, M M, Casabona, J, Martínez, M J, Membrillo De Novales, F J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-03-2024
• Subjects: tecovirimat; STI; emerging infections; HIV; mpox
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofae105

Abstract
Background
We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease.
Methods
This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected.
Results
Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died.
Conclusions
Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.
The SEIMC-CEME-22 study in Spain investigated the mpox outbreak. Predominantly middle-aged, cisgender men with a high HIV prevalence were affected, primarily through sexual transmission. Prominent symptoms included rash (95.7%) and fever (48.2%). STI were concurrently diagnosed. Diverse treatments were administered.