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Abstract
Objectives In 2022, a global outbreak of mpox was reported. In the UK, it predominantly affected gay, bisexual and men who have sex with men (GBMSM). The study objectives were to describe the impact of the mpox outbreak on healthcare service usage in England in 2022, particularly emergency department (ED) attendance, inpatient admission and a number of bed days. Additionally, we wanted to explore whether pre-exposure prophylaxis (PrEP) usage, as a marker of condomless anal intercourse, which increases the risk of sexually transmitted infections associated with compromised skin integrity, was associated with higher ED attendance or hospital attendance.
Methods Data on adult males with laboratory-confirmed mpox were linked with hospital records and described. Using routinely collected data and self-reported exposure data (including PrEP usage) from surveillance questionnaires, multinomial regression was used to estimate adjusted relative risk ratios (aRRRs) with 95% CIs for ED attendance and hospital admission compared with those not admitted.
Results Among 3542 adult males with mpox during May to December 2022, 544 (15.4%) attended ED and 202 (5.7%) were admitted to the hospital. London had the most cases (2393, 68.7%), ED attendances (391, 71.9%) and hospital admissions (121, 59.9%). In multinomial regression, we found strong evidence that compared with people living with HIV, the aRRR for hospital admissions was higher in those not using PrEP (6.9 (95% CI 2.3 to 20.6) vs 4.9 (95% CI 1.7 to 14.1)). The aRRR for ED attendance was 0.63 (95% CI 0.36 to 1.1) for those not using PrEP versus 0.49 (95% CI 0.31 to 0.79).
Conclusions This outbreak had a considerable impact on health services, particularly in high-incidence areas. Commissioners of sexual and healthcare services should review plans for healthcare provision for similar sexually transmitted infection or novel outbreaks among GBMSM or naïve populations in the future. Further studies are needed to confirm and identify reasons for the higher likelihood of hospital admission seen for GBMSM without HIV infection.
- PUBLIC HEALTH
- Epidemiology
- INFECTION
- HEALTH SERVICES RESEARCH
Data availability statement
Data are available upon reasonable request. Due to the risk of deductive disclosure, we are unable to share the raw data. UKHSA operates a robust governance process for access to protected data, where it is lawful, ethical and safe to do so. Organisations looking to access UKHSA data for public health purposes can contact DataAccess@ukhsa.gov.uk to request an application pack. Further information can be found on (https://www.gov.uk/government/publications/accessing-ukhsa-protected-data/accessing-ukhsa-protected-data).
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Data availability statement
Data are available upon reasonable request. Due to the risk of deductive disclosure, we are unable to share the raw data. UKHSA operates a robust governance process for access to protected data, where it is lawful, ethical and safe to do so. Organisations looking to access UKHSA data for public health purposes can contact DataAccess@ukhsa.gov.uk to request an application pack. Further information can be found on (https://www.gov.uk/government/publications/accessing-ukhsa-protected-data/accessing-ukhsa-protected-data).
Footnotes
Handling editor Anna Maria Geretti
Contributors All authors were involved in the development of the protocol and submission for ethics approval. RV, AB and KP ensured the correct data was available, and HT and KP led the analysis and write up of results. All authors were involved in review and editing the submissions to ethics and editing of this manuscript. KP acts as guarantor.
Funding RV receives support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging Infections and the NIHR HPRU in Gastrointestinal Infections. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. Funding was not applicable to this study.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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