RT Journal Article
SR Electronic
T1 Understanding sexual transmission dynamics and transmission contexts of monkeypox virus: a mixed-methods study of the early outbreak in Belgium (May–June 2022)
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP sextrans-2022-055601
DO 10.1136/sextrans-2022-055601
A1 Jef Vanhamel
A1 Valeska Laisnez
A1 Laurens Liesenborghs
A1 Isabel Brosius
A1 Nicole Berens-Riha
A1 Thibaut Vanbaelen
A1 Chris Kenyon
A1 Koen Vercauteren
A1 Marie Laga
A1 Naïma Hammami
A1 Oriane Lambricht
A1 Romain Mahieu
A1 Amaryl Lecompte
A1 Wim Vanden Berghe
A1 Bea Vuylsteke
YR 2022
UL http://sti.bmj.com/content/early/2023/01/20/sextrans-2022-055601.abstract
AB Objective The available epidemiological and clinical evidence from the currently ongoing monkeypox (MPX) outbreak in non-endemic areas suggests an important factor of sexual transmission. However, limited information on the behaviour and experiences of individuals with an MPX infection has to date been provided. We aimed to describe the initial phase of the MPX outbreak in Belgium, and to provide a more in-depth description of sexual behaviour and transmission contexts.Methods We used routine national surveillance data of 139 confirmed MPX cases with date of symptom onset until 19 June 2022, complemented with 12 semistructured interviews conducted with a subsample of these cases.Results Sexualised environments, including large festivals and cruising venues for gay men, were the suspected exposure setting for the majority of the cases in the early outbreak phase. In-depth narratives of sexual behaviour support the hypothesis of MPX transmission through close physical contact during sex. Despite awareness of the ongoing MPX outbreak, low self-perceived risk of MPX acquisition and confusing initial signs and symptoms for other STIs or skin conditions delayed early detection of an MPX infection. In addition, we describe relevant contextual factors beyond individual behaviour, related to sexual networks, interpersonal interactions and health systems. Some of these factors may complicate early MPX detection and control efforts.Conclusion Our results highlight the role of sexual contact and networks in the transmission of MPX during the early phase of the outbreak in Belgium. Risk communication messages should consistently and transparently state the predominant sexual transmission potential of MPX virus, and prevention and control measures must be adapted to reflect multilevel factors contributing to MPX transmission risk.Data are available upon reasonable request. All relevant data supporting our findings are included in this published article. The complete dataset of conducted interviews is not made publicly available because they might contain information that could identify other persons, yet additional anonymised data are available from the corresponding author on reasonable request.