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The following is a summary of “Temporary adaptations to sexual behaviour during the mpox outbreak in 23 countries in Europe and the Americas: findings from a retrospective cross-sectional online survey,” published in the September 2024 issue of Infectious Disease by Prochazka et al.

With a rapid gain in cases between May and August 2022, new mpox diagnoses were reduced in Europe and America; understanding the extent of behavioral changes, vaccination coverage, and mpox prevalence in these regions can help in understanding the transmission dynamics of the virus.

Researchers conducted a retrospective study to examine changes in sexual behavior related to mpox among affected communities in Europe and the Americas during the 1st year of the outbreak.

They conducted an online survey in 23 countries between May 19 and May 31, 2023. Eligible participants were 18 years old or older and identified as gay, bisexual, men who have sex with men, transgender, or non-binary, who were described and compared mpox prevalence, vaccination rates, and behavioral adaptations and used regression analyses to estimate crude prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) with 95% CIs for behavioral outcomes.

The results showed that of 17,428 individuals who completed the survey, 16,875 (96.8%) were eligible for inclusion, while 1,086 (6.4%) participants reported mpox during the outbreak. Vaccination with at least 1 dose was reported by 4,987 (29.6%), while 3,502 (20.8%) reported receiving 2 doses. Vaccination rates were lower in Latin America, Eastern Europe, and the Western Balkans compared to Western Europe and Northern America (P< 0.0001). Behavioral adaptations regarding sexual practices were by 8,583 (50.9%) of 16,875 participants, with 3,045 (35.5%) continuing adaptations until May 2023. Among participants, 9,884 (58.6%) expressed concerns about mpox, making them more likely to adapt their behavior (PR 2.43 [95% CI 2.34–2.53]). In adjusted regression models, participants who were vaccinated (aPR 0.25 [95% CI 0.21–0.28] for 2 doses and 0.43 [0.37–0.51] for 1 dose) or had mpox (0.37 [0.30–0.44]) were less likely to maintain adaptations compared to those who did not. Participants in Latin America and northern America were more likely to modify their sexual behavior and to continue these adaptations than those in Western Europe.

They concluded adaptations to sexual behavior, combined with naturally acquired immunity, likely contributed to the decline in mpox transmission, emphasizing the importance of equitable access to mpox vaccines.

Source: thelancet.com/journals/laninf/article/PIIS1473-3099(24)00531-0/abstract