Monkeypox outbreaks in the context of the COVID-19 pandemic: Network and clustering analyses of global risks and modified SEIR prediction of epidemic trends

Jing Gao; Cui Zhou; Hanwei Liang; Rao Jiao; Åsa M Wheelock; Kedi Jiao; Jian Ma; Chutian Zhang; Yongman Guo; Sitong Luo; Wannian Liang; Lei Xu

doi:10.3389/fpubh.2023.1052946

Monkeypox outbreaks in the context of the COVID-19 pandemic: Network and clustering analyses of global risks and modified SEIR prediction of epidemic trends

Front Public Health. 2023 Jan 24:11:1052946. doi: 10.3389/fpubh.2023.1052946. eCollection 2023.

Authors

Jing Gao^{1

2

3

4}, Cui Zhou^{1

2}, Hanwei Liang^{1

2}, Rao Jiao⁵, Åsa M Wheelock⁴, Kedi Jiao^{1

2}, Jian Ma^{1

2}, Chutian Zhang^{1

2}, Yongman Guo^{1

2}, Sitong Luo^{1

2}, Wannian Liang^{1

2}, Lei Xu^{1

2}

Affiliations

¹ Vanke School of Public Health, Tsinghua University, Beijing, China.
² Institute for Healthy China, Tsinghua University, Beijing, China.
³ Respiratory Medicine Unit, Department of Medicine and Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
⁴ Heart and Lung Centre, Department of Pulmonary Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁵ Department of Mathematical Science, Tsinghua University, Beijing, China.

Abstract

Background: Ninety-eight percent of documented cases of the zoonotic disease human monkeypox (MPX) were reported after 2001, with especially dramatic global spread in 2022. This longitudinal study aimed to assess spatiotemporal risk factors of MPX infection and predict global epidemiological trends.

Method: Twenty-one potential risk factors were evaluated by correlation-based network analysis and multivariate regression. Country-level risk was assessed using a modified Susceptible-Exposed-Infectious-Removed (SEIR) model and a risk-factor-driven k-means clustering analysis.

Results: Between historical cases and the 2022 outbreak, MPX infection risk factors changed from relatively simple [human immunodeficiency virus (HIV) infection and population density] to multiple [human mobility, population of men who have sex with men, coronavirus disease 2019 (COVID-19) infection, and socioeconomic factors], with human mobility in the context of COVID-19 being especially key. The 141 included countries classified into three risk clusters: 24 high-risk countries mainly in West Europe and Northern America, 70 medium-risk countries mainly in Latin America and Asia, and 47 low-risk countries mainly in Africa and South Asia. The modified SEIR model predicted declining transmission rates, with basic reproduction numbers ranging 1.61-7.84 in the early stage and 0.70-4.13 in the current stage. The estimated cumulative cases in Northern and Latin America may overtake the number in Europe in autumn 2022.

Conclusions: In the current outbreak, risk factors for MPX infection have changed and expanded. Forecasts of epidemiological trends from our modified SEIR models suggest that Northern America and Latin America are at greater risk of MPX infection in the future.

Keywords: COVID-19; SEIR; global health; monkeypox; prediction; risk assessment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Disease Outbreaks
HIV Infections* / epidemiology
Homosexuality, Male
Humans
Longitudinal Studies
Male
Mpox (monkeypox)* / epidemiology
Pandemics
Sexual and Gender Minorities*

Grants and funding

This work was funded by the Vanke School of Public Health, Tsinghua University, China; Sanming Project of Medicine in Shenzhen (No. SZSM202111001); and National Natural Science Foundation of China (No. L2124008).