Preparing for mpox resurgence: Surveillance lessons from outbreaks in Toronto, Canada

Author:

Sachdeva Herveen12,Shahin Rita12,Ota Sylvia1,Isabel Sandra34,Mangat Chand S5,Stuart Rebecca1,Padhi Shovita12,Chris Allison12,Mishra Sharmistha678910,Tan Darrell H S67810,Braukmann Tom W3,Eshaghi AliReza3,Mejia Edgard M5,Hizon Nikho A5,Finkelstein Michael12

Affiliation:

1. Toronto Public Health , Toronto, Ontario , Canada

2. Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada

3. Public Health Ontario , Toronto, Ontario , Canada

4. Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec, Québec, G1 V 4G2 , Canada

5. Wastewater Surveillance Unit, National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg, Manitoba , Canada

6. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto , Toronto, Ontario , Canada

7. Department of Medicine, Temerty Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada

8. Institute of Health Policy, Management and Evaluation, and Institute of Medical Science, University of Toronto , Toronto, Ontario , Canada

9. ICES , Toronto, Ontario , Canada

10. Division of Infectious Diseases, St. Michael’s Hospital , Toronto, Ontario , Canada

Abstract

Abstract Background Along with many global jurisdictions, Toronto, Canada experienced an outbreak of mpox in the spring/summer of 2022. Case counts declined following the implementation of a large vaccination campaign. A surge of case reports in early 2023 led to speculation that asymptomatic and/or undetected local transmission was occurring in the city. Methods Mpox cases and positive laboratory results are reported to Toronto Public Health. Epidemic curves and descriptive risk factor summaries for the 2022 and 2023 outbreaks were generated. First and second dose vaccination was monitored. Monkeypox virus wastewater surveillance and whole genome sequencing (WGS) were conducted to generate hypotheses about the source of the 2023 resurgence. Results 515 cases were reported in the spring/summer outbreak of 2022 and 17 in the 2022-2023 resurgence. Wastewater data correlated with the timing of reported cases. WGS showed that the 2022-2023 resurgent cases were distinct from the other 2022 cases and closer to sequences from another country, suggesting a new importation as a source for recent cases. At the start of the 2022-2023 resurgence, it was estimated that only 16% of first dose vaccine recipients had completed their second dose vaccination. Discussion This investigation demonstrates the importance of ongoing surveillance and preparedness for mpox outbreaks. Undetected local transmission was not a likely source of the 2022-2023 resurgence. Ongoing pre-exposure vaccine promotion remains important to mitigate disease burden.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Immunology and Allergy

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