Optimizing Mpox surveillance strategies and preventing epidemic resurgence: a three-province mathematical modeling study

Mpox is a viral disease that causes blisters and lesions on the body. It is generally transmitted from animals to humans but, during the 2022 global outbreak, human-to-human transmission was sustained through sexual contacts. The outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBM) in Canada's three largest cities. Following a rapid public health response, it was brought under control in Canada. The mpox virus isn't completely gone, however, and we are not indefinitely protected from epidemic resurgence. With potential for mpox resurgence, public health authorities will need guidance to identify and define new outbreaks that could lead to significant transmission. Conditions that would facilitate new epidemics include sub-optimal vaccine coverage, loss of immunity, and changes in sexual networks. Wastewater-based surveillance (WBS) could be used to detect mpox and track outbreaks but has not been validated yet. Other potential surveillance strategies should consider the overlap between mpox and other sexually transmitted infections. For instance, 3 out of 5 people diagnosed with mpox in Canada had a recent history of sexually transmitted infections. Our project aims to inform national decision-making by answering three questions: 1.If new cases emerge, how will we know if there is about to be another large outbreak versus one that is self-contained? 2.What would it take to stop a new outbreak in its tracks, given the current coverage of vaccinations and infection-derived immunity? 3.Which surveillance strategies need to be put in place to detect new cases early and efficiently? To fill these knowledge gaps, our interdisciplinary team of trainees, epidemiologists, modelers, clinicians, engineers, microbiologists, health economists, public health professionals, and community-based researchers will help our country prepare for and respond to future infectious threats.