Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study)
Authors: Ramírez-Olivencia G , Velasco Arribas M , Vera García M M , Casabona J , Martínez M J , Membrillo De Novales F J ,   CEME-22 Study Group, Ramírez-Olivencia G , Arribas M Velasco , García M M Vera , Casabona J , Martínez M J , De Novales F J Membrillo , García E Orviz , Ubeda A Cabello , Muñoz P , López P Álvarez , De La Serna J I Bernardino , Camacho I Pérez , González J López-Contreras , Liarte Á Gutiérrez , Ryan P , Guerra G Jiménez , Gallego M J Vivancos , Gutiérrez M J Urrutikoetxea , Betancor M A Hernández , Beamonte A M Milagro , González E Lagaretos , Serrano A Muñoz , Jiménez J A Lepe , Sancho A Ruiz , Flórez J Alcoba , De Cea Á Mena , Lorite M N Navarrete , Corma-Gómez A , Ocete M D , Sacristán M Simón , Segarra O Martín , Román A Rivero , Sánchez E Delgado , Tendero D Torrús , Borrego B Valle , Gámez S L Sanbonmatsu , Van Den Eynde E , González A Pérez , Serra F Artigues , Pérez P González-Ruano , Neira D V Gerez , Amador-Prous C , Galparsoro H Azkune , Martín L Mao , Rosado D García , Expósito Ó Martínez , Fernández-Llamazares G Soria , Soto M Blanco , Rodríguez M Á Morán , Castellano M M Treviño , Masiá M M , Navarro A M Castillo , Berrocal M A Sepúlveda , Gómez L Sánchez , Alonso A Vallejo , Artero E Álvarez , Barber M D C Sáez , Morell E Bernal , Ayerdi Ó , Acosta I Carrillo , Veintimilla C , Vidovic-Mendoza P , Mora M , Baza B 
Published: February 2024

Abstract

Background
We conducted a multicentric national study (SEIMC-CEME-22), to describe the clinical and epidemiological profile of the mpox outbreak in Spain, including the management of the disease.

Methods
This was a retrospective national observational study conducted by Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) and Foundation SEIMC-GESIDA. We included patients with a confirmed mpox diagnosis before 13 July 2022, and attended at the Spanish health network (the early phase of the outbreak). Epidemiological, clinical, and therapeutic data were collected.

Results
Of a total of 1472 patients from 52 centers included, 99% of them were cisgender men, mostly middle-aged, and 98.6% were residents in Spain. The main suspected route of transmission was sexual exposure, primarily among MSM. Occupational exposure was reported in 6 patients. Immunosuppression was present in 40% of patients, mainly due to human immunodeficiency virus (HIV). Only 6.5% of patients had been vaccinated against orthopoxvirus. Virus sequencing was performed in 147 patients (all B.1 lineage). Rash was the most frequent symptom (95.7%), followed by fever (48.2%), adenopathies (44.4%) myalgias (20.7%), proctitis (17%), and headache (14.7%). Simultaneously diagnosed sexually transmitted infections included syphilis (n = 129), gonococcal infection (n = 91), HIV (n = 67), chlamydia (n = 56), hepatitis B (n = 14), and hepatitis C (n = 11). No therapy was used in 479 patients (33%). Symptomatic therapies and antibiotics were used in 50% of cases. The most used therapy regimens were systemic corticoids (90 patients), tecovirimat (6 patients), and cidofovir (13 patients). Smallpox immunoglobulins were used in 1 patient. Fifty-eight patients were hospitalized, and 1 patient died.

Conclusions
Mpox outbreak in Spain affected primarily middle-aged men who were sexually active and showed a high rate of HIV infection. A range of heterogeneous therapeutics options was performed.