Clinical and Epidemiological Characteristics of the 2022 Mpox Outbreak in Spain (CEME-22 Study)
Germán Ramírez‐Olivencia, M Velasco Arribas, M M Vera García, Jordi Casabona, Miguel J. Martínez, Francisco Javier Membrillo de Novales, CEME-22 Study Group, Germán Ramírez‐Olivencia, M Velasco Arribas, M M Vera García, J Casabona, Miguel J. Martínez, F J Membrillo De Novales, Eva Orviz, A Cabello Ubeda, Patricia Muñóz, P Álvarez López, J I Bernardino De La Serna, Inés Pérez Camacho, J López-Contreras González, Ángela Gutiérrez, Pablo Ryan, Gemma Jiménez-Guerra, M J Vivancos Gallego, M J Urrutikoetxea Gutiérrez, Marina Betancor, Ana Milagro, E Lagaretos González, Adriana Serrano, J A Lepe Jiménez, Andrés Ruiz Sancho, Julia Alcoba-Flórez, A. Mena de, Miguel Nicolás Navarrete Lorite, Anaïs Corma‐Gómez, María Dolores Ocete, María Simón Sacristán, Oriol Martín Segarra, Antonio Rivero Román, Elsa Delgado-Sánchez, Diego Torrús Tendero, Beatriz Valle Borrego, Stephanie Gamez, Eva Van den Eynde, Aurora Pérez González, Francisca Artigues Serra, P González-Ruano Pérez, D.V. Gerez Neira, Concepción Amador-Prous, Harkaitz Azkune Galparsoro, Laura Martín, Dácil García Rosado, Ó Martínez Expósito, Guillermo Soria Fernández‐Llamazares, Montserrat Soto, Mercedes Rodríguez, M M Treviño Castellano, Mar Masiá, Ana Navarro, Martina Berrocal, L Sánchez Gómez, Alena Alonso, Elisa Álvarez Artero, M D C Sáez Barber, E Bernal Morell, Oskar Ayerdi, Isabel C. Iglesias Acosta, C Veintimilla, P Vidovic-Mendoza, Marta Mora-Rillo, Begoña Baza
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.