AccScience Publishing / MI / Online First / DOI: 10.36922/MI025180039
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Prospective screening for monkeypox infection among men who have sex with men at an infectious diseases outpatient clinic in Copenhagen, Denmark

Nuno Felipe Miranda Freire de Andrade1* ,  Mette Pinholt2 ,  Julie Maria Korsholm Mindedahl Nyamadi1 ,  Gitte Kronborg1,3 ,  Frederik Neess Engsig1*
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1 Department of Infectious Diseases, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Capital Region, Denmark
2 Department of Clinical Microbiology, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Capital Region, Denmark
3 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Capital Region, Denmark
MI, 025180039 https://doi.org/10.36922/MI025180039
Received: 29 April 2025 | Revised: 27 May 2025 | Accepted: 17 June 2025 | Published online: 4 July 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Since 2022, over 102,000 cases of mpox clade IIb have been reported worldwide, primarily among men who have sex with men. Key risk factors include human immunodeficiency virus (HIV) infection and the use of HIV pre-exposure prophylaxis (PrEP). In Denmark, the pox vaccine (Imvanex®) has been available to at-risk individuals since 2022. However, emerging cases of mpox reinfection have raised concerns regarding vaccine-induced immunity and the potential for asymptomatic transmission. This study aimed to assess the necessity of screening for mpox in an asymptomatic yet high-risk population, the majority of whom had been vaccinated. Between August and October 2023, we screened 123 PrEP users for mpox at the outpatient clinic of Copenhagen University Hospital – Amager and Hvidovre, Denmark. Polymerase chain reaction testing for mpox was conducted using rectal swabs. Among the participants, 97 had received at least one dose of the mpox vaccine. No mpox cases were detected. These findings suggest that in a highly vaccinated, high-risk population during a period of very low mpox prevalence in Denmark, asymptomatic mpox circulation is unlikely. The results support the current public health strategy of prioritizing mpox testing for symptomatic individuals and implementing contact tracing during low-prevalence periods with high vaccine coverage.

Keywords
Mpox
Vaccination
Screening
Men who have sex with men
Pre-exposure prophylaxis
Human immunodeficiency virus
Transmission
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing
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