AccScience Publishing / MI / Online First / DOI: 10.36922/MI025180039
Submit to MI
Cite this article
8
Download
217
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
COMMUNICATION

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*
Show Less
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/ )
Download PDF
Cite
XML
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.
References
  1. Available from: https://www.ecdc.europa.eu/en/mpox. [Last accessed on 2024 Oct 24].

 

  1. World Health Organization. 2022 Mpox (Monkeypox) Outbreak: Global Trends; 2024. Available from: https:// worldhealthorg.shinyapps.io/mpx_global [Last accessed on 2024 Oct 24].

 

  1. Ongoing Clade II Mpox Global Outbreak-Mpox-CDC. Available from: https://www.cdc.gov/mpox/outbreaks/2022/ index-1.htm [Last accessed on 2024 Nov 02].

 

  1. CROI. Conference on Retroviruses and Opportunistic Infections; 2025. Available from: https://www.croiconference. org/abstract/3822-2025 [Last accessed on 2025 May 25].

 

  1. Tiee MS, Mbala-Kingebeni P, Tshiani Mbaya O, et al. Tecovirimat for clade I MPXV infection in the democratic republic of Congo. N Engl J Med. 2024;390(21):1992-2001. doi: 10.1056/NEJMoa2412439

 

  1. Internationalt Udbrud af Mpox (Abekopper), Situationen i Danmark. International Outbreak of Mpox. Situation in Denmark. Available from: https://www.ssi.dk/sygdomme [Last accessed on 2024 Oct 24].

 

  1. Thornhill JP, Palich R, Ghosn J, et al. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: A global case series. Lancet. 2022;400(10367):1953-1965. doi: 10.1016/S0140-6736(22)02187-0

 

  1. Laurenson-Schafer H, Sklenovská N, Hoxha A, et al. Description of the first global outbreak of mpox: An analysis of global surveillance data. Lancet Glob Health. 2023;11(7):e1012-e1023. doi: 10.1016/S2214-109X(23)00198-5

 

  1. De Vries HJ, Götz HM, Bruisten S, et al. Mpox outbreak among men who have sex with men in Amsterdam and Rotterdam, the Netherlands: No evidence for undetected transmission prior to May 2022, a retrospective study. Euro Surveill. 2023;28(17):2200869. doi: 10.2807/1560-7917.ES.2023.28.17.2200869

 

  1. Pan D, Nazareth J, Sze S, et al. Transmission of monkeypox/ mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak. J Med Virol. 2023;95(2):e28534. doi: 10.1002/jmv.28534

 

  1. Jia L, Yan B, Fang Y, et al. Cases of Monkeypox show highly-overlapping co-infection with HIV and syphilis. Front Public Health. 2024;11:1276821. doi: 10.3389/fpubh.2023.1276821

 

  1. Hazra A, Zucker J, Bell E, et al. Mpox in people with past infection or a complete vaccination course: A global case series. Lancet Infect Dis. 2024;24(1):57-64. doi: 10.1016/S1473-3099(23)00492-9

 

  1. Mitjà O, Alemany A, Marks M, et al. Mpox in people with advanced HIV infection: A global case series. Lancet. 2023;401(10380):939-949. doi: 10.1016/S0140-6736(23)00273-8

 

  1. Protopapas K, Dimopoulou D, Kalesis N, Akinosoglou K, Moschopoulos CD. Mpox and lessons learned in the light of the recent outbreak: A narrative review. Viruses. 2024;16(10):1620. doi: 10.3390/v16101620

 

  1. Pinnetti C, Cimini E, Mazzotta V, et al. Mpox as AIDS-defining event with a severe and protracted course: Clinical, immunological, and virological implications. Lancet Infect Dis. 2024;24(2):e127-e135. doi: 10.1016/S1473-3099(23)00482-6

 

  1. Orma-Gómez A, Cabello A, Orviz E, et al. Long or complicated mpox in patients with uncontrolled HIV infection. J Med Virol. 2024;96(3):e29511. doi: 10.1002/jmv.29511

 

  1. Thy M, Peiffer-Smadja N, Mailhe M, et al. Breakthrough infections after postexposure vaccination against Mpox. N Engl J Med. 2022;387(26):2477-2479. doi: 10.1056/NEJMc2211944

 

  1. Raccagni AR, Canetti D, Mileto D, et al. Two individuals with potential monkeypox virus reinfection. Lancet Infect Dis. 2023;23(5):522-524. doi: 10.1016/S1473-3099(23)00185-8

 

  1. Musumeci S, Najjar I, Amari EBE, et al. A case of Mpox reinfection. Clin Infect Dis. 2023;77(1):135-137. doi: 10.1093/cid/ciad147

 

  1. Ferré VM, Bachelard A, Zaidi M, et al. Detection of monkeypox virus in anorectal swabs from asymptomatic men who have sex with men in a sexually transmitted infection screening program in Paris, France. Ann Intern Med. 2022;175(10):1491-1492. doi: 10.7326/M22-2183

 

  1. Agustí C, Martínez-Riveros H, Hernández-Rodríguez À, et al. Self-sampling monkeypox virus testing in high-risk populations, asymptomatic or with unrecognized Mpox, in Spain. Nat Commun. 2023;14(1):5998. doi: 10.1038/s41467-023-40490-9

 

  1. De Baetselier I, Van Dijck C, Kenyon C, et al. Retrospective detection of asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium. Nat Med. 2022;28(11):2288-2292. doi: 10.1038/s41591-022-02004-w

 

  1. Tarín-Vicente EJ, Alemany A, Agud-Dios M, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: A prospective observational cohort study. Lancet. 2022;400(10353):661-669. doi: 10.1016/S0140-6736(22)01436-2

 

  1. NSW Mpox Surveillance Report. Mpox NSW Outbreak 2024 - Week Ending 26 October 2024; Available from: https://www.health.nsw.gov.au/infectious/mpox/pages/ surveillance-reports.aspx [Last accessed on 2024 Oct 26].

 

  1. Peiró-Mestres A, Fuertes I, Camprubí-Ferrer D, et al. Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022. Euro Surveill. 2022;27(28):2200503. doi: 10.2807/1560-7917.ES.2022.27.28.2200503

 

  1. Rizzo A, Mileto D, Moschese D, et al. Role of multi-site sampling in the diagnosis of human Monkeypox. J Infect. 2023;86(2):154-225. doi: 10.1016/j.jinf.2022.12.010

 

  1. Cordeiro R, Pelerito A, De Carvalho IL, et al. An overview of monkeypox virus detection in different clinical samples and analysis of temporal viral load dynamics. J Med Virol. 2024;96(12):e70104. doi: 10.1002/jmv.70104

 

  1. Grabmeier-Pfistershammer K, Skorepa C, Breuer M, Masood M, Chromy D, Strassl R. No evidence of asymptomatic monkeypox infection in a highly sexually active MSM population in Austria. HIV Med. 2024;25(1):150-153. doi: 10.1111/hiv.13535

 

  1. Van Dijck C, De Baetselier I, Kenyon C, et al. Mpox screening in high-risk populations finds no asymptomatic cases. Lancet Microbe. 2023;4(3):e132-e133. doi: 10.1016/S2666-5247(22)00357-3

 

  1. Satapathy P, Mohanty P, Manna S, et al. Potentially asymptomatic infection of monkeypox virus: A systematic review and meta-analysis. Vaccines (Basel). 2022;10(12):2083. doi: 10.3390/vaccines10122083

 

Share
Back to top
Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept