Clinical characterisation and outcomes of human clade IIb mpox virus disease - a European multicentre observational cohort study (MOSAIC)
Elise Pesonel, Cédric Laouénan, Laetitia Guiraud, Josephine Bourner, Isabelle Hoffmann, Diana Molino, Coralie Tardivon, Delphine Bachelet, France Mentré, Alain Amstutz, Laura Merson, Amanda Rojek, Minerva Cervantes Gonzalez, Andrea Antinori, Antonella Castagna, Silvia Nozza, Valérie Pourcher, Agnès Libois, Jake Dunning, Evelina Tacconelli, Maya Hites, Fernando De La Calle Prieto, Peter Horby, Yazdan Yazdanpanah, Alexandra Calmy, F-Xavier Lescure, Piero Olliaro, , Maya Hites, Leïla Belkhir, Marie-Angélique De Scheerder, Jean-Christophe Goffard, Agnès Libois, Zineb Khalil, Catherine Orban, Lucie Seyler, Clotilde Visée, Florence Ader, Antoine Bachelard, Yasmine Bouaraba, Jean-Marc Chapplain, Hugues Cordel, François Danion, Aurélien Dinh, Nikita Dobremel, Manuel Etienne, Pierre Frange, Karine Faure, François Goehringer, Karine Lacombe, Xavier Lescure, Rodolphe Manaquin, Guillaume Martin-Blondel, Jean-Michel Mansuy, Giovanny Gombert, Duc Nguyen, Romain Palich, Gilles Pialoux, Aoife Cotter, Virginie Gautier, Evelina Tacconelli, Oriana Awwad, Andrea Antinori, Antonella Castagna, Silvia Nozza, Angelo Roberto Raccagni, Elena Bruzzesi, Antonio Cascio, Annamaria Cattelan, Maddalena Cordioli, Giulia De Luca, Lorenza Lambertenghi, Giulia Marchetti, Valentina Mazzotta, Emanuele Nicastri, Vincenzo Scaglione, Carlo Tascini, Jorge Machado, Lurdes Santos, Wong Chen Seong, Travis Ren Teen Chia, Wilnard Yeong Tze Tan, Fernando De La Calle Prieto, Vicente Estrada, Miguel Nicolás Navarrete Lorite, Alfredo Soler Carracedo, Maria Velasco Arribas, Dominique Braun, Alexandra Calmy, Matthias Cavassini, Lorenzo Ciullini, Stéphane Emonet, Chiara Fedeli, Yvan Gosmain, Laetitia Guiraud, Benjamin Hampel, Olivier Segeral, Cornelia Staehelin, Marcel Stöckle, Alejandro Arenas-Pinto, Mike Beadsworth, Margherita Bracchi, Joby Cole, Jake Dunning, Michael Marks, Brendan Payne, Malcolm G Semple, Claire Waddington, Chris WardAbstract
Background
The global mpox outbreak which started in May 2022 was caused by a novel clade IIb variant of the mpox virus (MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation.
Methods
To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022-July 2023 in individuals with confirmed MPXV infection enrolled in six European Countries. Case-management decisions were left to the attending physician. Participants were monitored for up to six months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time-to-lesion resolution, clinical status, and virus clearance.
Results
The 518 participants not receiving any specific treatment (“untreated”) were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) as and peri-genital (74%). By Day 14 from the first PCR-positive sample, 39% had resolved lesions. Time-to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as in-patients, 34% and 58% had resolved lesions by D14 from the first PCR-positive sample and from treatment start, respectively. Time-to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by Day 180.
Conclusion
MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterisation for ongoing mpox outbreaks.