Epidemiology and Health

Epidemiologic Investigations

Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea: Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim; Epidemiol Health. 2024;46:e2024092. Published online November 24, 2024; DOI: https://doi.org/10.4178/epih.e2024092

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Abstract Summary PDF: Abstract
OBJECTIVES
This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.
METHODS
We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.
RESULTS
Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had human immunodeficiency virus (HIV) infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.
CONCLUSIONS
In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.; Summary

Korean summary
- 대한민국 수도권의 mpox 의심환자 160명 중 59.3%(n=95)가 mpox-PCR 검사에서 양성으로 확인되었다. - 확진 환자 중 97.9%(n=93)는 남성이었고 35.5%(n=33)는 HIV에 감염되었으며 엠폭스 감염의 위험요인으로는 일회성 파트너와의 성적 접촉, 항문생식기 병변, 병변 부위의 통증이 포함되었다. - 양성 환자의 검체 특성은 피부 및 점막 병변 샘플이 가장 높은 양성률을 보였고, 혈액 샘플은 가장 낮은 양성률을 보였다.

Key Message
- Of the 160 suspected mpox cases in the Capital Region of South Korea, 59.3% (n=95) were confirmed as PCR-positive. - Among the confirmed cases, 97.9% were male and 35.5% were infected with HIV, and risk factors of mpox infection included sexual contact with casual partner, anogenital lesion, and pain on lesions. - Skin and mucosal lesion samples had the highest positivity rate, while blood samples had the lowest.

Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in Korea: Taeyoung Kim, Eonjoo Park, Jun Suk Eun, Eun-young Lee, Ji Won Mun, Yunsang Choi, Shinyoung Lee, Hansol Yeom, Eunkyoung Kim, Jongmu Kim, Jihyun Choi, Jinho Ha, Sookkyung Park; Epidemiol Health. 2023;45:e2023040. Published online March 23, 2023; DOI: https://doi.org/10.4178/epih.e2023040

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Abstract

OBJECTIVES
As few mpox cases have been reported in Korea, we aimed to identify the characteristics of mpox infection by describing our epidemiologic investigation of a woman patient (index patient, the third case in Korea) and a physician who was infected by a needlestick injury (the fourth case).

METHODS

We conducted contact tracing and exposure risk evaluation through interviews with these 2 patients and their physicians and contacts, as well as field investigations at each facility visited by the patients during their symptomatic periods. We then classified contacts into 3 levels according to their exposure risk and managed them to minimize further transmission by recommending quarantine and vaccination for post-exposure prophylaxis and monitoring their symptoms.

RESULTS

The index patient had sexual contact with a man foreigner during a trip to Dubai, which was considered the probable route of transmission. In total, 27 healthcare-associated contacts across 7 healthcare facilities and 9 community contacts were identified. These contacts were classified into high (7 contacts), medium (9 contacts), and low (20 contacts) exposure risk groups. One high-risk contact was identified as a secondary patient: a physician who was injured while collecting specimens from the index patient.

CONCLUSIONS

The index patient visited several medical facilities due to progressive symptoms prior to isolation. Although the 2022 mpox epidemic mainly affected young men, especially men who have sex with men, physicians should also consider mpox transmission in the general population for the timely detection of mpox-infected patients.

Summary

Korean summary
국내 엠폭스 3번환자는 전파 가능 시기에 7곳의 의료기관을 방문했으며, 접촉자로 분류된 27명의 의료기관 접촉자와 9명의 지역사회 접촉자 중 주사침 자상을 입은 의료인 1명이 추가 확진되었다. 적시에 엠폭스 환자를 발견하기 위하여 의료인들은 전파위험이 낮은 일반 인구의 감염 가능성에 대한 고려가 필요하다.

Key Message
As a result of contact tracing of a mpox patient in the early phase of epidemic, she visited 7 healthcare facilities to be diagnosed which infers diagnosing those who are statistically not at high risk is challenging. Yet the risk of contracting mpox seems relatively low as only one of 36 contacts was infected; a healthcare personnel who sustained a needlestick injury.

Citations

Citations to this article as recorded by

Clinical Features of Mpox Patients in Korea: A Multicenter Retrospective Study
So Yun Lim, Hyeon Jae Jo, Su-Yeon Lee, Miyoung Ahn, Yeonjae Kim, Jaehyun Jeon, Eu Suk Kim, BumSik Chin, Jae-Phil Choi, Nam Joong Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef
Transmission potential of mpox in mainland China, June-July 2023: estimating reproduction number during the initial phase of the epidemic
Andrei R. Akhmetzhanov, Pei-Hsuan Wu
PeerJ.2024; 12: e16908. CrossRef
Genomic Analysis of Monkeypox Virus During the 2023 Epidemic in Korea
Chi-Hwan Choi, Minji Lee, Sang Eun Lee, Jin-Won Kim, Hwachul Shin, Myung-Min Choi, Hwajung Yi, Min-Kyung Kim, Jaehyun Jeon, Jun-Sun Park, Yeonjae Kim, So Yun Lim, BumSik Chin, Yoon-Seok Chung
Journal of Korean Medical Science.2024;[Epub] CrossRef
Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea
Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim
Epidemiology and Health.2024; 46: e2024092. CrossRef
Mpox exposure and transmission in healthcare settings during the 2022 global outbreak
Kimon C Zachary, Lisa L Philpotts, Erica S Shenoy
Current Opinion in Infectious Diseases.2023; 36(4): 257. CrossRef

Review

Monkeypox: the resurgence of forgotten things: Sun Bean Kim, Jaehun Jung, Kyong Ran Peck; Epidemiol Health. 2022;44:e2022082. Published online September 26, 2022; DOI: https://doi.org/10.4178/epih.e2022082

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Abstract Summary PDF

Abstract

Monkeypox, a rare zoonotic disease, is primarily prevalent in Central and Western Africa. However, monkeypox is emerging as a worldwide concern due to the 2022 monkeypox outbreak, which is the first instance of widespread community transmission outside Africa. Monkeypox is caused by the monkeypox virus, which belongs to the genus <i>Orthopoxvirus</i> and presents as a vesicular-pustular disease that may be preceded by fever, malaise, and other constitutional symptoms. If present, lymphadenopathy may distinguish it from chickenpox or smallpox. However, contrary to previous manifestations, most monkeypox patients presented with atypical features during the 2022 outbreak. Monkeypox is usually a self-limiting disease with symptoms lasting between 2 weeks and 4 weeks and is mainly transmitted when a person comes into contact with an infected animal, person, or fomites contaminated with the virus. Very few treatment options are available for this disease. Tecovirimat has been licensed in some countries for the treatment of smallpox and monkeypox infections. Two other medications, cidofovir and brincidofovir, have been found to be effective against poxviruses in in vitro and animal studies, but data on human cases of monkeypox are limited. Although Imvamune (JYNNEOS), a vaccine against monkeypox, is authorized in the United States, there are currently no established routine vaccination programs. Current preventive strategies focus on the detection of probable cases and containment of the outbreak through the implementation of selected ring vaccination programs. Fundamental principles to prevent the spread of monkeypox, including maintaining personal hygiene and avoiding close contact with symptomatic patients, are of paramount importance.

Summary

Korean summary
원숭이두창은 orthopoxvirus에 속하는 원숭이두창 바이러스에 의해 발생하며, 중앙아프리카와 서아프리카에서 주로 발견되는 희귀한 인수공통감염병이었으나 2022년에 집단 발병했던 원숭이두창 환자들은 이전부터 널리 알려진 증세와 달리 비전형적인 임상 특징을 보이고 있고, 전 세계적으로 아프리카와의 역학적 연관성없이 아프리카 이외의 여러 지역에서 원숭이두창이 집단 발병하면서 보건학적 화두로 대두되었다. 원숭이두창에 대한 치료는 증상 호전을 위한 대증 요법이 주가 되며, 매우 제한적인 항바이러스제가 치료 약제로 이용된다. 2019년 미국에서 Imvamune (Jynneos)가 성인을 대상으로 원숭이두창 백신으로 사용이 승인되었다. 하지만 예방 접종뿐만 아니라 손씻기 등의 개인위생 유지, 의심 혹은 확진 환자와의 긴밀한 접촉을 피하는 것 등이 원숭이두창 확산을 막기 위한 가장 중요한 기본 원칙이다.

Key Message
Monkeypox is caused by the monkeypox virus, which belongs to the genus Orthopoxvirus and presents as a vesicular-pustular disease that may be preceded by fever, malaise, and other constitutional symptoms. Contrary to previous manifestations, most monkeypox patients presented with atypical features during the 2022 outbreak. Very few treatment options are available for this disease and current preventive strategies focus on the detection of probable cases and containment of the outbreak through the implementation of selected ring vaccination programs. Fundamental principles to prevent the spread of monkeypox, including maintaining personal hygiene and avoiding close contact with symptomatic patients, are of paramount importance.

Citations

Citations to this article as recorded by

DMSO enhanced one-pot HDA-CRISPR/Cas12a biosensor for ultrasensitive detection of Monkeypox virus
Luxin Yu, Yuebiao Tang, Yuanzhong Sun, Houqi Wang, Hai Yi, Yangqing Zhong, Zheng Shao, Shiqing Zhou, Suhui He, Ke Cao, Lifei Peng, Zhangquan Chen
Talanta.2025; 287: 127660. CrossRef
Understanding the resurgence of mpox: key drivers and lessons from recent outbreaks in Africa
Adewunmi Akingbola, Christopher Abiodun Adegbesan, Olajumoke Adewole, Courage Idahor, Tolani Odukoya, Emmanuel Nwaeze, Shekoni Mayowa, Owolabi Abdullahi, Petra Kerubo Mariaria
Tropical Medicine and Health.2025;[Epub] CrossRef
Breaking Barriers: Current Advances and Future Directions in Mpox Therapy
Bhumi M. Shah, Palmi Modi
Current Drug Targets.2024; 25(1): 62. CrossRef
How to cope with suspected mpox patients in the outpatient clinic
Nam Joong Kim, Sun Huh
Journal of the Korean Medical Association.2023; 66(5): 325. CrossRef
An International Outburst of New Form of Monkeypox Virus
Kiran Dobhal, Pallavi Ghildiyal, A.N.M. Ansori, Vikash Jakhmola
Journal of Pure and Applied Microbiology.2022; 16(suppl 1): 3013. CrossRef

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