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Abstract

Background

Mpox, caused by monkeypox virus (MPXV), was considered a rare zoonotic disease before May 2022, when a global epidemic of cases in non-endemic countries led to the declaration of a Public Health Emergency of International Concern. Cases of mpox in Ireland, a country without previous mpox reports, could reflect extended local transmission or multiple epidemiological introductions.

Aim

To elucidate the origins and molecular characteristics of MPXV circulating in Ireland between May 2022 and October 2023.

Methods

Whole genome sequencing of MPXV from 75% of all Irish mpox cases (182/242) was performed and compared to sequences retrieved from public databases (n = 3,362). Bayesian approaches were used to infer divergence time between sequences from different subclades and evaluate putative importation events from other countries.

Results

Of 242 detected mpox cases, 99% were males (median age: 35 years; range: 15–60). All 182 analysed genomes were assigned to Clade IIb and, presence of 12 distinguishable subclades suggests multiple introductions into Ireland. Estimation of time to divergence of subclades further supports the hypothesis for multiple importation events from numerous countries, indicative of extended and sustained international spread of mpox. Further analysis of sequences revealed that 92% of nucleotide mutations were from cytosine to thymine (or from guanine to adenine), leading to a high number of non-synonymous mutations across subclades; mutations associated with tecovirimat resistance were not observed.

Conclusion

We provide insights into the international transmission dynamics supporting multiple introductions of MPXV into Ireland. Such information supported the implementation of evidence-informed public health control measures.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2024-04-18
2024-05-01
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.16.2300505
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Multiple introductions of monkeypox virus to Ireland during the international mpox outbreak, May 2022 to October 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Gabriel+Gonzalez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gonzalez Gabriel</a>, <a href="/search?value1=Michael+Carr&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carr Michael</a>, <a href="/search?value1=Tom%C3%A1s+M+Kelleher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kelleher Tomás M</a>, <a href="/search?value1=Emer+O%E2%80%99Byrne&option1=author&noRedirect=true" class="nonDisambigAuthorLink">O’Byrne Emer</a>, <a href="/search?value1=Weronika+Banka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Banka Weronika</a>, <a href="/search?value1=Brian+Keogan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Keogan Brian</a>, <a href="/search?value1=Charlene+Bennett&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bennett Charlene</a>, <a href="/search?value1=Geraldine+Franzoni&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Franzoni Geraldine</a>, <a href="/search?value1=Patrice+Keane&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Keane Patrice</a>, <a href="/search?value1=Cliona+Kenna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kenna Cliona</a>, <a href="/search?value1=Luke+W+Meredith&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meredith Luke W</a>, <a href="/search?value1=Nicola+Fletcher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fletcher Nicola</a>, <a href="/search?value1=Jose+Maria+Urtasun-Elizari&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Urtasun-Elizari Jose Maria</a>, <a href="/search?value1=Jonathan+Dean&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dean Jonathan</a>, <a href="/search?value1=Ciaran+Browne&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Browne Ciaran</a>, <a href="/search?value1=Fiona+Lyons&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lyons Fiona</a>, <a href="/search?value1=Brendan+Crowley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Crowley Brendan</a>, <a href="/search?value1=Derval+Igoe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Igoe Derval</a>, <a href="/search?value1=Eve+Robinson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Robinson Eve</a>, <a href="/search?value1=Greg+Martin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martin Greg</a>, <a href="/search?value1=Jeff+Connell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Connell Jeff</a>, <a href="/search?value1=Cillian+F+De+Gascun&option1=author&noRedirect=true" class="nonDisambigAuthorLink">De Gascun Cillian F</a>, <a href="/search?value1=Daniel+Hare&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hare Daniel</a></span>. Multiple introductions of monkeypox virus to Ireland during the international mpox outbreak, May 2022 to October 2023. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(16):pii=2300505. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.16.2300505" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.16.2300505</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 18 Sept 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 05 Feb 2024 </span> </p>
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