{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:56:57Z","timestamp":1790128617157,"version":"4.0.1"},"reference-count":54,"publisher":"National Academy of Sciences","issue":"37","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001732","name":"Danish National Research Foundation","doi-asserted-by":"crossref","award":["DNRF170"],"award-info":[{"award-number":["DNRF170"]}],"id":[{"id":"10.13039\/501100001732","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2025,9,16]]},"abstract":"<jats:p>We analyzed the patterns of transmission in the 2022 clade IIb mpox epidemic as it unfolded in the European population of men who have sex with men (MSM). We developed an agent-based model that simulates sexual pair formation, incorporating both brief and longer-term sexual relationships. The model implements survey data on the sexual behavior of MSM and accounts for the highly heterogeneous nature of the sexual contact network within this community. When simulating the mpox epidemic, the model reproduces the reported numbers of sexual partners of mpox-infected individuals. We find that infection-derived immunity had little impact on ending the European outbreak. Instead, we suggest that the marked decrease in serial interval observed across the epidemic reflects a substantial increase in self-isolating behavior among infected persons and that this is sufficient to explain the early control of the epidemic. Our work highlights the critical interplay between relationship dynamics and adaptive behaviors in shaping mpox epidemic patterns and achieving control in 2022. Despite continued propagation of clade IIb mpox, the European MSM population remains protected by immunity, primarily vaccine-induced.<\/jats:p>","DOI":"10.1073\/pnas.2502861122","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T15:51:41Z","timestamp":1757519501000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":6,"title":["Relationship dynamics and behavioral adaptations in the control of the 2022 mpox epidemic"],"prefix":"10.1073","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5863-2012","authenticated-orcid":false,"given":"Ulrik","family":"Hvid","sequence":"first","affiliation":[{"name":"PandemiX - Center for Interdisciplinary Study of Pandemic Signatures","place":["Copenhagen, Denmark"]},{"name":"Biocomplexity, Niels Bohr Institute","place":["Copenhagen, Denmark"]},{"name":"University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1535-8526","authenticated-orcid":false,"given":"Lone","family":"Simonsen","sequence":"additional","affiliation":[{"name":"PandemiX - Center for Interdisciplinary Study of Pandemic Signatures","place":["Copenhagen, Denmark"]},{"name":"Department of Science and Environment","place":["Roskilde, Denmark"]},{"name":"Roskilde University","place":["Roskilde, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3864-8860","authenticated-orcid":false,"given":"Morten","family":"Frisch","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Research","place":["Copenhagen, Denmark"]},{"name":"Project SEXUS Group","place":["Copenhagen, Denmark"]},{"name":"Statens Serum Institut","place":["Copenhagen, Denmark"]},{"name":"Department of Clinical Medicine","place":["Aalborg, Denmark"]},{"name":"Center for Sexology Research","place":["Aalborg, Denmark"]},{"name":"Aalborg University","place":["Aalborg, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9820-3567","authenticated-orcid":false,"given":"Kim","family":"Sneppen","sequence":"additional","affiliation":[{"name":"PandemiX - Center for Interdisciplinary Study of Pandemic Signatures","place":["Copenhagen, Denmark"]},{"name":"Biocomplexity, Niels Bohr Institute","place":["Copenhagen, Denmark"]},{"name":"University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"e_1_3_5_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107373"},{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2024.02.003"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2022.27.27.2200471"},{"key":"e_1_3_5_4_2","unstructured":"European Centre for Disease Prevention and Control Monkeypox multi-country outbreak \u2013 second update. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/Monkeypox-multi-country-outbreak-second-update.pdf. Accessed 24 August 2025."},{"key":"e_1_3_5_5_2","unstructured":"World Health Organization 2022\u20132024 Mpox (Monkeypox) outbreak: Global trends [internet dashboard]. Geneva: WHO; 2024. https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/. Accessed 15 January 2025."},{"key":"e_1_3_5_6_2","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS) Recommended population size estimates of men who have sex with men. Geneva: UNAIDS; 2020. ISBN: 978-92-9-173286-9. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2020-recommended-population-size-estimates-of-men-who-have-sex-with-men_en.pdf."},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-919"},{"key":"e_1_3_5_8_2","doi-asserted-by":"crossref","first-page":"e073153","DOI":"10.1136\/bmj-2022-073153","article-title":"Transmission dynamics of monkeypox in the United Kingdom: Contact tracing study","volume":"379","author":"Ward T.","year":"2022","unstructured":"T. Ward, R. Christie, R. S. Paton, F. Cumming, C. E. Overton, Transmission dynamics of monkeypox in the United Kingdom: Contact tracing study. BMJ 379, e073153 (2022).","journal-title":"BMJ"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiad414"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-38816-8"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00492-9"},{"key":"e_1_3_5_12_2","unstructured":"Centers for Disease Control and Prevention Interim clinical considerations for use of vaccine for mpox prevention in the United States (2025). https:\/\/www.cdc.gov\/mpox\/hcp\/vaccine-considerations\/vaccination-overview.html. Accessed 10 June 2025."},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiad254"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.add4507"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03526-9"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-46590-4"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00451-6"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207323"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107132"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2024.29.21.2300608"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00794-0"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc6810"},{"key":"e_1_3_5_23_2","unstructured":"EC for Disease Prevention Control WHORO for Europe Risk communication and community engagement approaches during the monkeypox outbreak in Europe (2022). https:\/\/www.ecdc.europa.eu\/en\/publications-data\/risk-communication-and-community-engagement-approaches-during-monkeypox-outbreak. Accessed 12 May 2025."},{"key":"e_1_3_5_24_2","unstructured":"M. Frisch E. Moseholm M. Andersson J. B. Andresen C. Graugaard Sex in Denmark. Key Findings from Project SEXUS 2017\u20132018 (Statens Serum Institut and Aalborg University 2019). https:\/\/files.projektsexus.dk\/2019-10-26_SEXUS-rapport_2017-2018.pdf. Accessed 23 August 2025."},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1006748"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-118"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm715152a3"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae105"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2023.101093"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01436-2"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28270"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25953"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02542-x"},{"key":"e_1_3_5_34_2","unstructured":"United Kingdom Health Security Agency Investigation into monkeypox outbreak in England: Technical briefing 8 \u2014 gov.uk (2022). https:\/\/www.gov.uk\/government\/publications\/monkeypox-outbreak-technical-briefings\/investigation-into-monkeypox-outbreak-in-england-technical-briefing-8. Accessed 30 June 2024."},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/0025-5564(95)00093-3"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-68154-8"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2810.221126"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid3006.231095"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0264425"},{"key":"e_1_3_5_40_2","doi-asserted-by":"crossref","unstructured":"D. Maniscalco Adaptive behavior in response to the 2022 mpox epidemic in the Paris region. medRxiv [Preprint] (2024). https:\/\/doi.org\/10.1101\/2024.10.25.24315987.","DOI":"10.1101\/2024.10.25.24315987"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00514-0"},{"key":"e_1_3_5_42_2","unstructured":"K. Kupferschmidt Explosive mpox outbreak in Sierra Leone overwhelms health systems (2025). https:\/\/www.science.org\/content\/article\/explosive-mpox-outbreak-sierra-leone-overwhelms-health-systems. Accessed June 6 2025."},{"key":"e_1_3_5_43_2","unstructured":"Australian Government Department of Health and Aged Care Mpox vaccination data (2025). https:\/\/www.health.gov.au\/topics\/immunisation\/immunisation-data\/mpox-vaccination-data. Accessed 6 June 2025."},{"key":"e_1_3_5_44_2","doi-asserted-by":"crossref","unstructured":"NHS England Vaccinations: Mpox (2025). https:\/\/www.england.nhs.uk\/statistics\/statistical-work-areas\/vaccinations-for-mpox\/. Accessed 6 June 2025.","DOI":"10.12968\/indn.2025.2.6a"},{"key":"e_1_3_5_45_2","doi-asserted-by":"crossref","unstructured":"P. E. Obermeier Emerging Infectious Diseases (Centers for Disease Control and Prevention (CDC) 2024) vol. 30 http:\/\/dx.doi.org\/10.3201\/eid3007.240092.","DOI":"10.3201\/eid3007.240092"},{"key":"e_1_3_5_46_2","unstructured":"Queensland Health Mpox (monkeypox) vaccination centres. https:\/\/www.health.qld.gov.au\/clinical-practice\/guidelines-procedures\/diseases-infection\/immunisation\/monkeypox-vaccination-centres. Accessed 16 January 2025."},{"key":"e_1_3_5_47_2","unstructured":"Bundeszentrale f\u00fcr gesundheitliche Aufkl\u00e4rung (BZgA) Erregersteckbrief Mpox (English pathogen factsheet). https:\/\/www.infektionsschutz.de\/download\/7073-Erregersteckbrief_Mpox_EN.pdf. Accessed 24 August 2025."},{"key":"e_1_3_5_48_2","unstructured":"National Health Service (NHS) Mpox. https:\/\/www.nhs.uk\/conditions\/mpox\/. Accessed 24 August 2025."},{"key":"e_1_3_5_49_2","unstructured":"European Centre for Disease Prevention and Control Rapid scientific advice on public health measures for mpox (2024\u20132025). https:\/\/www.ecdc.europa.eu\/en\/infectious-disease-topics\/mpox\/rapid-scientific-advice-public-health-measures-mpox-2024-2025. Accessed 21 January 2025."},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanmic.2025.101132"},{"key":"e_1_3_5_51_2","unstructured":"European Centre for Disease Prevention and Control Recommendations for preparedness planning for public health threats. https:\/\/www.ecdc.europa.eu\/en\/publications-data\/recommendations-preparedness-planning-public-health-threats."},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.28769"},{"key":"e_1_3_5_53_2","unstructured":"U. Hvid TANGO_model. Github. https:\/\/github.com\/UlrikHvid\/TANGO_model. Deposited 27 August 2025."},{"key":"e_1_3_5_54_2","unstructured":"European MSM Internet Survey (EMIS). The European MSM Internet Survey. https:\/\/www.emis-project.eu. Accessed 27 August 2025."}],"updated-by":[{"DOI":"10.1073\/pnas.2529771122","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000}}],"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.2502861122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T16:05:29Z","timestamp":1762445129000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/10.1073\/pnas.2502861122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":54,"journal-issue":{"issue":"37","published-print":{"date-parts":[[2025,9,16]]}},"alternative-id":["10.1073\/pnas.2502861122"],"URL":"https:\/\/doi.org\/10.1073\/pnas.2502861122","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.05.02.25326849","asserted-by":"object"}]},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"assertion":[{"value":"2025-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2502861122"}}