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Adv."],"published-print":{"date-parts":[[2026,4,3]]},"abstract":"<jats:p>The intensifying outbreaks of the novel monkeypox virus clade Ib in the Democratic Republic of the Congo have raised global concern about the potential for wider epidemic spread. Some clade Ib mpox outbreaks have shown a distinct transmission pattern in which transmission associated with both sexual and nonsexual contacts coexist. Here, we characterize these outbreaks in a network epidemic model, which incorporates sexual and nonsexual contacts, and project age- and route-specific transmission potentials under a wide range of scenarios. Our analyses suggest that the dominant route of transmission may shift over time from sexual to nonsexual contacts, which leads to larger epidemics. The age groups contributing most to overall infections and mortality also change over time, suggesting that target groups for intervention should be adjusted accordingly. For countries at risk of travel-associated mpox outbreaks, these findings highlight the importance of monitoring evolving monkeypox virus transmission patterns and interacting transmission routes to support timely and effective control measures.<\/jats:p>","DOI":"10.1126\/sciadv.aec1931","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:58:42Z","timestamp":1775066322000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark","source":"Crossref","is-referenced-by-count":4,"title":["Dynamic shift in the dominant transmission route of clade Ib monkeypox virus across networks with sexual and nonsexual contacts"],"prefix":"10.1126","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8235-757X","authenticated-orcid":true,"given":"Fuminari","family":"Miura","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands."},{"name":"Center for Marine Environmental Studies, Ehime University, Matsuyama, Japan."},{"name":"Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-7641","authenticated-orcid":true,"given":"Ka Yin","family":"Leung","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5257-4503","authenticated-orcid":true,"given":"Maria","family":"Xiridou","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3941-714X","authenticated-orcid":true,"given":"Marten","family":"van Antwerpen","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4817-8986","authenticated-orcid":true,"given":"Nicola","family":"Low","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1881-0637","authenticated-orcid":true,"given":"Niel","family":"Hens","sequence":"additional","affiliation":[{"name":"Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium."},{"name":"Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0795-7157","authenticated-orcid":true,"given":"Emmanuel Hasivirwe","family":"Vakaniaki","sequence":"additional","affiliation":[{"name":"Institut National de Recherche Biom\u00e9dicale (INRB), Kinshasa, Democratic Republic of the Congo."},{"name":"Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium."},{"name":"Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1725-5627","authenticated-orcid":true,"given":"Jacco","family":"Wallinga","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands."},{"name":"Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"221","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03130-3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2411368"},{"key":"e_1_3_2_4_2","unstructured":"World Health Organization 2022-25 Mpox Outbreak: Global Trends (2025) https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/."},{"key":"e_1_3_2_5_2","unstructured":"WHO Rapid Risk Assessment - 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