{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:49:12Z","timestamp":1782755352214,"version":"3.54.5"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MPhasis F1 Foundation"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>We construct a model for mpox outbreaks in low and middle-income countries where the disease is non-endemic, using India as an example. We simulate potential outbreak scenarios using BharatSim, a flexible agent-based simulation framework. The spread of mpox is modelled as being driven primarily through sexual contacts within a subnetwork of men who have sex with men (MSM), embedded within a larger network representing their household and workplace contacts. Our model allows for disease spread through this expanded network, including the possibility of heterosexual transmission. We quantify the outbreak size, the dynamics of infection within and outside the MSM subnetwork, and the implications of vaccination and prophylactic measures for curtailing disease spread. These results should inform planning and policy measures for mpox control in generic LMIC settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006630","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:33:36Z","timestamp":1782754416000},"page":"e0006630","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simulating a potential mpox outbreak: Implications for control in non-endemic settings"],"prefix":"10.1371","volume":"6","author":[{"given":"Philip","family":"Cherian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5528-4002","authenticated-orcid":true,"given":"Gautam I.","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"pgph.0006630.ref001","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7203a4","article-title":"Epidemiology of human mpox - worldwide, 2018\u20132021","volume":"72","author":"AM McCollum","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"pgph.0006630.ref002","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.3201\/eid2704.203569","article-title":"Reemergence of human monkeypox and declining population immunity in the context of urbanization, Nigeria, 2017\u20132020","volume":"27","author":"PY Nguyen","year":"2021","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pgph.0006630.ref003","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bmb\/ldad002","article-title":"Monkeypox: a review of the 2022 outbreak","volume":"145","author":"EY Lim","year":"2023","journal-title":"Br Med Bull"},{"issue":"1","key":"pgph.0006630.ref004","article-title":"Monkeypox disease with a focus on the 2022 outbreak; a narrative review","volume":"11","author":"Z Tehranchinia","year":"2023","journal-title":"Arch Acad Emerg Med"},{"issue":"5","key":"pgph.0006630.ref005","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.jaad.2022.07.007","article-title":"Monkeypox emerges on a global scale: a historical review and dermatologic primer","volume":"87","author":"J Bryer","year":"2022","journal-title":"J Am Acad Dermatol"},{"key":"pgph.0006630.ref006","unstructured":"World Health Organization. Global Mpox Trends; 2025. Available from: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/"},{"issue":"6615","key":"pgph.0006630.ref007","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1126\/science.add4507","article-title":"Heavy-tailed sexual contact networks and monkeypox epidemiology in the global outbreak, 2022","volume":"378","author":"A Endo","year":"2022","journal-title":"Science"},{"key":"pgph.0006630.ref008","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7220a2","article-title":"The CDC domestic mpox response - United States, 2022\u20132023","volume":"72","author":"JH McQuiston","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"10370","key":"pgph.0006630.ref009","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0140-6736(22)02075-X","article-title":"Monkeypox","volume":"401","author":"O Mitj\u00e0","year":"2023","journal-title":"Lancet"},{"issue":"8","key":"pgph.0006630.ref010","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox virus infection in humans across 16 countries \u2014 April\u2013June 2022","volume":"387","author":"JP Thornhill","year":"2022","journal-title":"N Engl J Med"},{"key":"pgph.0006630.ref011","unstructured":"World Health Organization. Mpox; 2024. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mpox"},{"key":"pgph.0006630.ref012","unstructured":"World Health Organization. World Health Organization Director-General declares mpox outbreak a public health emergency of international concern; 2024. Available from: https:\/\/www.who.int\/news\/item\/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern"},{"issue":"10497","key":"pgph.0006630.ref013","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1016\/S0140-6736(25)01203-6","article-title":"Clade IIb mpox outbreak in Sierra Leone","volume":"405","author":"O Mitj\u00e0","year":"2025","journal-title":"Lancet"},{"issue":"8068","key":"pgph.0006630.ref014","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1038\/d41586-025-01805-6","article-title":"Skyrocketing mpox outbreak in Sierra Leone raises fears of wider spread","volume":"642","author":"M Kozlov","year":"2025","journal-title":"Nature"},{"key":"pgph.0006630.ref015","author":"K Kupferschmidt","year":"2025"},{"key":"pgph.0006630.ref016","unstructured":"Kumar S, Kataria R, Sharma A. India Against Mpox; 2024. Available from: http:\/\/pib.gov.in\/PressNoteDetails.aspx?NoteId=152119"},{"issue":"4","key":"pgph.0006630.ref017","doi-asserted-by":"crossref","first-page":"628","DOI":"10.4103\/ijcm.ijcm_719_22","article-title":"Monkeypox: current situation in India: an old virus, a new menace?","volume":"47","author":"T Singh","year":"2022","journal-title":"Indian J Community Med"},{"key":"pgph.0006630.ref018","unstructured":"BBC. Kerala: India reports first mpox case in current outbreak; 2024. Available from: https:\/\/www.bbc.com\/news\/articles\/clyl1jlxr02o"},{"issue":"12","key":"pgph.0006630.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1012682","article-title":"BharatSim: an agent-based modelling framework for India","volume":"20","author":"P Cherian","year":"2024","journal-title":"PLoS Comput Biol"},{"key":"pgph.0006630.ref020","doi-asserted-by":"crossref","first-page":"100540","DOI":"10.1016\/j.onehlt.2023.100540","article-title":"Mathematical modeling of mpox: a scoping review","volume":"16","author":"J Molla","year":"2023","journal-title":"One Health"},{"key":"pgph.0006630.ref021","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268823000791","article-title":"Monkeypox: a review of epidemiological modelling studies and how modelling has led to mechanistic insight","volume":"151","author":"M Banuet-Martinez","year":"2023","journal-title":"Epidemiol Infect"},{"issue":"12","key":"pgph.0006630.ref022","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.4236\/jamp.2017.512191","article-title":"Modeling the transmission dynamics of the monkeypox virus infection with treatment and vaccination interventions","volume":"05","author":"S Usman","year":"2017","journal-title":"JAMP"},{"issue":"4","key":"pgph.0006630.ref023","first-page":"459","article-title":"Clinico-epidemiological features of monkeypox patients with an animal or human source of infection","volume":"66","author":"Z Jezek","year":"1988","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pgph.0006630.ref024","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S1473-3099(03)00856-9","article-title":"Human monkeypox: an emerging zoonosis","volume":"4","author":"DB Di Giulio","year":"2004","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"pgph.0006630.ref025","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciac723","article-title":"The roles of unrecognized mpox cases, contact isolation and vaccination in determining epidemic size in Belgium: a modeling study","volume":"76","author":"C Van Dijck","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pgph.0006630.ref026","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1473-3099(23)00492-9","article-title":"Mpox in people with past infection or a complete vaccination course: a global case series","volume":"24","author":"A Hazra","year":"2024","journal-title":"Lancet Infect Dis"},{"issue":"26","key":"pgph.0006630.ref027","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1056\/NEJMoa2215201","article-title":"Vaccine effectiveness of JYNNEOS against mpox disease in the United States","volume":"388","author":"NP Deputy","year":"2023","journal-title":"N Engl J Med"},{"issue":"9","key":"pgph.0006630.ref028","article-title":"Effectiveness of a single dose of JYNNEOS vaccine in real world: a systematic review and meta-analysis","volume":"7","author":"AM Taha","year":"2024","journal-title":"Health Sci Rep"},{"key":"pgph.0006630.ref029","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-078243","article-title":"Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection: emulation of a target trial","volume":"386","author":"C Navarro","year":"2024","journal-title":"BMJ"},{"key":"pgph.0006630.ref030","author":"European Medicines Agency","year":"2022"},{"key":"pgph.0006630.ref031","unstructured":"World Health Organization. WHO prequalifies the first vaccine against mpox; 2024. Available from: https:\/\/www.who.int\/news\/item\/13-09-2024-who-prequalifies-the-first-vaccine-against-mpox"},{"key":"pgph.0006630.ref032","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr.mm7340a2","article-title":"Risk of clade II mpox associated with intimate and nonintimate close contact among men who have sex with men and transgender adults \u2014 United States, August 2022\u2013July 2023","volume":"73","author":"AN Chard","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pgph.0006630.ref033","doi-asserted-by":"crossref","DOI":"10.1136\/sti.2010.044909","article-title":"From individuals to complex systems: exploring the sexual networks of men who have sex with men in three cities of Karnataka, India","volume":"86","author":"R Lorway","year":"2010","journal-title":"Sex Transm Infect"},{"issue":"6","key":"pgph.0006630.ref034","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1007\/s10461-014-0946-1","article-title":"Women connected to at risk Indian men who have sex with men: an unexplored network","volume":"19","author":"S Satyanarayan","year":"2015","journal-title":"AIDS Behav"},{"issue":"2","key":"pgph.0006630.ref035","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4314\/ahs.v23i2.8","article-title":"Socio-demographic and behavioural determinants of HIV prevalence among homosexual and bisexual men having sex with men (MSM) in India: integrated bio-behavioural surveillance","volume":"23","author":"A Santhakumar","year":"2023","journal-title":"Afr Health Sci"},{"issue":"5","key":"pgph.0006630.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0004475","article-title":"Programmatic mapping and population size estimation of key population in India: method and findings","volume":"5","author":"P Kumar","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0006630.ref037","article-title":"Size Estimation of high-risk groups for hiv infection in india based on data from national integrated bio-behavioral surveillance and targeted interventions","volume":"64","author":"E Arumugam","year":"2020","journal-title":"Indian J Public Health"},{"key":"pgph.0006630.ref038","unstructured":"Press Trust of India. Gay population 25 lakh, 7 per cent HIV infected: Govt to SC; 2012. Available from: https:\/\/www.indiatoday.in\/india\/north\/story\/gay-population-25-lakh-7-per-cent-hiv-infected-govt-95844-2012-03-12"},{"key":"pgph.0006630.ref039","unstructured":"The Telegraph Online. Gay count at 25 lakh; 2012. Available from: https:\/\/www.telegraphindia.com\/india\/gay-count-at-25-lakh\/cid\/440396"},{"key":"pgph.0006630.ref040","unstructured":"World Health Organization. Recommended population size estimates of men who have sex with men; 2020. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240015357"},{"key":"pgph.0006630.ref041","unstructured":"United Nations Programme on HIV\/AIDS. Unaids Report 2024; 2024. Available from: https:\/\/crossroads.unaids.org\/"},{"issue":"3","key":"pgph.0006630.ref042","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1006748","article-title":"A dynamic power-law sexual network model of gonorrhoea outbreaks","volume":"15","author":"LK Whittles","year":"2019","journal-title":"PLoS Comput Biol"},{"issue":"7248","key":"pgph.0006630.ref043","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1136\/bmj.320.7248.1510","article-title":"Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study","volume":"320","author":"JP Dodds","year":"2000","journal-title":"BMJ"},{"issue":"6","key":"pgph.0006630.ref044","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/00007435-200406000-00012","article-title":"Scale-free networks and sexually transmitted diseases: a description of observed patterns of sexual contacts in Britain and Zimbabwe","volume":"31","author":"A Schneeberger","year":"2004","journal-title":"Sex Transm Dis"},{"issue":"4","key":"pgph.0006630.ref045","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s00453-009-9340-1","article-title":"A sequential algorithm for generating random graphs","volume":"58","author":"M Bayati","year":"2009","journal-title":"Algorithmica"},{"key":"pgph.0006630.ref046","doi-asserted-by":"crossref","DOI":"10.25080\/TCWV9851","volume-title":"Exploring network structure, dynamics, and function using NetworkX","author":"A Hagberg","year":"2008"},{"key":"pgph.0006630.ref047","unstructured":"World Health Organization. Broader transmission of mpox due to clade Ib MPXV \u2013 Global situation; 2025. Available from: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2025-DON587"},{"issue":"1","key":"pgph.0006630.ref048","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1186\/s12879-024-10066-z","article-title":"A seroprevalence study indicates a high proportion of clinically undiagnosed MPXV infections in men who have sex with men in Berlin, Germany","volume":"24","author":"U Marcus","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pgph.0006630.ref049","article-title":"Risk factors associated with human Mpox infection: a systematic review and meta-analysis","volume":"10","author":"CLJ Ugwu","year":"2025","journal-title":"BMJ Glob Health"},{"issue":"12","key":"pgph.0006630.ref050","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1007\/s10461-015-1058-2","article-title":"Comparison of sexual risk, HIV\/STI prevalence and intervention exposure among men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) in India: implications for HIV prevention","volume":"19","author":"L Ramakrishnan","year":"2015","journal-title":"AIDS Behav"},{"issue":"9","key":"pgph.0006630.ref051","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0107439","article-title":"Predictors of bisexual behaviour among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: data from HIV sentinel surveillance","volume":"9","author":"S Godbole","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0006630.ref052","doi-asserted-by":"crossref","first-page":"4100","DOI":"10.1038\/s41467-023-38816-8","article-title":"The role of vaccination and public awareness in forecasts of Mpox incidence in the United Kingdom","volume":"14","author":"SPC Brand","year":"2023","journal-title":"Nat Commun"},{"issue":"12","key":"pgph.0006630.ref053","doi-asserted-by":"crossref","first-page":"2200772","DOI":"10.2807\/1560-7917.ES.2023.28.12.2200772","article-title":"Mpox outbreak in the Netherlands, 2022: public health response, characteristics of the first 1,000 cases and protection of the first-generation smallpox vaccine","volume":"28","author":"CE van Ewijk","year":"2023","journal-title":"Euro Surveill"},{"issue":"1","key":"pgph.0006630.ref054","doi-asserted-by":"crossref","first-page":"19755","DOI":"10.1038\/s41598-024-68154-8","article-title":"Quantification of the time-varying epidemic growth rate and of the delays between symptom onset and presenting to healthcare for the mpox epidemic in the UK in 2022","volume":"14","author":"R Hinch","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pgph.0006630.ref055","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1038\/s41467-024-46590-4","article-title":"The decline of the 2022 Italian mpox epidemic: role of behavior changes and control strategies","volume":"15","author":"G Guzzetta","year":"2024","journal-title":"Nat Commun"},{"issue":"1","key":"pgph.0006630.ref056","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.50984","article-title":"Estimated testing, tracing, and vaccination targets for containment of the US mpox outbreak","volume":"6","author":"MH Chitwood","year":"2023","journal-title":"JAMA Network Open"},{"key":"pgph.0006630.ref057","volume-title":"Modeling infectious diseases in humans and animals","author":"MJ Keeling","year":"2007"},{"issue":"5","key":"pgph.0006630.ref058","doi-asserted-by":"crossref","first-page":"832","DOI":"10.3201\/eid1005.030419","article-title":"Ring vaccination and smallpox control","volume":"10","author":"M Kretzschmar","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"pgph.0006630.ref059","unstructured":"Shmerling RH. Ring vaccination might help curtail monkeypox outbreaks; 2022. Available from: https:\/\/www.health.harvard.edu\/blog\/ring-vaccination-might-help-curtail-monkeypox-202206062757"},{"key":"pgph.0006630.ref060","unstructured":"Enserink M. Ring vaccination revisited; 2003. Available from: https:\/\/www.science.org\/content\/article\/ring-vaccination-revisited"},{"key":"pgph.0006630.ref061","first-page":"100363","article-title":"Optimizing vaccination strategies for mpox control in endemic areas: modeling insights from the Democratic Republic of Congo","volume":"31","author":"A Pandey","year":"2026","journal-title":"Microb Risk Anal"},{"key":"pgph.0006630.ref062","unstructured":"CDC. Mpox in the United States and around the world: current situation; 2025. Available from: https:\/\/www.cdc.gov\/mpox\/situation-summary\/index.html"},{"key":"pgph.0006630.ref063","unstructured":"European Centre for Disease Prevention and Control. Transmission of monkeypox virus clade I: overall risk remains low in the EU\/EEA; 2025. Available from: https:\/\/www.ecdc.europa.eu\/en\/news-events\/transmission-monkeypox-virus-clade-i-overall-risk-remains-low-eueea"},{"issue":"8","key":"pgph.0006630.ref064","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/23744235.2024.2364801","article-title":"Prevention of sexual transmission of mpox: a systematic review and qualitative evidence synthesis of approaches","volume":"56","author":"S Paparini","year":"2024","journal-title":"Infect Dis (Lond)"},{"key":"pgph.0006630.ref065","article-title":"The impact of HIV and high-risk behaviours on the wives of married men who have sex with men and injection drug users: implications for HIV prevention","author":"SS Solomon","year":"2010","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pgph.0006630.ref066","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262094","article-title":"Mapping and size estimation of men who have sex with men in virtual platforms in Delhi, India","volume":"17","author":"S Isac","year":"2022","journal-title":"PLoS One"},{"key":"pgph.0006630.ref067","volume-title":"Sexual and social networks of MSM and Hijras in India: a qualitative study","author":"V Chakrapani","year":"2007"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:33:53Z","timestamp":1782754433000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006630"}},"subtitle":[],"editor":[{"given":"Andr\u00e9s F.","family":"Henao-Mart\u00ednez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":67,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006630","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}