{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T05:47:56Z","timestamp":1794462476444,"version":"4.9.1"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May\u2013December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells\/\u03bcL; 83% had HIV-RNA &lt; 50 copies\/mL; and 1.8% CD4+T-cell &lt; 200 cells\/\u03bcL. PWH had no increased risk for complications, except those with CD4+T-cell &lt; 200 cells\/\u03bcL. PWH with CD4+T-cell &lt; 200 cells\/\u03bcL were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p &lt; 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.<\/jats:p>","DOI":"10.3390\/microorganisms11112701","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T10:51:28Z","timestamp":1699008688000},"page":"2701","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3543-1970","authenticated-orcid":false,"given":"Raquel","family":"Mart\u00edn-Iguacel","sequence":"first","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6481-452X","authenticated-orcid":false,"given":"Carles","family":"Pericas","sequence":"additional","affiliation":[{"name":"Epidemiology Service, Public Health Agency of Barcelona, 08023 Barcelona, Spain"},{"name":"Department of Medicine, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Institute of Biomedical Research Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreu","family":"Bruguera","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"CIBER Epidemiologia y Salud P\u00fablica (CIBERESP), 28029 Madrid, Spain"},{"name":"Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Aut\u00f2noma de Barcelona, 08916 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Rosell","sequence":"additional","affiliation":[{"name":"Subdirecci\u00f3 General de Vigil\u00e0ncia i Resposta a Alertes i Emerg\u00e8ncies de Salut P\u00fablica\u2014ASPCAT, Tei\u00e0, Catalu\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Research Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain"},{"name":"Subdirecci\u00f3 General de Vigil\u00e0ncia i Resposta a Alertes i Emerg\u00e8ncies de Salut P\u00fablica\u2014ASPCAT, Tei\u00e0, Catalu\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3727-7340","authenticated-orcid":false,"given":"Yesika","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"CIBER Epidemiologia y Salud P\u00fablica (CIBERESP), 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Alonso","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"Fight Infections Foundation, Badalona, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-9316","authenticated-orcid":false,"given":"Daniel Kwakye","family":"Nomah","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"Fundaci\u00f3 Institut D\u2019investigaci\u00f3 en Ci\u00e8ncies de la Salut Germans Trias I Pujol (IGTP), 08916 Badalona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Luis","family":"Blanco","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, University of Barcelona, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1138-5770","authenticated-orcid":false,"given":"Pere","family":"Domingo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4227-1987","authenticated-orcid":false,"given":"Patricia","family":"\u00c1lvarez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hospital Universitari de la Vall d\u2019Hebron, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Saumoy","family":"Linares","sequence":"additional","affiliation":[{"name":"HIV and STD Unit, Infectious Disease Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Consuelo","family":"Vilades Laborda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universitari Tarragona Juan XXIII, Universitat Rovira i Virgili, Tarragona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arantxa","family":"Mera","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital de Palam\u00f3s, 17230 Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Calzado Isbert","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Parc Taul\u00ed University Hospital, Sabadell, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2189-9823","authenticated-orcid":false,"given":"Isik Somuncu","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8057-7755","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer, University of Barcelona, 08916 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Casabona","sequence":"additional","affiliation":[{"name":"Centre of Epidemiological Studies of HIV\/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain"},{"name":"Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Aut\u00f2noma de Barcelona, 08916 Badalona, Spain"},{"name":"Department of Internal Medicine, Hospital de Palam\u00f3s, 17230 Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7158-6753","authenticated-orcid":false,"given":"Josep M.","family":"Llibre","sequence":"additional","affiliation":[{"name":"Fight Infections Foundation, Badalona, 08916 Barcelona, Spain"},{"name":"Infectious Diseases Department, University Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2200422","DOI":"10.2807\/1560-7917.ES.2022.27.22.2200422","article-title":"Community Transmission of Monkeypox in the United Kingdom, April to May 2022","volume":"27","author":"Vivancos","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_2","first-page":"2200424","article-title":"Ongoing Monkeypox Virus Outbreak, Portugal, 29 April to 23 May 2022","volume":"27","author":"Duque","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_3","first-page":"2200471","article-title":"Monkeypox Outbreak Predominantly Affecting Men Who Have Sex with Men, Madrid, Spain, 26 April to 16 June 2022","volume":"27","author":"Bueno","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_4","unstructured":"World Health Organization, Geneva (2023, October 30). Multi-Country Monkeypox Outbreak in Non-Endemic Countries. Available online: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON385."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2200499","DOI":"10.2807\/1560-7917.ES.2022.27.27.2200499","article-title":"A Shift from Travel-Associated Cases to Autochthonous Transmission with Berlin as Epicentre of the Monkeypox Outbreak in Germany, May to June 2022","volume":"27","author":"Selb","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2200421","DOI":"10.2807\/1560-7917.ES.2022.27.22.2200421","article-title":"Epidemiological, Clinical and Virological Characteristics of Four Cases of Monkeypox Support Transmission through Sexual Contact, Italy, May 2022","volume":"27","author":"Antinori","year":"2022","journal-title":"Eurosurveillance"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1001\/jama.2022.12513","article-title":"The WHO Declaration of Monkeypox as a Global Public Health Emergency","volume":"328","author":"Nuzzo","year":"2022","journal-title":"JAMA"},{"key":"ref_8","unstructured":"(2023, October 30). Multi-Country Outbreak of Mpox, External Situation Report #28. Available online: https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-mpox--external-situation-report-28---19-september-2023."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bunge, E.M., Hoet, B., Chen, L., Lienert, F., Weidenthaler, H., Baer, L.R., and Steffen, R. (2022). The Changing Epidemiology of Human Monkeypox\u2014A Potential Threat? A Systematic Review. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010141"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox Virus Infection in Humans across 16 Countries\u2014April\u2013June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/S0140-6736(22)02187-0","article-title":"Human Monkeypox Virus Infection in Women and Non-Binary Individuals during the 2022 Outbreaks: A Global Case Series","volume":"400","author":"Thornhill","year":"2022","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0140-6736(23)00273-8","article-title":"Mpox in People with Advanced HIV Infection: A Global Case Series","volume":"401","author":"Alemany","year":"2023","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1056\/NEJMc2300805","article-title":"Effectiveness of Smallpox Vaccination to Prevent Mpox in Military Personnel","volume":"389","author":"Titanji","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Malone, S.M., Mitra, A.K., Onumah, N.A., Brown, A., Jones, L.M., Tresvant, D., Brown, C.S., Onyia, A.U., and Iseguede, F.O. (2023). Safety and Efficacy of Post-Eradication Smallpox Vaccine as an Mpox Vaccine: A Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20042963"},{"key":"ref_15","unstructured":"(2023, October 30). N\u00fam Disposici\u00f3n 2837 Del BOE N\u00fam. 65 de 2015. Available online: https:\/\/www.boe.es\/buscar\/doc.php?id=BOE-A-2015-2837."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e241","DOI":"10.1093\/ije\/dyad083","article-title":"Cohort Profile: PISCIS, a Population-Based Cohort of People Living with HIV in Catalonia and Balearic Islands","volume":"52","author":"Bruguera","year":"2023","journal-title":"Int. J. Epidemiol."},{"key":"ref_17","unstructured":"Government of Catalonia (2023, October 30). Public Program of Data Analysis for Health Research and Innovation in Catalonia \u2013PADRIS\u2013. AQuAS. Barcelona, Available online: https:\/\/aquas.gencat.cat\/web\/.content\/minisite\/aquas\/fem\/avaluacio\/procediments\/Methodological_Guide_RWD_HTA_AQuAS_2022.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data from 6 Countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"404","DOI":"10.15585\/mmwr.mm7215a5","article-title":"Epidemiologic and clinical features of mpox-associated deaths\u2014United States, May 10, 2022\u2013March 7, 2023","volume":"72","author":"Riser","year":"2023","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_20","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":"Deputy","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"553","DOI":"10.15585\/mmwr.mm7220a3","article-title":"Estimated effectiveness of JYNNEOS vaccine in preventing mpox: A multijurisdictional case-control study\u2014United States, August 19, 2022\u2013March 31, 2023","volume":"72","author":"Dalton","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1038\/s41591-023-02229-3","article-title":"Real-World Effectiveness of a Single Dose of Mpox Vaccine in Males","volume":"29","author":"Zucker","year":"2023","journal-title":"Nat. Med."},{"key":"ref_23","unstructured":"(2023, October 30). Centers for Disease Control and Prevention Rates of Mpox Cases by Vaccination Status, Available online: https:\/\/www.cdc.gov\/poxvirus\/mpox\/cases-data\/mpx-vaccine-effectiveness.html#print."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"pgad095","DOI":"10.1093\/pnasnexus\/pgad095","article-title":"Evaluation of Mpox Vaccine Dose-Sparing Strategies","volume":"2","author":"Dimitrov","year":"2023","journal-title":"PNAS Nexus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"398","DOI":"10.15585\/mmwr.mm7215a4","article-title":"Racial and ethnic disparities in mpox cases and vaccination among adult males\u2014United States, May\u2013December 2022","volume":"72","author":"Kota","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1007\/s10461-018-2270-7","article-title":"Intersectional Identities and HIV: Race and Ethnicity Drive Patterns of Sexual Mixing","volume":"23","author":"Birkett","year":"2019","journal-title":"AIDS Behav."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/11\/2701\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:16:41Z","timestamp":1760131001000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/11\/2701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["microorganisms11112701"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11112701","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]}}}