Projecting international mpox spread in Asia: ongoing global health risk

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Abstract The global mpox outbreak affected many Asian countries in 2023, following a sustained local transmission in Japan. Given the large population sizes and limited vaccine rollout in Asia, the potential risk of global mpox reemergence arising from Asia is of concern. Using a mathematical model incorporating heterogeneous sexual networks among MSM, calibrated to incidence data in Japan, we projected the patterns of international mpox spread across 42 Asian countries. Our simulations highlight countries at a high risk of mpox introductions, many of which were low- and middle-income countries (LMICs) in South-eastern Asia. Our analysis also suggests a shifting focus of importation risk from Eastern Asia to South-eastern Asia, and subsequently to Central, Southern and Western Asia, which roughly coincided with the observed spread patterns in 2023. Global cooperation and support are warranted, especially for LMICs with an elevated risk of mpox introduction, to minimise the risk of continued circulation in Asia and beyond.

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