Mpox in Northeast Brazil: Spatiotemporal analysis and predictors associated with confirmed diagnosis

The mpox outbreaks reported in several countries from May 2022 have shown an epidemiological profile different from that observed in previous years, raising a global public health alert. This issue is particularly important for Brazil, the second country with the highest number of mpox cases. Herein, we performed a retrospective cross-sectional study on mpox cases notified in Pernambuco state, northeastern Brazil, between July 2022 and March 2023. Confirmed mpox cases were analyzed in a space-time series and their social and clinical characteristics were compared with those of suspect-negative cases, including a multivariate logistic regression to identify predictors associated with a positive diagnosis. A total of 1493 suspected mpox cases were reported, of which 362 cases (24.2%) were confirmed and distributed in 33 municipalities. Most mpox cases occurred between epidemiological weeks (EW) 33 and 39 of 2022, with the highest moving average in EW 34 and 35 (36 and 31.5, respectively). The most frequent clinical signs and symptoms were rash (87.3%), fever (60.2%), headache (45.3%), and genital/perianal lesions (40.3%). In the multivariate analysis, three variables showed considerable performance in predicting a positive mpox diagnosis (area under the ROC curve = 0.87; 95% CI: 0.84-0.90): sexual orientation (nonheterosexual; OR: 23.08; 95% CI: 13.97-38.15), male sex (OR: 2.05; 95% CI: 1.10-3.85), and multiple partnerships (OR: 1.95; 95% CI: 1.15-3.32). Overall, in addition to the detailed spatiotemporal description of mpox cases, which may contribute to appropriate public health measures, our study brings insights into mpox epidemiology by describing predictors associated with a positive diagnosis.