Borges, VítorDuque, Mariana PerezMartins, João VieiraVasconcelos, PaulaFerreira, RitaSobral, DanielPelerito, Anade Carvalho, Isabel LopesNúncio, Maria SofiaBorrego, Maria JoséRoemer, CorneliusNeher, Richard A.O’Driscoll, MeganRocha, RaquelLopo, SílviaNeves, RaquelPalminha, PaulaCoelho, LuísNunes, AlexandraIsidro, JoanaPinto, MiguelSantos, João DouradoMixão, VerónicaSantos, DanielaDuarte, SilviaVieira, LuísMartins, FátimaMachado, JorgeVeríssimo, Vítor CabralGrau, BertaPeralta-Santos, AndréNeves, JoséCaldeira, MargaridaPestana, MafaldaFernandes, CândidaCaria, JoãoPinto, RaquelPóvoas, DianaMaltez, FernandoSá, Ana IsabelSalvador, Mafalda BritoTeófilo, EugénioRocha, MiguelMoneti, VirginiaDuque, Luis Miguele Silva, Francisco FerreiraBaptista, TeresaVasconcelos, JoanaCasanova, SaraMansinho, KamalAlves, João VazAlves, JoãoSilva, AntónioAlpalhão, MiguelBrazão, CláudiaSousa, DiogoFilipe, PauloPacheco, PatríciaPeruzzu, Francescade Jesus, Rita PatrocínioFerreira, LuísMendez, JosefinaJordão, SofiaDuarte, FredericoGonçalves, Maria JoãoPena, EduardaSilva, Claúdio NunesGuimarães, André RodriguesTavares, MargaridaFreitas, GraçaCordeiro, RitaGomes, João Paulo2023-10-042023-10-042023-09-11Nat Med. 2023 Sep 11. doi: 10.1038/s41591-023-02542-x. Online ahead of print.http://hdl.handle.net/10400.18/8652Free PMC article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579057/Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.engMpox VirusMPXVViral ZoonosisOutbreakGenomic EpidemiologyViral Genome SequencePortugalInfectious DiseasesInfecções Sistémicas e ZoonosesInfecções Emergentesjournal article10.1038/s41591-023-02542-x