Cordeiro, RitaCaetano, Constantino P.Sobral, DanielFerreira, RitaCoelho, LuísPelerito, Anade Carvalho, Isabel LopesNamorado, SóniaLoyens, Dinis B.Mexia, RicardoFernandes, CândidaNeves, José MiguelJoão, Ana LuísaRocha, MiguelDuque, Luís MiguelCorreia, InêsBaptista, TeresaBrazão, CláudiaSousa, DiogoFilipe, PauloAlpalhão, MiguelMaltez, FernandoPóvoas, DianaPinto, RaquelCaria, JoãoPatrocínio de Jesus, RitaPacheco, PatríciaPeruzzu, FrancescaMéndez, JosefinaFerreira, LuísMansinho, KamalAlves, João VazVasconcelos, JoanaDomingos, JoãoCasanova, SaraDuarte, FredericoGonçalves, Maria JoãoSalvador, Mafalda BritoGuimarães, Mafalda AndresenMartins, SueilaOliveira, Marvin SilvaSantos, DanielaVieira, LuísNúncio, Maria SofiaBorges, VítorGomes, João Paulo2025-03-122025-03-122024-12Emerg Microbes Infect. 2024 Dec;13(1):2412635. doi: 10.1080/22221751.2024.2412635. Epub 2024 Oct 112222-1751http://hdl.handle.net/10400.18/10436In 2023, a second wave of the global mpox epidemic, which is mainly affecting men who have sex with men (MSM), was observed in some countries. Herein, we benefited from a large viral sequence sampling (76/121; 63%) and vast epidemiological data to characterise the re-emergence and circulation of the (MPXV) in Portugal during 2023. We also modelled transmission and forecasted public health scenarios through a compartmental susceptible-exposed-infectious-recovered (SEIR) model. Our results suggest that the 2023 mpox wave in Portugal resulted from limited introduction(s) of MPXV belonging to C.1.1 sublineage, hypothetically from Asia, followed by sustained viral transmission and potential exportation to other countries. We estimated that the contribution of the MSM high sexual activity group to mpox transmission was 120 (95% CrI: 30-3553) times higher than that of the low sexual activity group. However, among the high sexual activity group, vaccinated individuals likely contributed approximately eight times less [0.123 (95% CrI: 0.068-0.208)] than the unvaccinated ones. Vaccination was also linked to potential reduced disease severity, with a Mpox Severity Score of 6.0 in the vaccinated group compared to 7.0 in unvaccinated individuals. Scenario analysis indicated that transmission is highly sensitive to sexual behaviour, projecting that a slight increase in the MSM sub-population with high sexual activity can trigger new mpox waves. This study strongly supports that continued vaccination, targeted awareness among risk groups and routine genomic epidemiology is needed to anticipate and respond to novel MPXV threats (e.g. global dissemination of clade I viruses).engMonkeypox VirusMen who have Sex with Men (MSM)High Sexual ActivitySecond WaveVaccinationEpidemiologyPublic HealthPortugalresearch article10.1080/22221751.2024.241263539360827