Mpox in Children and Adolescents during Multicountry Outbreak, 2022-2023.

The 2022-2023 mpox outbreak predominantly affected adult men; 1.3% of reported cases were in children and adolescents <18 years of age. Analysis of global surveillance data showed 1 hospital intensive care unit admission and 0 deaths in that age group. Transmission routes and clinical manifestations varied across age subgroups.

Description of the first global outbreak of mpox: an analysis of global surveillance data.

BACKGROUND: In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS: In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS: Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4%] of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9%] of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7%] of 21 749). 3927 (7·3%) of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95% CI 1·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], p<0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], p<0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION: Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING: WHO Contingency Fund for Emergencies. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

Personal sampling for inhalable aerosol exposures of carbon black manufacturing industry workers.

The study was concerned with the measurement of inhalable aerosol exposures in the carbon black production industry. The primary goal of the study was to determine the extent to which inhalable aerosol exposure, as measured by the Institute of Occupational Medicine (IOM) personal inhalable sampling head, compared to "total" aerosol exposure, as measured by traditional methodology. A secondary objective was the evaluation of another inhalable aerosol sampler for carbon black aerosol measurement. In addition, an exploratory evaluation of the applicability of the National Institute for Occupational Safety and Health (NIOSH) analytical method (Method 5040) for the determination of carbon black, measured as elemental carbon, was conducted. A field study was carried out in a number of North American carbon black production plants using three samplers: the 2 Lpm IOM sampler as a reference sampler for the inhalable fraction, the 2 Lpm closed-face 37-mm plastic cassette that has been used for many years for total aerosol, and the 3.5 Lpm GSP sampler that has recently been identified by some as a possible candidate for inhalable aerosol. No such studies have previously been reported for the carbon black industry. Further, there have been no reports of the GSP performance in direct comparison to a reference instrument like the IOM sampler. The results showed that inhalable aerosol exposures for workers in carbon black production and packing areas were higher than the corresponding total aerosol exposures by a factor of nearly three, implying the presence of significantly coarser aerosol than previously thought based simply on knowledge of the carbon black production process. The fact that the aerosols collected in portions of the process comprised high proportions of non-elemental carbon particulate was thought likely to be responsible, underlining the need to consider whether gravimetric assessment for such exposure is the most appropriate metric. In addition, and somewhat surprisingly, the GSP sampler emerged clearly as a good alternative to the IOM sampler for collecting inhalable aerosol in carbon black industry workplaces like those studied (although this conclusion cannot yet be extended to other workplaces).