Monkeypox outbreaks in the context of the COVID-19 pandemic: Network and clustering analyses of global risks and modified SEIR prediction of epidemic trends

Background: Ninety-eight percent of documented cases of the zoonotic disease human monkeypox (MPX) were reported after , with especially dramatic global spread in . This longitudinal study aimed to assess spatiotemporal risk factors of MPX infection and predict global epidemiological trends. Method: Twenty-one potential risk factors were evaluated by correlation-based network analysis and multivariate regression. Country-level risk was assessed using a modified Susceptible-Exposed-Infectious-Removed (SEIR) model and a risk-factor-driven k-means clustering analysis. Results: Between historical cases and the outbreak, MPX infection risk factors changed from relatively simple [human immunodeficiency virus (HIV) infection and population density] to multiple [human mobility, population of men who have sex with men, coronavirus disease (COVID-) infection, and socioeconomic factors], with human mobility in the context of COVID-being especially key. The included countries classified into three risk clusters: high-risk countries mainly in West Europe and Northern America, medium-risk countries mainly in Latin America and Asia, and low-risk countries mainly in Africa and South Asia. The modified SEIR model predicted declining transmission rates, with basic reproduction numbers ranging . -. in the early stage and . -. in the current stage. The estimated cumulative cases in Northern and Latin America may overtake the number in Europe in autumn . Conclusions: In the current outbreak, risk factors for MPX infection have changed and expanded. Forecasts of epidemiological trends from our modified SEIR models suggest that Northern America and Latin America are at greater risk of MPX infection in the future.