Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)

Elise Pesonel; Cédric Laouénan; Laetitia Guiraud; Josephine Bourner; Isabelle Hoffmann; Diana Molino; Coralie Tardivon; Delphine Bachelet; France Mentré; Alain Amstutz; Laura Merson; Amanda Rojek; Minerva Cervantes Gonzalez; Andrea Antinori; Antonella Castagna; Silvia Nozza; Valérie Pourcher; Agnès Libois; Jake Dunning; Evelina Tacconelli; Maya Hites; Fernando De La Calle Prieto; Peter Horby; Yazdan Yazdanpanah; Alexandra Calmy; François-Xavier Lescure; Piero Olliaro; Maya Hites; Leïla Belkhir; Marie-Angélique De Scheerder; Jean-Christophe Goffard; Agnès Libois; Zineb Khalil; Catherine Orban; Lucie Seyler; Clotilde Visée; Florence Ader; Antoine Bachelard; Yasmine Bouaraba; Jean-Marc Chapplain; Hugues Cordel; François Danion; Aurélien Dinh; Nikita Dobremel; Manuel Etienne; Pierre Frange; Karine Faure; François Goehringer; Karine Lacombe; Xavier Lescure; Rodolphe Manaquin; Guillaume Martin-Blondel; Jean-Michel Mansuy; Giovanny Gombert; Romain Palich; Gilles Pialoux; Aoife Cotter; Virginie Gautier; Evelina Tacconelli; Oriana Awwad; Andrea Antinori; Antonella Castagna; Silvia Nozza; Angelo Roberto Raccagni; Elena Bruzzesi; Antonio Cascio; Annamaria Cattelan; Maddalena Cordioli; Giulia De Luca; Lorenza Lambertenghi; Giulia Marchetti; Valentina Mazzotta; Emanuele Nicastri; Vincenzo Scaglione; Carlo Tascini; Jorge Machado; Lurdes Santos; Wong Chen Seong; Travis Ren Teen Chia; Wilnard Yeong Tze Tan; Fernando De La Calle Prieto; Vicente Estrada; Miguel Nicolás Navarrete Lorite; Alfredo Soler Carracedo; Maria Velasco Arribas; Dominique Braun; Alexandra Calmy; Matthias Cavassini; Lorenzo Ciullini; Stéphane Emonet; Chiara Fedeli; Yvan Gosmain; Laetitia Guiraud; Benjamin Hampel; Olivier Segeral; Cornelia Staehelin; Marcel Stöckle; Alejandro Arenas-Pinto; Mike Beadsworth; Margherita Bracchi; Joby Cole; Jake Dunning; Michael Marks; Brendan Payne; Malcolm G Semple; Claire Waddington; Chris Ward; Dominique Costagliola; Jérémie Guedj; Inge Christoffer Olsen; Diane Descamps; Christophe Batejat; Jessica Vanhomwegen; Maude Bouscambert-Duchamp; Julio Garcia Rodriguez; Alexandre Gaymard; Andreas Lind; Fabrizio Maggi; Hervé Raoul; Jeroen Van Kampen; Sabine Yerly; Nicolas Yin; Léo Chenard; Ismaila Deme; Alpha Diallo; Séverine Gibowski; Sabrina Kali; Guillaume Le Meut; Sophie Letrou; Claire Madelaine; Hervé Raoul; Ventzislava Petrov Sanchez

doi:10.1093/cid/ciae657

Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)

Elise Pesonel^*
, Cédric Laouénan
, Laetitia Guiraud
, Josephine Bourner
, Isabelle Hoffmann
, Diana Molino
, Coralie Tardivon
, Delphine Bachelet
, France Mentré
, Alain Amstutz
, Laura Merson
, Amanda Rojek
, Minerva Cervantes Gonzalez
, Andrea Antinori
, Antonella Castagna
, Silvia Nozza
, Valérie Pourcher
, Agnès Libois
, Jake Dunning
, Evelina Tacconelli

Maya Hites, Fernando De La Calle Prieto, Peter Horby, Yazdan Yazdanpanah, Alexandra Calmy, François-Xavier Lescure, Piero Olliaro, Maya Hites, Leïla Belkhir, Marie-Angélique De Scheerder, Jean-Christophe Goffard, Agnès Libois, Zineb Khalil, Catherine Orban, Lucie Seyler, Clotilde Visée, Florence Ader, Antoine Bachelard, Yasmine Bouaraba, Jean-Marc Chapplain, Hugues Cordel, François Danion, Aurélien Dinh, Nikita Dobremel, Manuel Etienne, Pierre Frange, Karine Faure, François Goehringer, Karine Lacombe, Xavier Lescure, Rodolphe Manaquin, Guillaume Martin-Blondel, Jean-Michel Mansuy, Giovanny Gombert, Romain Palich, Gilles Pialoux, Aoife Cotter, Virginie Gautier, Evelina Tacconelli, Oriana Awwad, Andrea Antinori, Antonella Castagna, Silvia Nozza, Angelo Roberto Raccagni, Elena Bruzzesi, Antonio Cascio, Annamaria Cattelan, Maddalena Cordioli, Giulia De Luca, Lorenza Lambertenghi, Giulia Marchetti, Valentina Mazzotta, Emanuele Nicastri, Vincenzo Scaglione, Carlo Tascini, Jorge Machado, Lurdes Santos, Wong Chen Seong, Travis Ren Teen Chia, Wilnard Yeong Tze Tan, Fernando De La Calle Prieto, Vicente Estrada, Miguel Nicolás Navarrete Lorite, Alfredo Soler Carracedo, Maria Velasco Arribas, Dominique Braun, Alexandra Calmy, Matthias Cavassini, Lorenzo Ciullini, Stéphane Emonet, Chiara Fedeli, Yvan Gosmain, Laetitia Guiraud, Benjamin Hampel, Olivier Segeral, Cornelia Staehelin, Marcel Stöckle, Alejandro Arenas-Pinto, Mike Beadsworth, Margherita Bracchi, Joby Cole, Jake Dunning, Michael Marks, Brendan Payne, Malcolm G Semple, Claire Waddington, Chris Ward, Dominique Costagliola, Jérémie Guedj, Inge Christoffer Olsen, Diane Descamps, Christophe Batejat, Jessica Vanhomwegen, Maude Bouscambert-Duchamp, Julio Garcia Rodriguez, Alexandre Gaymard, Andreas Lind, Fabrizio Maggi, Hervé Raoul, Jeroen Van Kampen, Sabine Yerly, Nicolas Yin, Léo Chenard, Ismaila Deme, Alpha Diallo, Séverine Gibowski, Sabrina Kali, Guillaume Le Meut, Sophie Letrou, Claire Madelaine, Hervé Raoul, Ventzislava Petrov Sanchez

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

12 Citations (Scopus)

Abstract

Background
The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation.

Methods
To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022–July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance.

Results
The 518 participants not receiving any specific treatment (“untreated”) were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) and perigenital (74%). By day 14 from the first polymerase chain reaction (PCR)–positive sample, 39% had resolved lesions. Time to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as inpatients; 34% and 58% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180.

Conclusions
MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.

Original language	English
Pages (from-to)	1060-1073
Number of pages	14
Journal	Clinical Infectious Diseases
Volume	80
Issue number	5
Early online date	3 Jan 2025
DOIs	https://doi.org/10.1093/cid/ciae657
Publication status	Published - 15 May 2025

Bibliographical note

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© 2025 Oxford University Press. All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Pesonel, E., Laouénan, C., Guiraud, L., Bourner, J., Hoffmann, I., Molino, D., Tardivon, C., Bachelet, D., Mentré, F., Amstutz, A., Merson, L., Rojek, A., Gonzalez, M. C., Antinori, A., Castagna, A., Nozza, S., Pourcher, V., Libois, A., Dunning, J., ... Sanchez, V. P. (2025). Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC). Clinical Infectious Diseases, 80(5), 1060-1073. https://doi.org/10.1093/cid/ciae657

@article{b42d941a99524da993ff347af09a4331,

title = "Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)",

abstract = "Background The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation. Methods To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022–July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance. Results The 518 participants not receiving any specific treatment (“untreated”) were diagnosed a median 5 days from symptom onset; 90\% were managed as outpatients. Lesions were mostly cutaneous (88\%) and perigenital (74\%). By day 14 from the first polymerase chain reaction (PCR)–positive sample, 39\% had resolved lesions. Time to 95\% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44\% as inpatients; 34\% and 58\% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95\% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180. Conclusions MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.",

author = "Elise Pesonel and C{\'e}dric Laou{\'e}nan and Laetitia Guiraud and Josephine Bourner and Isabelle Hoffmann and Diana Molino and Coralie Tardivon and Delphine Bachelet and France Mentr{\'e} and Alain Amstutz and Laura Merson and Amanda Rojek and Gonzalez, \{Minerva Cervantes\} and Andrea Antinori and Antonella Castagna and Silvia Nozza and Val{\'e}rie Pourcher and Agn{\`e}s Libois and Jake Dunning and Evelina Tacconelli and Maya Hites and Prieto, \{Fernando De La Calle\} and Peter Horby and Yazdan Yazdanpanah and Alexandra Calmy and Fran{\c c}ois-Xavier Lescure and Piero Olliaro and Maya Hites and Le{\"i}la Belkhir and Scheerder, \{Marie-Ang{\'e}lique De\} and Jean-Christophe Goffard and Agn{\`e}s Libois and Zineb Khalil and Catherine Orban and Lucie Seyler and Clotilde Vis{\'e}e and Florence Ader and Antoine Bachelard and Yasmine Bouaraba and Jean-Marc Chapplain and Hugues Cordel and Fran{\c c}ois Danion and Aur{\'e}lien Dinh and Nikita Dobremel and Manuel Etienne and Pierre Frange and Karine Faure and Fran{\c c}ois Goehringer and Karine Lacombe and Xavier Lescure and Rodolphe Manaquin and Guillaume Martin-Blondel and Jean-Michel Mansuy and Giovanny Gombert and Romain Palich and Gilles Pialoux and Aoife Cotter and Virginie Gautier and Evelina Tacconelli and Oriana Awwad and Andrea Antinori and Antonella Castagna and Silvia Nozza and Raccagni, \{Angelo Roberto\} and Elena Bruzzesi and Antonio Cascio and Annamaria Cattelan and Maddalena Cordioli and Luca, \{Giulia De\} and Lorenza Lambertenghi and Giulia Marchetti and Valentina Mazzotta and Emanuele Nicastri and Vincenzo Scaglione and Carlo Tascini and Jorge Machado and Lurdes Santos and Seong, \{Wong Chen\} and Chia, \{Travis Ren Teen\} and Tan, \{Wilnard Yeong Tze\} and Prieto, \{Fernando De La Calle\} and Vicente Estrada and Lorite, \{Miguel Nicol{\'a}s Navarrete\} and Carracedo, \{Alfredo Soler\} and Arribas, \{Maria Velasco\} and Dominique Braun and Alexandra Calmy and Matthias Cavassini and Lorenzo Ciullini and St{\'e}phane Emonet and Chiara Fedeli and Yvan Gosmain and Laetitia Guiraud and Benjamin Hampel and Olivier Segeral and Cornelia Staehelin and Marcel St{\"o}ckle and Alejandro Arenas-Pinto and Mike Beadsworth and Margherita Bracchi and Joby Cole and Jake Dunning and Michael Marks and Brendan Payne and Semple, \{Malcolm G\} and Claire Waddington and Chris Ward and Dominique Costagliola and J{\'e}r{\'e}mie Guedj and Olsen, \{Inge Christoffer\} and Diane Descamps and Christophe Batejat and Jessica Vanhomwegen and Maude Bouscambert-Duchamp and Rodriguez, \{Julio Garcia\} and Alexandre Gaymard and Andreas Lind and Fabrizio Maggi and Herv{\'e} Raoul and Kampen, \{Jeroen Van\} and Sabine Yerly and Nicolas Yin and L{\'e}o Chenard and Ismaila Deme and Alpha Diallo and S{\'e}verine Gibowski and Sabrina Kali and Meut, \{Guillaume Le\} and Sophie Letrou and Claire Madelaine and Herv{\'e} Raoul and Sanchez, \{Ventzislava Petrov\}",

year = "2025",

month = may,

day = "15",

doi = "10.1093/cid/ciae657",

language = "English",

volume = "80",

pages = "1060--1073",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "5",

}

Pesonel, E, Laouénan, C, Guiraud, L, Bourner, J, Hoffmann, I, Molino, D, Tardivon, C, Bachelet, D, Mentré, F, Amstutz, A, Merson, L, Rojek, A, Gonzalez, MC, Antinori, A, Castagna, A, Nozza, S, Pourcher, V, Libois, A, Dunning, J, Tacconelli, E, Hites, M, Prieto, FDLC, Horby, P, Yazdanpanah, Y, Calmy, A, Lescure, F-X, Olliaro, P, Hites, M, Belkhir, L, Scheerder, M-AD, Goffard, J-C, Libois, A, Khalil, Z, Orban, C, Seyler, L, Visée, C, Ader, F, Bachelard, A, Bouaraba, Y, Chapplain, J-M, Cordel, H, Danion, F, Dinh, A, Dobremel, N, Etienne, M, Frange, P, Faure, K, Goehringer, F, Lacombe, K, Lescure, X, Manaquin, R, Martin-Blondel, G, Mansuy, J-M, Gombert, G, Palich, R, Pialoux, G, Cotter, A, Gautier, V, Tacconelli, E, Awwad, O, Antinori, A, Castagna, A, Nozza, S, Raccagni, AR, Bruzzesi, E, Cascio, A, Cattelan, A, Cordioli, M, Luca, GD, Lambertenghi, L, Marchetti, G, Mazzotta, V, Nicastri, E, Scaglione, V, Tascini, C, Machado, J, Santos, L, Seong, WC, Chia, TRT, Tan, WYT, Prieto, FDLC, Estrada, V, Lorite, MNN, Carracedo, AS, Arribas, MV, Braun, D, Calmy, A, Cavassini, M, Ciullini, L, Emonet, S, Fedeli, C, Gosmain, Y, Guiraud, L, Hampel, B, Segeral, O, Staehelin, C, Stöckle, M, Arenas-Pinto, A, Beadsworth, M, Bracchi, M, Cole, J, Dunning, J, Marks, M, Payne, B, Semple, MG, Waddington, C, Ward, C, Costagliola, D, Guedj, J, Olsen, IC, Descamps, D, Batejat, C, Vanhomwegen, J, Bouscambert-Duchamp, M, Rodriguez, JG, Gaymard, A, Lind, A, Maggi, F, Raoul, H, Kampen, JV, Yerly, S, Yin, N, Chenard, L, Deme, I, Diallo, A, Gibowski, S, Kali, S, Meut, GL, Letrou, S, Madelaine, C, Raoul, H & Sanchez, VP 2025, 'Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)', Clinical Infectious Diseases, vol. 80, no. 5, pp. 1060-1073. https://doi.org/10.1093/cid/ciae657

TY - JOUR

T1 - Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)

AU - Pesonel, Elise

AU - Laouénan, Cédric

AU - Guiraud, Laetitia

AU - Bourner, Josephine

AU - Hoffmann, Isabelle

AU - Molino, Diana

AU - Tardivon, Coralie

AU - Bachelet, Delphine

AU - Mentré, France

AU - Amstutz, Alain

AU - Merson, Laura

AU - Rojek, Amanda

AU - Gonzalez, Minerva Cervantes

AU - Antinori, Andrea

AU - Castagna, Antonella

AU - Nozza, Silvia

AU - Pourcher, Valérie

AU - Libois, Agnès

AU - Dunning, Jake

AU - Tacconelli, Evelina

AU - Hites, Maya

AU - Prieto, Fernando De La Calle

AU - Horby, Peter

AU - Yazdanpanah, Yazdan

AU - Calmy, Alexandra

AU - Lescure, François-Xavier

AU - Olliaro, Piero

AU - Hites, Maya

AU - Belkhir, Leïla

AU - Scheerder, Marie-Angélique De

AU - Goffard, Jean-Christophe

AU - Libois, Agnès

AU - Khalil, Zineb

AU - Orban, Catherine

AU - Seyler, Lucie

AU - Visée, Clotilde

AU - Ader, Florence

AU - Bachelard, Antoine

AU - Bouaraba, Yasmine

AU - Chapplain, Jean-Marc

AU - Cordel, Hugues

AU - Danion, François

AU - Dinh, Aurélien

AU - Dobremel, Nikita

AU - Etienne, Manuel

AU - Frange, Pierre

AU - Faure, Karine

AU - Goehringer, François

AU - Lacombe, Karine

AU - Lescure, Xavier

AU - Manaquin, Rodolphe

AU - Martin-Blondel, Guillaume

AU - Mansuy, Jean-Michel

AU - Gombert, Giovanny

AU - Palich, Romain

AU - Pialoux, Gilles

AU - Cotter, Aoife

AU - Gautier, Virginie

AU - Tacconelli, Evelina

AU - Awwad, Oriana

AU - Antinori, Andrea

AU - Castagna, Antonella

AU - Nozza, Silvia

AU - Raccagni, Angelo Roberto

AU - Bruzzesi, Elena

AU - Cascio, Antonio

AU - Cattelan, Annamaria

AU - Cordioli, Maddalena

AU - Luca, Giulia De

AU - Lambertenghi, Lorenza

AU - Marchetti, Giulia

AU - Mazzotta, Valentina

AU - Nicastri, Emanuele

AU - Scaglione, Vincenzo

AU - Tascini, Carlo

AU - Machado, Jorge

AU - Santos, Lurdes

AU - Seong, Wong Chen

AU - Chia, Travis Ren Teen

AU - Tan, Wilnard Yeong Tze

AU - Prieto, Fernando De La Calle

AU - Estrada, Vicente

AU - Lorite, Miguel Nicolás Navarrete

AU - Carracedo, Alfredo Soler

AU - Arribas, Maria Velasco

AU - Braun, Dominique

AU - Calmy, Alexandra

AU - Cavassini, Matthias

AU - Ciullini, Lorenzo

AU - Emonet, Stéphane

AU - Fedeli, Chiara

AU - Gosmain, Yvan

AU - Guiraud, Laetitia

AU - Hampel, Benjamin

AU - Segeral, Olivier

AU - Staehelin, Cornelia

AU - Stöckle, Marcel

AU - Arenas-Pinto, Alejandro

AU - Beadsworth, Mike

AU - Bracchi, Margherita

AU - Cole, Joby

AU - Dunning, Jake

AU - Marks, Michael

AU - Payne, Brendan

AU - Semple, Malcolm G

AU - Waddington, Claire

AU - Ward, Chris

AU - Costagliola, Dominique

AU - Guedj, Jérémie

AU - Olsen, Inge Christoffer

AU - Descamps, Diane

AU - Batejat, Christophe

AU - Vanhomwegen, Jessica

AU - Bouscambert-Duchamp, Maude

AU - Rodriguez, Julio Garcia

AU - Gaymard, Alexandre

AU - Lind, Andreas

AU - Maggi, Fabrizio

AU - Raoul, Hervé

AU - Kampen, Jeroen Van

AU - Yerly, Sabine

AU - Yin, Nicolas

AU - Chenard, Léo

AU - Deme, Ismaila

AU - Diallo, Alpha

AU - Gibowski, Séverine

AU - Kali, Sabrina

AU - Meut, Guillaume Le

AU - Letrou, Sophie

AU - Madelaine, Claire

AU - Raoul, Hervé

AU - Sanchez, Ventzislava Petrov

PY - 2025/5/15

Y1 - 2025/5/15

N2 - Background The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation. Methods To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022–July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance. Results The 518 participants not receiving any specific treatment (“untreated”) were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) and perigenital (74%). By day 14 from the first polymerase chain reaction (PCR)–positive sample, 39% had resolved lesions. Time to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as inpatients; 34% and 58% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180. Conclusions MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.

AB - Background The global mpox outbreak that started in May 2022 was caused by a novel clade IIb variant of the mpox virus (Orthopoxvirus monkeypox, MPXV). It differed from the traditional Western and Central Africa disease in transmission patterns and clinical presentation. Methods To address the need for detailed clinical and virologic data, we conducted an observational cohort study (MOSAIC) during May 2022–July 2023 in individuals with confirmed MPXV infection enrolled in 6 European countries. Case management decisions were left to the attending physician. Participants were monitored for up to 6 months for clinical signs/symptoms and clinical and virologic outcomes through hospital visits, phone interviews, and self-administered questionnaires. Outcomes included time to lesion resolution, clinical status, and virus clearance. Results The 518 participants not receiving any specific treatment (“untreated”) were diagnosed a median 5 days from symptom onset; 90% were managed as outpatients. Lesions were mostly cutaneous (88%) and perigenital (74%). By day 14 from the first polymerase chain reaction (PCR)–positive sample, 39% had resolved lesions. Time to 95% unculturable virus was longest in cutaneous lesions (52 days). A putative systemic antiviral was available for 57 participants, 44% as inpatients; 34% and 58% had resolved lesions by day 14 from the first PCR-positive sample and from treatment start, respectively. Time to 95% unculturable virus was 60 days in skin and oropharynx. No death or recrudescence occurred by day 180. Conclusions MOSAIC provides comprehensive insights into the clinical and virologic characteristics of mpox caused by the clade IIb variant. The study forms the basis of clinical characterization for ongoing mpox outbreaks.

U2 - 10.1093/cid/ciae657

DO - 10.1093/cid/ciae657

M3 - Article (Academic Journal)

C2 - 39749987

SN - 1058-4838

VL - 80

SP - 1060

EP - 1073

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 5

ER -

Clinical Characterization and Outcomes of Human Clade IIb Mpox Virus Disease: A European Multicenter Mpox Observational Cohort Study (MOSAIC)

Abstract

Bibliographical note

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