Simulating a potential mpox outbreak in India: Implications for outbreak control in non-endemic settings

We construct an agent-based model for mpox outbreaks in low and middle-income countries where the disease is non-endemic, using India as an example. We simulate potential outbreak scenarios using BharatSim, an agent-based simulation framework. The spread of mpox is modelled as being driven primarily through sexual contacts within a subnetwork of men having sex with men (MSM). This subnetwork is embedded within a larger network representing their household and workplace contacts. We allow for disease spread through this expanded network. We quantify the outbreak size, the dynamics of infection within and outside the MSM subnetwork, and the implications of vaccination and prophylactic measures for curtailing disease spread. These results should inform planning and policy measures for mpox control in generic LMIC settings. Author summaryMpox continues to be classified as a Public Health Emergency of International Concern. While the disease is very largely sexually transmitted, through networks of men having sex with men (MSM), there is an emerging consensus that household and workplace transmission could expand the scope of a potential outbreak. Relatively little is known about mpox transmission in non-endemic settings, where disease reservoirs are absent. We construct and simulate an agent-based model of disease spread for a potential mpox outbreak in low and middle-income countries, using India as an example. Our model uses a network description of the population, with an embedded subnetwork of MSMs. Transmission events in both homes and workplaces lead to the spread of disease on the extended network. Our results tie into a discussion of potental policy interventions, including targeted vaccination programs, for mpox control.