Responding to the mpox outbreak in real time

In 2022, the World Health Organization (WHO) began receiving reports of mpox virus infections from regions of the world where it is not endemic.

Just one week after the first mpox case was detected in Toronto in May 2022, the Emerging and Pandemic Infections Consortium (EPIC) and its hospital partners, including Sunnybrook Research Institute, Unity Health Toronto and the University Health Network, came together to mount a rapid research response to the global mpox outbreak.

The response was led by Darrell Tan (Unity Health) and Sharmistha Mishra (Unity Health) along with co-investigators Adrienne Chan and Rob Kozak (Sunnybrook), Sharon Walmsley (UHN), Allison McGeer (Sinai Health) and Mario Ostrowski (Unity), all of whom are cross-appointed to U of T and are members of EPIC.

Building on frameworks it had created to facilitate SARS-CoV-2 research during the pandemic, EPIC’s expertise enabled researchers to share materials and resources quickly, an essential factor in rapid outbreak and pandemic response. With the support of its hospital partners, EPIC mobilized more than $1 million in funding to launch five research projects to better understand everything from the range of symptoms associated with mpox infection to how changes in the virus’s genetic code correspond with changes in its ability to cause disease.

A central component of the research response was meaningful engagement with the gay, bisexual and men who have sex with men community, who were most impacted by the outbreak, as well as with other community partners. Within three months, the team produced a modelling study focused on optimizing vaccine rollout to minimize the outbreak’s impact. The results of the study helped to inform vaccine prioritization strategies by public health units across Ontario.

“Given our increasingly connected world, our findings really highlight the importance of global vaccine equity in responding to outbreaks, and also in preventing them in the first place,” says Jesse Knight, lead author on the study, and a recent PhD graduate of U of T’s Temerty Faculty of Medicine.

Though the outbreak abated later in the year, the research has continued. EPIC researchers contributed to an online atlas of mpox lesions published by the WHO, which will help researchers diagnose the disease more easily across different skin tones. The researchers who led EPIC’s mpox rapid research response also formed the Canada-Africa Mpox Partnership (CAMP), which launched in 2022. CAMP brings together 68 researchers with multidisciplinary expertise from Canada, Nigeria, the U.S. and U.K.

In March 2024, the team published another study demonstrating that DNA from the mpox virus can be found in different parts of the body for up to four weeks after symptom onset.