Planning for Mpox on a College Campus: A Model-Based Decision-Support Tool

Background: In spring and summer 2022, an outbreak of mpox occurred worldwide, largely confined to men who have sex with men (MSM). There was concern that mpox could break swiftly into congregate settings and populations with high levels of regular frequent physical contact, like university campus communities. Objective: To estimate the likelihood of an mpox outbreak and the potential effect of mitigation measures in a residential college setting. Design: A stochastic dynamic SEIR (susceptible, exposed but not infectious, infectious, or recovered) model of mpox transmission in a study population was developed, composed of: a high-risk group representative of the population of MSM with a basic reproductive number (R-0) of 2.4 and a low-risk group with an R0 of 0.8. Base input assumptions included an incubation time of 7.6 days and time to recovery of 21 days. Setting: U.S. residential college campus. Participants: Hypothetical cohort of 6500 students. Intervention: Isolation, quarantine, and vaccination of close contacts. Measurements: Proportion of 1000 simulations producing sustained transmission; mean cases given sustained transmission; maximum students isolated, quarantined, and vaccinated. All projections are estimated over a planning horizon of 100 days. Results: Without mitigation measures, the model estimated an 83% likelihood of sustained transmission, leading to an average of 183 cases. With detection and isolation of 20%, 50%, and 80% of cases, the average infections would fall to 117, 37, and 8, respectively. Reactive vaccination of contacts of detected cases (assuming 50% detection and isolation) reduced mean cases from 37 to 17, assuming 20 vaccinated contacts per detected case. Preemptive vaccination of 50% of the high-risk population before outbreak reduced cases from 37 to 14, assuming 50% detection and isolation. Limitation: A model is a stylized portrayal of behavior and transmission on a university campus. Conclusion: Based on our current understanding of mpox epidemiology among MSM in the United States, this model based analysis suggests that future outbreaks of mpox on college campuses may be controlled with timely detection and isolation of symptomatic cases.