Underdetected dispersal and extensive local transmission drove the 2022 mpox epidemic.

The World Health Organization declared mpox a public health emergency of international concern in July 2022. To investigate global mpox transmission and population-level changes associated with controlling spread, we built phylogeographic and phylodynamic models to analyze MPXV genomes from five global regions together with air traffic and epidemiological data. Our models reveal community transmission prior to detection, changes in case reporting throughout the epidemic, and a large degree of transmission heterogeneity. We find that viral introductions played a limited role in prolonging spread after initial dissemination, suggesting that travel bans would have had only a minor impact. We find that mpox transmission in North America began declining before more than 10% of high-risk individuals in the USA had vaccine-induced immunity. Our findings highlight the importance of broader routine specimen screening surveillance for emerging infectious diseases and of joint integration of genomic and epidemiological information for early outbreak control. [Display omitted] • Phylodynamic models reveal swift early mpox spread between five global regions • Extensive, underdetected dissemination promoted rapid local transmission • Later mpox introductions played a negligible role in prolonging regional epidemics • N. America epidemic declined before 10% of high-risk group had vaccine-induced immunity Joint analysis of genomic, mobility, and epidemiological data reveals that the 2022 mpox epidemic was characterized by rapid, underdetected local spread among high-risk groups following initial regional viral seeding events. Local behavioral changes played a larger role in curbing transmission than did travel restrictions and vaccination campaigns. [ABSTRACT FROM AUTHOR]