Mpox Rapid Research Response
In July 2022, less than two months after the first mpox (formerly known as monkeypox) case was reported in Toronto, EPIC launched a collaborative mpox rapid research response to address gaps in our understanding about the disease, specifically with regards to viral shedding and evolution, transmission dynamics and risk, and immune response.
The initiative brought together scientists and clinicians at the University of Toronto and its hospital partners, including Sinai Health Systems, Sunnybrook Research Institute, Unity Health Toronto and University Health Network. The goal of these efforts is to generate data that could help inform the public health response to mpox locally in Canada and in countries where the virus is endemic.
The collaborative research response is co-led by Darrell Tan and Sharmistha Mishra, associate professors in the Temerty Faculty of Medicine and infectious disease physicians at St. Michael’s Hospital, a site of Unity Health Toronto. The interdisciplinary and collaborative research response is supported by funds from EPIC, the McLaughlin Center, Sunnybrook Research Institute, the Temerty Faculty of Medicine, Unity Health Toronto, University Health Network and the U of T Institutional Strategic Initiatives office.
The Mpox Prospective Observational Cohort Study
A key component of EPIC’s mpox rapid research response is the Mpox Prospective Observational Cohort Study (MPOCS) led by Darrell Tan. The cohort includes people with suspected or confirmed mpox infection.
MPOCS participants meet regularly with clinicians and provide valuable information through completing questionnaires and symptom diaries and sharing biological samples, such as blood, urine, semen and swabs of different body parts. These samples are also stored in a biobank so that researchers can, with participant consent, conduct additional studies that will help us understand the biology of mpox.
The cohort study will initially focus on answering four main questions:
- How does mpox infection progress in an individual over time and how does this progression vary between individuals?
- What are the social, economic and psychosocial impacts of mpox infection and isolation?
- What are the transmission risks associated with different types of exposure (sexual versus non-sexual close contact, household, environmental, etc…)?
- How does viral shedding differ between body sites and across different timepoints during an infection?
Community engagement is a central tenet underlying MPOCS and has been incorporated into the study design from the beginning. The study includes a community advisory board and the study investigators are actively engaged with a large group of community organizations serving the sexual minority communities most affected by mpox in Canada.
We are tremendously grateful to everyone who has engaged with us and taken part in MPOCS. Without you, this work would not be possible!
The Mpox Biobank
The Mpox Biobank was created to collect and store biological samples and personal health information of people affected by mpox. Biological samples stored in the biobank include blood, urine, semen/vaginal fluid, rectal swabs, throat swabs, nose swabs and skin lesion swabs that were collected during study visits for the MPOCS study. If you provided samples, information about the use of the Mpox Biobank will be shared here. At this time, no studies have accessed samples from the Mpox Biobank.
In addition to MPOCS, here are the other projects supported by EPIC’s mpox rapid research response:
Project #1: Immune responses
Using blood samples from MPOCS participants, scientists will study how the immune system responds to mpox infection and how that response changes over the course of the infection. This will lead to insights about immune markers that could help predict how an individual will fare and how protected they are from infection or reinfection. This project is led by Scott Gray-Owen (University of Toronto), Rupert Kaul (University Health Network) and Mario Ostrowski (Unity Health Toronto).
Project #2: Viral genetics
Using samples from MPOCS participants, scientists will delve into the genetics of the mpox virus to understand how it has changed during the outbreak. This will help create a map of viral evolution, identify any new variants may emerge and determine how genetic changes affect the virus’ ability to infect and cause disease. This project is led by Robert Kozak (Sunnybrook Health Sciences Centre).
Project #3: Environmental transmission
This project will examine the potential and risks of mpox transmission via contaminated surfaces and long-range aerosols. The researchers will also look at how effective different cleaning products and methods are at decontaminating surfaces. This project is co-led by Christopher Kandel (Michael Garron Hospital), Robert Kozak (Sunnybrook), Allison McGeer (Sinai Health Systems) and Matthew Muller (Unity Health Toronto) in partnership with Public Health Ontario laboratories and infection prevention and control teams at four hospitals (Sinai Health Systems, Sunnybrook Health Science Centre, Unity Health Toronto and University Health Network).
Project #4: Mathematical modelling of mpox transmission
This project will use data-driven mathematical modelling to examine mpox transmission in the context of complex sexual networks. It is led by Sharmistha Mishra (Unity Health Toronto).
Project #5: Therapeutic clinical trial
This randomized controlled trial (PLATINUM-CAN) will assess the safety and effectiveness of the smallpox drug tecovirimat as a treatment for mpox and is part of a larger international effort led out of the UK to consolidate clinical trials data from multiple sites (PLATINUM-UK). PLATINUM-CAN is led by Marina Klein (McGill University) and the Toronto sites are led by Sharon Walmsley (University Health Network) and Darrell Tan (Unity Health Toronto). This trial has received additional funding support from the Public Health Agency of Canada and the Canadian Institutes of Health Research (CIHR) Canadian HIV Trials Network.
These projects are also supported by CIHR and the International Development Research Centre through funding for the Canada-Africa Mpox Partnership (CAMP), a collaborative initiative that brings together 68 researchers from Canada, Nigeria, the U.S. and U.K. to address key questions related to mpox transmission, prevention and treatment. The funding provided by the EPIC mpox rapid research response was crucial in enabling our members to secure additional funding and participate in larger national and international collaborations.
A case of human monkeypox in Canada. Sukhdeo, S., Aldhaheri, K., Lam, P.E., and Walmsley, S. Canadian Medical Association Journal. August 2 2022. 194(29):E1031-1035. DOI: https://doi.org/10.1503/cmaj.220886
Atypical clinical presentation of monkeypox complicated by myopericarditis. Tan, D.H.S., Jaeranny, S., Li, M., Sukhdeo, S.S., Monge, J.C., Callejas, M.F., Hasso, M., Fattouh, R., Lalonde, S.D., Lam, J., and Mishra, S. Open Forum Infectious Diseases. August 2022. 9(8): ofac394. DOI: https://doi.org/10.1093/ofid/ofac394
Environmental testing of surfaces in the room of a patient with mpox. Muller, M.P., Mishra, S., McGeer, A., Patel, S., Gubbay, J., Hasso, M., Chan, A.K., Kozak, R., Leis, J.A., and Tan, D.S. Clinical Infectious Diseases. August 19 2022. 76(1):179-181. DOI: https://doi.org/10.1093/cid/ciac654
Monkeypox virus infection in humans across 16 countries – April-June 2022. Thornhill, J.P., Barkati, S., Walmsley, S., et al. for the SHARE-net Clinical Group. New England Journal of Medicine. August 25 2022. 387:679-691. DOI: 10.1056/NEJMoa2207323
Human monkeypox: cutaneous lesions in 8 patients in Canada. Sukhdeo, S., Tan, D.H.S., and Mishra, S. Canadian Medical Association Journal. October 3 2022. 194(38):E1323-1327. DOI: https://doi.org/10.1093/cid/ciac654
Maximizing the impact of limited vaccine supply under different early epidemic conditions: a 2-city modelling analysis of monkeypox virus transmission among men who have sex with men. Knight, J., Tan, D.H.S., and Mishra, S. Canadian Medical Association Journal. November 28 2022. 194(46):E1560-67. DOI: https://doi.org/10.1503/cmaj.221232.
Monkeypox-associated disciform keratitis. Alsarhani, W.K., Chan, C.C., Boyd, S.R., Hasso, M., Almeer, A., and Tan, D.H.S. Cornea. December 9 2022. DOI: 10.1097/ICO.0000000000003171.
Human monkeypox: a comparison of the characteristics of the new epidemic to the endemic disease. Sukhdeo, S., Mishra, S., and Walmsley, S. BMC Infectious Diseases. December 12 2022. 22(1):928. DOI: 10.1186/s12879-022-07900-7.
Environmental surface contamination with monkeypox virus in the ambulatory setting in Toronto, Canada. Sukhdeo, S., Muller, M., McGeer, A., Leis, J.A., Chan, A., Gubbay, J.B., Patel, S., Khan, S., Perusini, S., Li, X.A., Kozak, R., Mishra, S., Tan, D.H.S. and Kandel, C. Open Forum Infectious Diseases. December 26 2022. ofac648. DOI: https://doi.org/10.1093/ofid/ofac648.
Bolded names indicate researchers who are members of EPIC.
To learn more about EPIC’s mpox rapid research response, please contact EPIC.
For general inquiries about MPOCS and how to get involved, please contact Sahar Ehtesham.
To learn more about the projects taking place at Unity Health Toronto (St. Michael’s Hospital) and how to get involved, please contact Shreya Shah.