Public health and clinical response to an mpox outbreak in Slovenia: case study, 2022-2023.

Objectives: The emergence of mpox outbreaks in non-endemic areas, characterised by human-to-human transmission and unique clinical presentations, poses challenges in containment efforts. This study aimed to analyse the 2022 outbreak in Slovenia and characterise the country's response to the outbreak.

Methods: A retrospective, observational study analysed all confirmed mpox cases in Slovenia between 1 January 2022 and 31 December 2023 and specific public health measures and responses in the country to contain the mpox outbreak. Data were collected from clinical facilities, public health institutions and civil society organisations and analysed accordingly.

Results: Of 149 suspected cases tested, 49 were confirmed, all cisgender men, predominantly men who have sex with men (93%), exhibiting skin lesions, with 20% being HIV infected and 62% reporting recently having sex abroad. Hospitalisation was required in 14%, no specific treatment was needed, and no fatalities occurred. After the rapid spread of mpox from May to mid-July 2022, only occasional cases were detected afterwards until the outbreak's termination in early September. Slovenia's containment strategy started immediately after the first case detection, involving rapid diagnostics and active case search, centralised case management and targeted public health measures. The LGBTIQ+ (Lesbian, Gay, Bisexual, Trans, Intersex, Queer and other sexual identities) community civil society organisation Legebitra played a critical role by launching awareness campaigns and promoting easily accessible vaccination. Despite its late start in September 2022, by the end of 2023, the vaccination campaign achieved coverage of 309 individuals.

Conclusions: Slovenia's response to the 2022 mpox outbreak highlights prompt multisectoral collaboration, community engagement and timely public health interventions. Rapid diagnostics, centralised case management and targeted outreach likely contributed to containment. While vaccination had limited impact during the outbreak, its importance for long-term prevention cannot be overstated. As the global threat of mpox persists, continuous surveillance, cross-border cooperation and proactive vaccination strategies are recommended activities to address future challenges.