Community-based sentinel surveillance for Mpox-like disease among men who have sex with men and transgender individuals in India: a cross-sectional study

Objectives: Mpox emerged as a significant public health threat beyond endemic regions during 2022-2023, with sustained transmission among men who have sex with men (MSM) and transgender populations. Community-based surveillance may improve case detection in high-risk groups. Methods: A cross-sectional sentinel surveillance study was conducted from October 2023 to February 2024 across seven community-based organizations in six geographic zones of India. Clinic attendees (n = 1796) were screened for Mpox-like disease (MPLD) using WHO/Centers for Disease Control and Prevention (CDC) case definitions. Suspected cases underwent clinical evaluation, sample collection, real-time polymerase chain reaction (PCR) testing for Mpox virus (Mpoxv) DNA, and serological testing for anti-Mpox immunoglobulin (Ig) G and IgM antibodies. Results: Six (0.33%) individuals met MPLD criteria. All were young, urban MSM (median age 26 years) without previous smallpox vaccination. Most presented with genital/perianal lesions and systemic symptoms. All PCR tests were negative for Mpoxv DNA. One (16.7%) participant was IgG-positive, which may indicate previous exposure; however, the possibility of cross-reactivity with other Orthopoxviruses cannot be excluded. Contact tracing of 15 individuals identified no additional cases. Conclusion: This study demonstrates the feasibility of community-based sentinel surveillance for MPLD in high-risk populations. No PCR-confirmed Mpox cases were identified; however, the findings provide insights into clinical and behavioral patterns, supporting early detection and preparedness efforts.