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In May 2022, a cluster of mpox cases were detected in the UK that could notbe traced to recent travel history from an endemic region. Over the comingmonths, the outbreak grew, with over 3000 total cases reported in the UK, andsimilar outbreaks occurring worldwide. These outbreaks appeared linked tosexual contact networks between gay, bisexual and other men who have sex withmen. Following the COVID-19 pandemic, local health systems were strained, andtherefore effective surveillance for mpox was essential for managing publichealth policy. However, the mpox outbreak in the UK was characterised bysubstantial delays in the reporting of the symptom onset date and specimencollection date for confirmed positive cases. These delays led to substantialbackfilling in the epidemic curve, making it challenging to interpret theepidemic trajectory in real-time. Many nowcasting models exist to tackle thischallenge in epidemiological data, but these lacked sufficient flexibility. Wehave developed a novel nowcasting model using generalised additive models tocorrect the mpox epidemic curve in England, and provide real-timecharacteristics of the state of the epidemic, including the real-time growthrate. This model benefited from close collaboration with individuals involvedin collecting and processing the data, enabling temporal changes in thereporting structure to be built into the model, which improved the robustnessof the nowcasts generated.

Nowcasting the 2022 mpox outbreak in England