Evidence map›Paper›PMID 42129165›Full record

ArticleNature communications2026

Extensive cryptic circulation sustains mpox among men who have sex with men.

Joseph A Lewnard, Miguel I Paredes, Matan Yechezkel, Gregg S Davis, Vennis Hong, Jessica Skela, Utsav Pandey, Noah T Parker, Lauren C Granskog, Magdalena E Pomichowski and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Nature communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Joseph A LewnardDivision of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA. jLewnard@berkeley.edu.ORCID 0000-0002-8505-8839
Miguel I ParedesVaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.ORCID 0000-0002-9712-1663
Matan YechezkelDivision of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Gregg S DavisDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Vennis HongDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Jessica SkelaDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Utsav PandeyRegional Reference Laboratories, Kaiser Permanente Southern California, Chino Hills, CA, USA.ORCID 0000-0001-5196-6073
Noah T ParkerDivision of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Lauren C GranskogDivision of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Magdalena E PomichowskiDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Iris Anne C ReyesDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Isabel Rodriguez-BarraquerDivision of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Nicola F MüllerDivision of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Sara Y TartofDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. Sara.Y.Tartof@kp.org.ORCID 0000-0003-2336-8476

Funding

U.S. Department of Health & Human Services | Centers for Disease Control and Prevention (CDC) CDC-RFA-FT-23-0069
6 · The paper itself

Abstract

Sporadic cases of clade IIb mpox continue to be notified among men who have sex with men, with most lacking identifiable transmission links. To resolve underlying dynamics, we tested prospectively for evidence of monkeypox virus infection in anorectal swabs from a cohort of men who have sex with men in Los Angeles, whom we monitored concurrently for clinical mpox diagnoses during summer, 2024. Here we estimate that infections exceeded reported mpox cases by a 33-fold margin (95% confidence interval: 16-68). Independent estimates derived from phylogenetic reconstruction and a meta-analysis of surveillance studies corroborated this extensive under-reporting. We estimate that undiagnosed infections must cause at least 31-44% of all transmission to explain observed monkeypox virus phylogenies; under realistic modeling assumptions, this proportion rises to 61-97%. Contrary to current guidance, our findings suggest a substantial proportion of monkeypox virus circulation may be associated with subclinical infections, challenging the feasibility of current mpox elimination targets.

Indexed as

Homosexuality, MaleMonkeypox virusMpox, MonkeypoxAdultHumansLos AngelesMalePhylogenyProspective Studies

Identifiers

PMID42129165
PMCPMC13172365

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.