Transient behavior changes and depletion of susceptibles in high contact groups led to case decline during 2022 mpox outbreak in MSM in Berlin

Transient behavior changes and depletion of susceptibles in high contact groups led to case decline during 2022 mpox outbreak in MSM in Berlin | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Transient behavior changes and depletion of susceptibles in high contact groups led to case decline during 2022 mpox outbreak in MSM in Berlin Nils Gubela, Hee-yeong Kim, Nikolay Lunchenkov, Daniel Stern, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6254021/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Communications Medicine → Version 1 posted You are reading this latest preprint version Abstract Mpox denotes a viral zoonosis caused by monkeypox virus (MPXV), which is endemic in West and Central Africa. In spring 2022, notable outbreaks of mpox clade IIb were recorded in several high-income countries, predominantly affecting men who have sex with men (MSM). At the peak of the outbreak, over 200 new mpox cases per week were reported in Berlin, which constitutes one of the largest MSM communities in Europe. Within the same year, the outbreak virtually disappeared, and it is unclear which factors contributed to its rapid decline. To investigate the concomitant effects of sexual contact networks, transient contact reductions and the effect of infection- vs. vaccine-derived immunity on the 2022 mpox outbreak, we calibrated an agent-based model with epidemic, vaccination, contact- and behavioral data. Our results indicate that vaccination had a marginal effect on the epidemic decline. Rather, a combination of infection-induced immunity of high-contact individuals, as well as transient behavior changes reduced the number of susceptible individuals below the epidemic threshold. However, the 2022 mpox vaccination campaign, together with infection-derived immunity may have contributed to herd-immunity in the Berlin MSM community against ongoing clade I mpox outbreaks, which are responsible for the death of 1,140 individuals in Kongo alone. However, demographic changes and immune waning will deteriorate this herd immunity over time. Biological sciences/Computational biology and bioinformatics/Computational models Health sciences/Diseases/Infectious diseases Health sciences/Medical research/Epidemiology Biological sciences/Systems biology/Dynamic networks Full Text Additional Declarations There is NO Competing Interest. Supplementary Files supplementarymaterials.pdf Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Communications Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6254021","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":431183131,"identity":"bc7c9072-7fbe-4896-840d-4ec01b112cc8","order_by":0,"name":"Nils 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