High mpox mortality in people living with HIV and immune suppression: Lessons from Sierra Leone for integrated outbreak preparedness and response

Vollständiger Abstract

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The 2025 mpox outbreak in Sierra Leone provides compelling evidence that people living with advanced HIV infection remain at greatly increased risk of death from mpox. The national cohort study by Ikoona et al demonstrates the value of integrated health information systems, linking 90% of confirmed mpox cases with their HIV status, largely using a national unique health identifier. The study illustrates how health service data can be used during an outbreak to identify vulnerable populations and guide interventions. In addition to broader public health interventions, these findings reinforce the need for integrated HIV/STI and mpox prevention and care services, pre-exposure vaccination for people at risk, sustained investment in surveillance and data systems, and sustained emergency preparedness, including pre-approved research protocols. The long-term goal should extend beyond emergency response towards the elimination of mpox as a public health problem.