Impact of International Travel on Clinical Outcomes of Mpox Cases in Jeddah, Saudi Arabia: A Retrospective Cohort Study.

BACKGROUND: Saudi Arabia is a global hub for air travel and mass gatherings; the first case of mpox in the Kingdom was linked to international travel. It is not clear whether travel-related mpox cases differ from locally acquired cases in how they present or in their outcomes in Jeddah, a major gateway city. We compared the clinical characteristics and outcomes of travel-related and locally acquired mpox cases. METHODS: This was a retrospective cohort study including 232 lab-confirmed cases in Jeddah. Cases were taken from the Health Electronic Surveillance Network (HESN) and hospital records of the first and second health clusters in Jeddah. They were grouped as travel-associated if international travel occurred within 21 days before symptom onset or the first positive test result, or as locally acquired. Then, we compared them by demographics, clinical features, disease severity, and outcomes, including hospitalization, ICU admission, hospital mortality, and length of hospital stay. Analysis of length of stay was done using multivariable linear regression, adjusting for age, sex, and facility type, and included planned sensitivity analyses. RESULTS: Of the 232 cases, 77 (33.2%) were travel-related, and 155 (66.8%) were locally acquired. Most patients were male (215/232, 92.7%), with a median age of 34 years. Most of the cases were mild: 227 cases (97.8%) had mild symptoms, and there were no severe cases. No one was admitted to the ICU or died in the hospital, and all patients recovered, regardless of their travel status. Travel-related cases were a bit older (median 36 vs 33 years, p = 0.006) and more often treated in private facilities (62/77, 80.5% vs 104/155, 67.1%; p = 0.048). Travel-related cases had a longer median hospital stay (21 vs 16 days, p = 0.002). After adjusting for age, sex, and facility type, international travel was not linked to length of stay (adjusted difference -0.9 days, 95% CI -3.9 to +2.1, p = 0.55), but private facility care was linked to a longer stay (+8.5 days, p < 0.001). CONCLUSIONS: In Jeddah city, most mpox cases were mild, with no serious outcomes or hospital mortality, regardless of travel history. Differences in hospital stay were mostly associated with the type of healthcare facility, not travel status. These findings highlight that risk assessment should focus on clinical presentation and risk factors, rather than international travel, as predictors of clinical outcomes and that ensuring proper surveillance and rapid detection is crucial.