Peer Review History
Original SubmissionFebruary 16, 2023 |
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PONE-D-23-04595The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022PLOS ONE Dear Dr. Smith, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 25 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
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This work was funded by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency (UKHSA), King’s College London (KCL) and the University of East Anglia (UEA). The views expressed are those of the authors and not necessarily those of the NIHR, UKHSA, Department of Health and Social Care, UEA, KCL, or University College London (UCL). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising." Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. 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Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. 5. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. [Data from the same dataset have been submitted for publication elsewhere. Those analyses investigate mpox beliefs, knowledge and intended behaviours. A pre-print of that article has been made available at https://doi.org/10.1101/2022.12.07.22283201.] Please clarify whether this [conference proceeding or publication] was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. 6. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. 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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Overall the study is well written and data are presented in a good way. Bellow are some points that the author should follow and correct the manuscript accordingly. 1. The introduction needs to have more literature on this subject. 2. In the introduction, the authors should clearly address the aim and objectives of the study. 3. From lines 45-68 of the introduction, the authors are addressing the methodological part of their work and also list some results. These contents are inappropriately placed in the introduction part and should be removed. 4. In line 45, the authors are explaining the survey they have conducted and are citing an article, what is that reference? 5. How the authors can link their study outcomes to the mpox epidemic? 6. In conclusion, how these results could be used for awareness to control or slow the epidemic? Reviewer #2: In this manuscript, Dr. Smith and colleagues explored the relationship between age and the number of sexual partners for MSM, MSW and WSM, constructing a larger and more recent database than existing studies. They found all the sexual partnership distributions are skewed but they exhibited different patterns in the relationship between partner counts and age: a linear declining relationship for WSM and a quadratic relationship for MSW and MSM. Overall, the study is well described and I think this study has a potential to be interesting and valuable. However, at present there are several critical issues and minor points that need to be addressed. [Major comments] 1. The authors undertook a survey in 5 September-6 October, highlighting their survey is more recent than other survey in the UK (e.g., Natsal-3) in the introduction section. However, Natsal-4 (https://www.natsal.ac.uk/natsal-survey/natsal-4) was conducted in September 2022 and is supposed to be more recent than this study. While I understand that it was not possible to include it in this study because this new dataset has not been made public, I encourage the authors not to focus too much on the recency of their data when claiming the merit of the study. (Because, if that is the primary merit of the study, it means that the merit would be lost when Natsal-4 is published; which I believe is not the intention of the authors) If possible, it would also be helpful to briefly mention/discuss Natsal-4 as this will give the readers useful reference and context. 2. Because it is an explanatory data analysis (as stated by the authors), I would recommend that the model selection should be based on BIC, not AIC. AIC is constructed by approximating generalization loss (or predictive performance; i.e. the divergence between the true distribution and predictive distribution) while BIC is based on model evidence, which indicates that BIC is more useful in selecting a correct model while the AIC is more appropriate in finding the best model for predicting future observations (https://doi.org/10.1016/B978-0-444-51862-0.50018-6). 3. I found that the authors’ definitions of MSM/MSW/WSM do not exclude sexually inactive people, who are now also counted as those having zero partner. This means “zero-partner individuals” comprise (i) sexually active persons but with no sexual contact over the study period, and (ii) sexually inactive persons, which may be problematic in the estimation. If the authors can distinguish those two based on the original data, they should simply exclude (ii), sexually inactive persons, from their analyses. If this is not possible, I think there are some options to address this issue. One is to left-truncate the distributions at partner count=1 to ignore zero counts. Alternatively, they can also use zero-inflated distribution, which enable the authors to allow for the sexually inactive persons statistically. 4. For the sentence at P5L128-130 “Among respondents who gave the correct answer to the attention check question, manual inspection of free-text responses to four questions did not suggest that any of these were generated by artificial intelligence algorithms.”, please elaborate on this. How did the authors distinguish human and AI? What kind of AI did they consider? 5. The authors utilized a negative-binomial distribution across all the groups (MSM/MSW/WSM) but using the same ad-hoc distribution for all cases might not be fully justified as each group may have a unique sexual partnership pattern. Besides, sexual distributions have been reported to typically have heavy-tailed or power-law tailed property in the large body of literatures (e.g., Schneeberger et al. https://doi.org/10.1097/00007435-200406000-00012, Endo et al. https://doi.org/10.1126/science.add4507, Ito et al. https://doi.org/10.1371/journal.pone.0221520). These studies suggest that a negative binomial may not fully capture the (extreme) level of heterogeneity in sexual partners. I’d like the authors to reanalyse all the groups, using heavy-tailed distributions such as Pareto or Weibull distributions, visually inspect the fit, and/or select a best-fit model for each group by BIC. 6. What type of distributions did the author employ in the regression models with which they tried such as hurdle regression, zero-inflated models, etc (described around P6L186)? Did the authors only use a negative binomial distribution to the other models? On that note, I do not generally agree with the “data not shown” practice the authors use here, because the statements cannot be interpreted without them along with full description of the methods. Please include in the Supplementary file. 7. Regarding the sentence, “The statistical model form reported here (negative binomial) was preferred because the outputs could be easily reported and replicated, supporting development of realistic mpox and sexually transmitted infection models.” at P7L188-191, I think this does not support their model choice at all since there is no statistical justification matched with data. I’m also not sure about what the authors imply by “because the outputs could be easily reported and replicated, supporting development of realistic mpox and sexually transmitted infection models”. As mentioned above, my understanding is that sexual partner data have been rarely characterized by negative binomial distributions. 8. Although the authors repeatedly highlighted their findings are useful in modelling sexually-associated transmissions, there is no description as to how it would be useful. I would be interested in how the authors’ findings could be plugged into disease models. I am not sure if data-driven network modelling for STIs allowing for age-dependent heterogeneity in sexual contact networks is possible as the authors suggest when there is little empirical data on age assortativity in sexual partner formation. 9. Related to #6; Although the authors said they decided not to present other model approaches (P6L186), I encourage them to show the comparison of all of the fitting including model selection to justify their choice of the final model. 10. It would be very informative to show log-log plots for the sexual partnership distributions. This would make readers easily understand how each distribution is skewed. 11. According to P8L211-212, 28% of MSW are also MSM in the data, which is fairly high compared to the actual proportion of the overlap. This is not surprising because MSM were oversampled due to the nature of the surveys except for Savanta GP, but for this reason I am not sure how we should interpret this 28% figure. I suggest the authors consider alternative ways to characterize the overlap between MSW and MSM. 12. The authors calculated median of partner counts in each cohort but, as I pointed out in the comment #3, the authors may wish to address the issue of people with zero partner counts when analyzing them (because the median would be sensitive to handling of these people). Probably excluding people with zero partner count would be enough for the purpose of quick comparison. 13. In the discussion section (P9L247-P10L265), the authors discussed that the drastic decline in mpox cases would be primarily attributed to behavioural changes citing some papers. However, there is another key factor that would play significant roles in shaping mpox epidemic sizes: that is, depletion of susceptibles effect over heavy-tailed sexual contact networks (Murayama et al. https://doi.org/10.1093/infdis/jiad254; Xiridou et al. https://doi.org/10.1101/2023.01.31.23285294). These studies suggest that accumulation of infection-derived immunity in heavy-tailed sexual networks can dramatically lower the herd immunity threshold and final sizes, and the observed decline in cases may not be primarily attributable to behavioural changes or interventions. I’d like more in-depth discussion in the manuscript that touches on the depletion of susceptibles effect. As a side note, ref 15 also discussed this effect as “the biggest factor”. So, it’d be inappropriate to say “early opinion was that decline in the outbreak was more due to behaviour change (15)”, citing ref 15. 14. I do not think discussing the impact of behavioural changes citing ref 14 without noting its limitations is a good idea. Ref 14 did not well inform the impact of behavioural changes on the transmission dynamics as they did not use quantitative measures, alongside that it is unclear from the study whether the results are representative of people who have many partners and are thus playing roles in mpox transmission. 15. Please discuss the strength of the study more convincingly than the authors currently state at P11L304-306. It is indeed a good point that the existing mpox modeling study (ref 2) relied on relatively limited MSM samples, but the authors did not clarify what changes their new data could bring to such studies. For example, the authors’ data indeed has 4x sample size than the data used in ref 2, but is it enough to significantly improve the results of that study (yes confidence intervals may be slightly narrower but is it just that?)? I would be convinced if the authors’ data can provide detailed information at the tail part of the sexual partner distributions that had not been available with small sample data. Other aspects of the authors’ data, including sub-samples and the presence of active 65+ individuals, would also be potentially useful in modeling but the authors did not discuss how. Meanwhile, it should also be noted that bias in sampling may undermine the strength of a large sample size. Savanta may be representative as they used quota sampling method, but other cohorts, in particular Grindr, are not. Then the sample size in Savanta becomes 369 (=161+208) and it is almost the same order (a few hundreds the authors said to ref 2 at P11L306). Rather than putting too much emphasis on the sample size, I think it’d be better to put more focus on their detailed information about each data (represented in Table S1-S9), which would be beneficial for those who attempt to construct an age-specific network model. [Minor comments] 1. The authors often described MSM/MSW/WSM as MSMs/MSWs/WSMs, but “s” should be deleted. 2. I recommend the authors make the overall writing more formal, objective, and quantitative throughout. There are a number of instances where the text is rather casual, empty, or vague . I present some examples below: “We wanted to-” at P2L56, “Grindr respondents were somewhat younger-“ at P7L195, “it is quite possible-” at P9L248, etc. 3. Typo: “low frequency sexual contact” at P4L122 -> “low frequency of sexual contact” 4. Ref 14 is a summary article based on the original research paper. Please cite this original paper instead (http://dx.doi.org/10.15585/mmwr.mm7135e1). 5. In light of the reproducibility of this study and also for the study to make an impact on future research, I hugely encourage the authors to share the data and stata code they made on a platform such as GitHub repository. It is stated that the data will be shared along with another paper but this only makes sense if that paper is published before this paper is published (and I am not fully sure of the point of safeguarding the data when the preprint is already public…?) 6. Please do not use abbreviations in Figures (e.g. ptnrs to partners). ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Jivan Qasim Ahmed Reviewer #2: No ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. 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Revision 1 |
The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022 PONE-D-23-04595R1 Dear Dr. Brainard, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Soham Bandyopadhyay Academic Editor PLOS ONE |
Formally Accepted |
PONE-D-23-04595R1 The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022 Dear Dr. Brainard: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Soham Bandyopadhyay Academic Editor PLOS ONE |
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