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de Perio MA, Horter L, Still W, Meh I, Persson N, Berns AL, Salinas A, Murphy K, Lafferty AG, Daltry D, Mackey S, Sockwell DC, Adams J, Rivas J, Somerville NJ, Valencia D. Evaluation of Mpox Exposures and Outcomes in Workplaces, 6 Jurisdictions, June 1-August 31, 2022. Public Health Rep 2024:333549241245655. [PMID: 38785340 DOI: 10.1177/00333549241245655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The risk for mpox virus (MPXV) transmission in most workplaces has not been thoroughly assessed in the context of the 2022 global mpox outbreak. Our objectives were to describe mpox case patients who worked while infectious and the subsequent workplace contact tracing efforts, risk assessments, and outcomes. METHODS The Centers for Disease Control and Prevention requested information from health departments in the United States in September 2022 to identify people with confirmed or probable mpox who worked outside the home while infectious, either before or after diagnosis, from June 1 through August 31, 2022. We collected and summarized data on demographic, clinical, and workplace characteristics of case patients and workplace contact investigations. We stratified data by industry and occupation categories. RESULTS In total, 102 case patients were reported by 6 jurisdictions. The most common industries were accommodation and food services (19.8%) and professional business, management, and technical services (17.0%). Contact investigations identified 178 total contacts; 54 cases (52.9%) had no contacts identified. Of 178 contacts, 54 (30.3%) were recommended to receive postexposure prophylaxis (PEP) and 18 (10.1%) received PEP. None of the contacts developed a rash or were tested for orthopox or mpox, and none were reported to have confirmed or probable mpox. CONCLUSION Data from 6 jurisdictions suggest that the risk of MPXV transmission from workers to others in workplace settings in many industries is low. These findings might support future updates to exposure risk classifications and work activity recommendations for patients. These findings also demonstrate the importance of collecting and analyzing occupation and industry data in case reports to better understand risks in workplaces.
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Affiliation(s)
- Marie A de Perio
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Libby Horter
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William Still
- District of Columbia Department of Health, Washington, DC, USA
| | - Ie Meh
- District of Columbia Department of Health, Washington, DC, USA
| | - Nancy Persson
- Rhode Island Department of Health, Providence, RI, USA
| | - Abby L Berns
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | | | | | - Skyler Mackey
- Virginia Department of Health, Alexandria, VA, USA
- Virginia Department of Health, Richmond, VA, USA
| | | | - Jeremy Adams
- Florida Department of Health, Tallahassee, FL, USA
| | | | - Nicholas J Somerville
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Diana Valencia
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Griffin I, Berry I, Navarra T, Priyamvada L, Carson WC, Noiman A, Jackson DA, Waltenburg MA, Still W, Lujan L, Beverly J, Willut C, Lee M, Mangla A, Shelus V, Hutson CL, Townsend MB, Satheshkumar PS. Serologic responses to the MVA-based JYNNEOS mpox vaccine in a cohort of participants from the District of Columbia (D.C.). Vaccine 2024:S0264-410X(24)00563-2. [PMID: 38762357 DOI: 10.1016/j.vaccine.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
We assessed early antibody responses after two doses of JYNNEOS (IMVANEX) mpox vaccine in the District of Columbia (D.C.) in persons at high risk for mpox without characteristic lesions or rash. Participants with PCR mpox negative specimens (oral swab, blood, and/or rectal swab) on the day of receipt of the first vaccine dose and who provided a baseline (day 0) serum sample and at least one serum sample at ∼28, ∼42-56 days, or 180 days post vaccination were included in this analysis. Orthopoxvirus (OPXV)-specific IgG and IgM ELISAs and neutralizing antibody titers were performed, and longitudinal serologic responses were examined. Based on participants' IgG and IgM antibody levels at baseline, they were categorized as naïve or non-naïve. Linear mixed effects regression models were conducted to determine if IgG antibody response over time varied by age, sex, HIV status, and route of administration for both naïve and non-naïve participants. Among both naïve and non-naïve participants IgG seropositivity rates increased until day 42-56, with 89.4 % of naïve and 92.1 % of non-naïve participants having detectable IgG antibodies. The proportion of naive participants with detectable IgG antibodies declined by day 180 (67.7 %) but remained high among non-naïve participants (94.4 %). Neutralizing antibody titers displayed a similar pattern, increasing initially post vaccination but declining by day 180 among naïve participants. There were no significant serologic response differences by age, sex, or HIV status. Serologic response did vary by route of vaccine administration, with those receiving a combination of intradermal and subcutaneous doses displaying significantly higher IgG values than those receiving both doses intradermally. These analyses provide initial insights into the immunogenicity of a two-dose JYNNEOS PEP regimen in individuals at high risk of mpox exposure in the United States.
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Affiliation(s)
- Isabel Griffin
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isha Berry
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terese Navarra
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lalita Priyamvada
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William C Carson
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adi Noiman
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David A Jackson
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA
| | - Michelle A Waltenburg
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA
| | | | | | | | | | | | | | - Victoria Shelus
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael B Townsend
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Panayampalli S Satheshkumar
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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3
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Allan-Blitz LT, Khan T, Elangovan K, Smith K, Multani A, Mayer KH. Addressing mpox at a Frontline Community Health Center: Lessons for the Next Outbreak. Public Health Rep 2024; 139:294-300. [PMID: 37846528 PMCID: PMC11037218 DOI: 10.1177/00333549231201682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
The 2022 mpox (formerly monkeypox) outbreak affected predominantly men who have sex with men (MSM), likely through sexual transmission, which resulted in institutions specializing in sexual health being at the frontlines of the mpox outbreak. Fenway Health in Boston serves close to 10 000 MSM annually, which includes more than 2400 MSM who are living with HIV and 3320 MSM with active HIV preexposure prophylaxis (PrEP) prescriptions. We report on the programs implemented and changes to clinical practice at Fenway Health during the mpox outbreak. Fenway Health diagnosed its first case of mpox in June 2022 and treated this patient with tecovirimat. In early July 2022, Fenway Health administered its first dose of the Jynneos vaccine under the Emergency Use Authorization for protection against mpox. As of October 6, 2022, 69 people had tested positive for the mpox virus at Fenway Health. Among the 69 people who tested positive, 43 (62.3%) self-identified as male, with the remaining not reporting a sex or gender identity, and 40 (58.0%) reported their sexual orientation as gay or bisexual. Twenty-five people (36.2%) were treated with tecovirimat. As of October 30, 2022, Fenway Health had administered 6376 doses of the Jynneos vaccine. The programmatic changes involved in rollout and scale-up of vaccination, treatment, and community outreach services at Fenway Health during the 2022 mpox outbreak that we describe here could inform strategies to address subsequent outbreaks.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | | | | | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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4
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Rainey JJ, Lin XM, Murphy S, Velazquez-Kronen R, Do T, Hughes C, Harris AM, Maitland A, Gundlapalli AV. Deployment of the National Notifiable Diseases Surveillance System during the 2022-23 mpox outbreak in the United States-Opportunities and challenges with case notifications during public health emergencies. PLoS One 2024; 19:e0300175. [PMID: 38603766 PMCID: PMC11008850 DOI: 10.1371/journal.pone.0300175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/23/2024] [Indexed: 04/13/2024] Open
Abstract
Timely case notifications following the introduction of an uncommon pathogen, such as mpox, are critical for understanding disease transmission and for developing and implementing effective mitigation strategies. When Massachusetts public health officials notified the Centers for Disease Control and Prevention (CDC) about a confirmed orthopoxvirus case on May 17, 2023, which was later confirmed as mpox at CDC, mpox was not a nationally notifiable disease. Because existing processes for new data collections through the National Notifiable Disease Surveillance System were not well suited for implementation during emergency responses at the time of the mpox outbreak, several interim notification approaches were established to capture case data. These interim approaches were successful in generating daily case counts, monitoring disease transmission, and identifying high-risk populations. However, the approaches also required several data collection approvals by the federal government and the Council for State and Territorial Epidemiologists, the use of four different case report forms, and the establishment of complex data management and validation processes involving data element mapping and record-level de-duplication steps. We summarize lessons learned from these interim approaches to inform and improve case notifications during future outbreaks. These lessons reinforce CDC's Data Modernization Initiative to work in close collaboration with state, territorial, and local public health departments to strengthen case-based surveillance prior to the next public health emergency.
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Affiliation(s)
- Jeanette J. Rainey
- Division of Global Health Security, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xia Michelle Lin
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sylvia Murphy
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Raquel Velazquez-Kronen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States of America
| | - Tuyen Do
- Office of the Director, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Christine Hughes
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron M. Harris
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron Maitland
- Division of Health Interview Statistics, National Center of Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States of America
| | - Adi V. Gundlapalli
- Office of the Director, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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5
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Alhalaseh Y, Modi MB, Haddad S, Souchik A, Speiser JJ, Massarani-Wafai R, Dahiya M. Mpox Case Presenting With Genital Lesions and Proctitis. Am J Dermatopathol 2024; 46:243-246. [PMID: 38457670 DOI: 10.1097/dad.0000000000002643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Monkeypox (Mpox) is a zoonotic Orthopoxvirus of the Poxviridae family, endemic to Africa. In August 2022, the US government declared it an emergency because of the worldwide spread. Traditionally, Mpox infection spreads through contact with infected animals. However, the 2022 outbreak Centers for Disease Control and Prevention (CDC) data note that 94% of cases had recent male-to-male sexual or close intimate contact, suggesting a novel sexual transmission. In this article, we report a 39-year-old HIV-positive man presenting with a diffuse cutaneous rash, perianal pain, and bloody stool of 2-week duration. A medical history includes intravenous drug use and multiple sexual partners. Physical examination revealed umbilicated, tan-colored, crusted cutaneous papules scattered across the face, trunk, and genital regions. Perianal lesion biopsy showed an acanthotic epidermis with spongiosis, ballooning degeneration of keratinocytes, and the formation of multinucleated syncytial keratinocytes. A dermal superficial/lichenoid mixed inflammatory cell infiltrate with multinucleated giant cells was noted. Perianal lesion polymerase chain reaction (PCR) was positive for Mpox. Colonoscopy revealed a 3-cm circumferential rectal ulcer with gray exudate and necrosis. A rectal ulcer biopsy showed an ulcerated mucosa with acute proctitis and necrosis. There were scattered macrophages with intranuclear inclusion and glassy vacuolization, and Mpox infection was confirmed by immunostaining with a Mpox-specific anti-Vaccinia virus antibody.
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Affiliation(s)
- Yazan Alhalaseh
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Mitul B Modi
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Sandra Haddad
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Adam Souchik
- Department of Dermatology, Loyola University Medical Center, Maywood, IL
| | - Jodi J Speiser
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Razan Massarani-Wafai
- Department of Pathology and Laboratory Medical Services, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL
| | - Madhu Dahiya
- Department of Pathology and Laboratory Medical Services, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL
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6
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Doyle TJ, Gumke M, Stanek D, Moore J, Buck B, Locksmith T, Tomson K, Schmedes S, Churchwell G, Hubsmith SJ, Krishnamoorthy B, Poschman K, Danforth B, Chacreton D. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021-2022. Emerg Infect Dis 2024; 30. [PMID: 38526187 PMCID: PMC10977815 DOI: 10.3201/eid3004.231392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March--June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.
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7
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Brooks JT, Reynolds MG, Torrone E, McCollum A, Spicknall IH, Gigante CM, Li Y, Satheshkumar PS, Quilter LAS, Rao AK, O'Shea J, Guagliardo SAJ, Townsend M, Hutson CL. How the Orthodox Features of Orthopoxviruses Led to an Unorthodox Mpox Outbreak: What We've Learned, and What We Still Need to Understand. J Infect Dis 2024; 229:S121-S131. [PMID: 37861379 DOI: 10.1093/infdis/jiad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Orthopoxviruses have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV), originally characterized in the late 1950s during outbreaks among captive primates, has been recognized since the 1970s to cause human disease (mpox) in West and Central Africa, where interhuman transmission has largely been associated with nonsexual, close physical contact. In May 2022, a focus of MPXV transmission was detected, spreading among international networks of gay, bisexual, and other men who have sex with men. The outbreak grew in both size and geographic scope, testing the strength of preparedness tools and public health science alike. In this article we consider what was known about mpox before the 2022 outbreak, what we learned about mpox during the outbreak, and what continued research is needed to ensure that the global public health community can detect, and halt further spread of this disease threat.
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Affiliation(s)
- John T Brooks
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary G Reynolds
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Torrone
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea McCollum
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian H Spicknall
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura A S Quilter
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Townsend
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Hutson
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Damhorst GL, Fujita AW, Fitts E, Szabo B, Bowers HB, Sabino C, Ahmed A, Wang E, Piantadosi A, McLendon K, Sullivan J, Greenleaf M, McCaslin D, Palmore M, Anderson AM, Aldred B, Gunthel C, Martin GS, Colasanti JA, Lam WA, Bassit L, Rao A, Sheth AN, Titanji BK. Multisite Mpox Infection and Viral Dynamics Among Persons With HIV in Metro Atlanta. J Infect Dis 2024; 229:S213-S218. [PMID: 38019187 PMCID: PMC10965212 DOI: 10.1093/infdis/jiad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
The 2022 mpox outbreak primarily involved sexual transmission among men who have sex with men and disproportionately affected persons with human immunodeficiency virus (HIV). We examined viral dynamics and clinical features in a cohort evaluated for mpox infection at a comprehensive HIV clinic in Atlanta, Georgia. Viral DNA was found in 8 oropharyngeal and 5 anorectal specimens among 10 mpox cases confirmed by lesion swab polymerase chain reaction. Within-participant anatomic site of lowest cycle threshold (Ct) value varied, and lower Ct values were found in oropharyngeal and anorectal swabs when corresponding symptoms were present. This provides insight into mpox infection across multiple anatomic sites among people with HIV.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | - A Wendy Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Eric Fitts
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pathology and Laboratory Medicine
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Heather B Bowers
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Courtney Sabino
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | | | - Ethan Wang
- Department of Pathology and Laboratory Medicine
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University
- Department of Pathology and Laboratory Medicine
| | | | - Julie Sullivan
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Morgan Greenleaf
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | | | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Clifford Gunthel
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Greg S Martin
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Wilbur A Lam
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Leda Bassit
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Anuradha Rao
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
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9
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Lucero-Obusan C, Oda G, Schirmer P, Edson C, Trevino C, Elbeik T, Holodniy M. Epidemiology of the 2022 Mpox Outbreak in the US Veterans Health Administration. J Infect Dis 2024; 229:S172-S180. [PMID: 38134309 DOI: 10.1093/infdis/jiad600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND In May 2022, mpox cases were reported in nonendemic countries, including the United States. We examined mpox infections in the Veterans Health Administration (VHA). METHODS Mpox diagnostic and whole genome sequencing (WGS) results, demographics, risk factors, hospitalizations, exposures, deaths, and pharmacy and immunization data were obtained from VHA data sources (23 May 2022-31 May 2023). RESULTS Of 1144 Veterans tested, 251 (21.9%) were presumptive positive for nonvariola orthopoxvirus (NVO) or confirmed positive for NVO and Monkeypox virus (MPXV). Incidence rate was 7.5 per 100 000 Veterans in care, with the highest rate observed in Veterans aged 25-34 years (13.83 cases per 100 000). Higher odds of NVO or NVO/MPXV positivity was associated with male sex; non-Hispanic Black race/ethnicity; syphilis or human immunodeficiency virus (HIV) positivity; or genital/rectal sample site, whereas older age and vaccination with JYNNEOS or vaccinia (smallpox) had lower odds. Among 209 with confirmatory testing, 90.4% reported intimate contact and/or an epidemiological link, 84.5% were men who have sex with men (MSM), 24.2% received tecovirimat, and 8.1% were hospitalized with 1 death. Eighty-six sequenced samples had evaluable WGS results. All were clade IIb, representing 10 different lineages from 20 states and the District of Columbia. CONCLUSIONS Mpox affected younger, MSM, non-Hispanic Black, and HIV/syphilis-positive men among US Veterans. Viral diversity was noted across geographic regions. At-risk Veterans would benefit from vaccination and risk reduction strategies for mpox and other sexually transmitted infections.
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Affiliation(s)
- Cynthia Lucero-Obusan
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Gina Oda
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Patricia Schirmer
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Connor Edson
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Christina Trevino
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Tarek Elbeik
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
| | - Mark Holodniy
- Public Health National Program Office, US Department of Veterans Affairs, Washington, District of Columbia
- National Public Health Reference Laboratory, US Department of Veterans Affairs, Palo Alto, California
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
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10
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Philpott DC, Bonacci RA, Weidle PJ, Curran KG, Brooks JT, Khalil G, Feldpausch A, Pavlick J, Wortley P, O'Shea JG. Low CD4 Count or Being Out of Care Increases the Risk for Mpox Hospitalization Among People With Human Immunodeficiency Virus and Mpox. Clin Infect Dis 2024; 78:651-654. [PMID: 37590957 PMCID: PMC10873466 DOI: 10.1093/cid/ciad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated immunosuppression may increase the risk of hospitalization with mpox. Among persons diagnosed with mpox in the state of Georgia, we characterized the association between hospitalization with mpox and HIV status. People with HIV and a CD4 count <350 cells/mm3 or who were not engaged in HIV care had an increased risk of hospitalization.
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Affiliation(s)
- David C Philpott
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert A Bonacci
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul J Weidle
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John T Brooks
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George Khalil
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jesse G O'Shea
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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McLean J, Gunaratne S, Zucker J. Update on Mpox: What the Primary Care Clinician Should Know. Med Clin North Am 2024; 108:355-371. [PMID: 38331485 PMCID: PMC10853636 DOI: 10.1016/j.mcna.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Mpox is a viral infection, which primarily caused sporadic outbreaks in West and Central Africa until causing a global epidemic in 2022. The disease has disproportionately affected people with human immunodeficiency virus and men who have sex with men. Transmission is through close physical contact, including sexual contact. Infection presents with a characteristic rash, with frequent anogenital involvement-polymerase chain reaction of skin lesions is diagnostic. Vaccination is available for primary prevention and postexposure prophylaxis. Treatment consists of supportive care, with antiviral medications available via clinical trials and/or for patients with severe disease.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA.
| | - Shauna Gunaratne
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Medical Center, 630 W 168th Street, Suite 876, New York, NY 10032, USA
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Huang X, Lin Z, Qin J, Yu D, Zhang F, Fang G, Chen X, He J, Cen P, Li M, Zhang R, Luo T, Jiang J, An S, Liang H, Ye L, Liang B. Willingness to accept monkeypox vaccine and its correlates among men who have sex with men in Southern China: a web-based online cross-sectional study. Front Public Health 2024; 12:1289918. [PMID: 38384873 PMCID: PMC10879393 DOI: 10.3389/fpubh.2024.1289918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Background The May 2022 global outbreak of monkeypox (MPX) poses a threat to the health of men who have sex with men. However, there is limited data on the willingness of MSM to receive monkeypox vaccination in Southern China. This study aimed to assess the knowledge of MPX, concerns regarding MPX, and willingness to receive monkeypox vaccination, as well as their correlates, among MSM in China. Methods We conducted a Web-based online survey of MSM in Southern China from August to September 2022. Data were collected on the socio-demographic characteristics, knowledge, worries, concerns regarding MPX and willingness to receive monkeypox vaccination. Multivariate logistic regression was employed to explore the factors associated with willingness to receive monkeypox vaccination. Results A total of 1903 participants completed the survey. Among them, approximately 69.9% reported being aware of MPX awareness, 94.1% of the participants supported the promotion of monkeypox vaccination. The majority of participants (91.4%) expressed their willingness to receive monkeypox vaccination. Participants who considered monkeypox vaccination safe [adjusted odds ratio (aOR) = 4.82, 95% CI: 1.35-17.18], agreed on the necessity of government promotion of monkeypox vaccination in China (aOR = 6.03, 95% CI: 1.07-33.93), believed in prioritizing monkeypox vaccination for MSM (aOR = 5.01, 95% CI: 1.10-22.71), and had friends or sexual partners who had already received the monkeypox or smallpox vaccination (aOR = 10.37, 95% CI: 2.11-50.99) are more likely to be vaccinated. Conversely, married individuals (aOR = 0.13, 95% CI: 0.03-0.47), those engaging in anal sex 4-6 times per week in the past 3 months (aOR = 0.26, 95% CI: 0.09-0.77) expressed hesitancy toward monkeypox vaccination. Conclusion There was a high willingness to receive monkeypox vaccination among MSM in China. The hesitancy toward the monkeypox vaccine can be effectively mitigated by addressing concerns about its safety and potential adverse reactions. Moreover, increasing acceptance of the monkeypox vaccination among MSM and their peers is crucial, as social influence significantly impacts vaccine attitudes and behaviors.
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Affiliation(s)
- Xinju Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhifeng Lin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiao Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Dee Yu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Fei Zhang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ganggang Fang
- Kaiyuan Center for Disease Control and Prevention, Kaiyuan, Yunnan, China
| | - Xi Chen
- Sanya Center for Disease Control and Prevention, Sanya, Hainan, China
| | - Jinfeng He
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Mu Li
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Rongjing Zhang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Tong Luo
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Sanqi An
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, Guangxi, China
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Le Vavasseur B, Bendaoud S, Taieb S, Heym B, Ysmail Dahlouk S, Leclerc EJ, Metaye A, Bessanguem B, Bourguignon J, Taouk M, Gabarre A, Marot S, Tepper S, Lidove O, Etienney I. Anal Monkeypox Disease: Description of 65 Cases. Dis Colon Rectum 2024; 67:280-285. [PMID: 37878465 DOI: 10.1097/dcr.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Monkeypox is a zoonosis endemic in Africa caused by 3 orthopoxvirus clades. Knowledge of the disease is limited, but a worldwide outbreak involving a new route of transmission was declared in April 2022. OBJECTIVE This study aimed to describe anal symptoms and outcomes in patients infected with Monkeypox virus presenting to an emergency proctology unit in Paris. DESIGN This was an observational study. SETTING We reported anal symptoms of all consecutive patients with monkeypox anal infection in a single proctology center between June 16, 2022, and July 26, 2022. Association with sexually transmitted infections and outcomes were also recorded. PATIENTS Sixty-five men with a mean age of 39.6 (19.9-64.6) years with confirmed monkeypox anal infection were included in the study. MAIN OUTCOME MEASURES Anal symptoms and their severity were clinically assessed. A favorable outcome consisted of a complete resolution of clinical manifestation. RESULTS Sexual transmission was reported in 51 patients (78.4%), among whom 63 (97%) were men who have sex with men. Twenty-eight (43%) were living with HIV, and 24 (36.9%) were taking tenofovir/emtricitabine for HIV preexposure prophylaxis. Anal symptoms appeared first in 36 patients (55.4%) and skin rash or other general symptoms in 22 patients (33.8%). Incubation time was 6.9 (1-26) days. Symptoms included painful perianal (n = 42 patients; 64.6%), anal (n = 28, 43%), and rectal (n = 25; 38.4%) ulcerations and perianal vesicles (n = 24; 36.9%). Proctitis was observed in 49 patients (75.4%). It was mild in 20 (40.8%) and intense in 29 (59.2%), and severe proctitis mimicking high intersphincteric suppuration was found in 4 (8.2%). Fifteen patients (23.1%) had concurrent sexually transmitted infection and 3 were hospitalized. Complete symptom resolution occurred within 12 days. LIMITATIONS We performed a single-center study during a short period of time. CONCLUSIONS Proctological symptoms are frequent in the current outbreak of monkeypox disease, probably linked to the route of transmission. Rectal ulcerations mimicking high intersphincteric suppuration should be recognized to avoid unnecessary surgery. See Video Abstract . ENFERMEDAD ANAL DE LA VIRUELA DEL MONO DESCRIPCIN DE CASOS ANTECEDENTES:La viruela del simio mono es una zoonosis endémica en África causada por tres clados de orthopoxvirus. El conocimiento de la enfermedad es limitado, pero en abril de 2022 se declaró un brote mundial que implica una nueva vía de transmisión.OBJETIVO:Describir los síntomas anales y los resultados en pacientes que sufren de infección por Monkeypox que asistieron a una unidad de proctología de emergencia en París.DISEÑO:Un estudio observacional.ESCENARIO:Informamos los síntomas anales de todos los pacientes consecutivos con infección anal por viruela del mono en un solo centro de proctología entre el 16/6/2022 y el 26/7/2022. También se registró la asociación con infecciones de transmisión sexual (ITS) y el resultado.PACIENTES:Sesenta y cinco hombres de 39,6 [19,9-64,6] años con infección anal confirmada.PRINCIPALES MEDIDAS DE RESULTADO:Los síntomas anales y su gravedad se evaluaron clínicamente. Un resultado favorable consistió en una resolución completa de la manifestación clínica.RESULTADOS:La transmisión sexual se informó en 51 (78,4%) pacientes, de los cuales 63 (97%) eran hombres que tuvieron sexo con hombres. Veintiocho (43%) vivían con el VIH y 24 (36,9%) tomaban Emtricitabina/Tenofovir para profilaxis previa por exposición al VIH. Los síntomas anales aparecieron primero en 36 (55,4%) pacientes y la erupción cutánea u otros síntomas generales en 22 (33,8%). El tiempo de incubación fue de 6,9 [1-26] días. Los síntomas incluyeron ulceraciones perianales dolorosas (n = 42 pacientes, 64,6%), anales (n = 28, 43%), rectales (n = 25, 38,4%) y vesículas perianales (n = 24, 36,9%). Se observó proctitis en 49 (75,4%) pacientes. Fue leve en 20 (40,8%) e intensa en 29 (59,2%) y proctitis severa simulando supuración interesfinteriana alta en 4 (8,2%). Quince (23,1%) pacientes presentaban ITS concurrentes y 3 fueron hospitalizados. La resolución completa de los síntomas ocurrió dentro de los 12 días.LIMITACIONES:Estudio de un solo centro y durante corto período de tiempo.CONCLUSIÓN:Los síntomas proctológicos son frecuentes en el brote actual de la enfermedad de la viruela del mono, probablemente relacionados con la vía de transmisión. Las ulceraciones rectales que simulan una supuración interesfinteriana alta deben reconocerse para evitar una cirugía innecesaria. (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Benjamin Le Vavasseur
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Sihem Bendaoud
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Sarah Taieb
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Beate Heym
- Microbiology Laboratory, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | | | - Eloise J Leclerc
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Antonin Metaye
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | | | - Josée Bourguignon
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Milad Taouk
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Anne Gabarre
- Microbiology Laboratory, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Stéphane Marot
- Virology Laboratory, La Pitié Salpêtrière hospital, Paris, France
| | - Sarah Tepper
- Emergency Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Olivier Lidove
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Isabelle Etienney
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
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Andersen EW, Kulie P, Castel AD, Lucar J, Benator D, Greenberg AE, Monroe A. Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC. Pathogens 2024; 13:124. [PMID: 38392862 PMCID: PMC10891655 DOI: 10.3390/pathogens13020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.
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Affiliation(s)
- Elisabeth W. Andersen
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Paige Kulie
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Jose Lucar
- Division of Infectious Diseases, The George Washington School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Debra Benator
- The Washington DC Veterans Affairs Administration, Washington, DC 20422, USA;
| | - Alan E. Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
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Ahmed SK, Dabou EA, Ibrahim FM, Mohammed MG, Chandran D, Basit J, Chakraborty S, Emran TB, Islam R, Dhama K. Challenges and Counteracting Strategies Including Optimum Health Service Practices for Frontline Nurses During the Mpox Outbreak and Futuristic Vision. SAGE Open Nurs 2024; 10:23779608241256209. [PMID: 38784647 PMCID: PMC11113054 DOI: 10.1177/23779608241256209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/28/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Monkeypox (mpox) is an evolving infectious disease caused by the monkeypox virus (MPXV). On July 23, 2022, the WHO declared the recent mpox outbreaks a public health emergency of international concern (PHEIC), which terminated on May 11, 2023. As of July 11, 2023, 88,288 confirmed cases and 149 deaths have been reported from 112 countries and territories. Currently, mpox is not a PHEIC, as the outbreak and its impacts are nearly over. Nurses played significant roles during the mpox 2022 outbreak as frontline workers. Purpose In light of the impending mpox global outbreak in 2022, this brief report provides an update on the enormous difficulties faced by frontline nurses while playing a crucial role in handling the mpox outbreak and some potential solutions to these difficulties. The methodological framework employed in this narrative brief report involves conducting a comprehensive analysis and synthesis of relevant literature and hypothetical scenarios. The aim is to put forth practical strategies that can effectively tackle the difficulties encountered by frontline nurses in the context of the mpox outbreak. Additionally, the report seeks to envision a healthcare system that is more resilient in the face of future challenges. Conclusion It is important to understand the challenges the nurses face from their perspective. As frontline health care workers, the various health issues of nurses and their concerns must be taken care of appropriately by adopting optimum health service practices, adequate safety measures, recommended precautionary measures, and boosting them mentally while handling mpox patients. Counseling and the arrangement of workshops are required. Appropriate care should be taken to address the various health issues concerning nurses by adopting health service practices at optimum levels. Side by side, recommended safety and precautionary measures should be followed.
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Affiliation(s)
- Sirwan Khalid Ahmed
- College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, Iraq
- Ministry of Health, General Directorate of Health-Raparin, Rania, Sulaymaniyah, Kurdistan Region, Iraq
| | - Eman A. Dabou
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, UAE
| | - Fatma M. Ibrahim
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, UAE
| | - Mona G. Mohammed
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, UAE
| | - Deepak Chandran
- (Department of Animal Husbandry, Government of Kerala, Palakkad, Kerala, India
| | - Jawad Basit
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Sandip Chakraborty
- State Disease Investigation Laboratory, ARDD, Abhoynagar, Agartala, West Tripura, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Rabiul Islam
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute (IVRI), Bareilly, Uttar Pradesh, India
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Hassan R, Wondmeneh S, Jimenez NG, Chapman K, Mangla A, Ashley P, Willut C, Lee M, Rhodes T, Gillani S, Copen C, Jackson DA, Waltenburg M, Delaney KP, Miles G, Agnew-Brune C, Oakley LP. Mpox Knowledge, Attitudes, and Practices Among Persons Presenting for JYNNEOS Vaccination-District of Columbia, August to October 2022. Sex Transm Dis 2024; 51:47-53. [PMID: 37921836 PMCID: PMC11027964 DOI: 10.1097/olq.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND More than 30,000 mpox cases have been confirmed in the United States since May 2022. Mpox cases have disproportionally occurred among adult gay, bisexual, and other men who have sex with men; transgender persons; and Black and Hispanic/Latino persons. We examined knowledge, attitudes, and practices regarding mpox vaccination among adults presenting for vaccination to inform prevention efforts. METHODS We collected mixed-methods data from a convenience sample of adults presenting for JYNNEOS vaccination at 3 DC Health mpox vaccine clinics during August-October 2022. Survey and interview topics included knowledge about mpox symptoms and vaccine protection, beliefs about vaccine access, and trusted sources of information. RESULTS In total, 352 participants completed self-administered surveys and 62 participants completed an in-depth interview. Three main themes emerged from survey and interview data. First, most participants had a general understanding about mpox, but gaps remained in comprehensive understanding about mpox symptoms, modes of transmission, vaccine protection, personal risk, and vaccine dosing strategies. Second, participants had high trust in public health agencies. Third, participants wanted more equitable and less stigmatizing access to mpox vaccine services. CONCLUSIONS Nonstigmatizing, inclusive, and clear communication from trusted sources, including public health agencies, is needed to address mpox knowledge gaps and increase vaccine access and uptake in affected communities. Mpox outreach efforts should continue innovative approaches, including person-level risk assessment tools, to address community needs.
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Affiliation(s)
- Rashida Hassan
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Wondmeneh
- Epidemic Intelligence Service, National Center for State, Tribal, Local and Territorial Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Kelly Chapman
- Epidemic Intelligence Service, National Center for State, Tribal, Local and Territorial Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | | | - Casey Copen
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - David A. Jackson
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michelle Waltenburg
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin P. Delaney
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gillian Miles
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christine Agnew-Brune
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa P. Oakley
- Multinational Mpox Response, Centers for Disease Control and Prevention, Atlanta, GA
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Acevedo A, Garrido M. Epidemiological and clinical differences of confirmed and discarded Mpox cases on the 2022 Chilean outbreak. IJID REGIONS 2023; 9:59-62. [PMID: 37915990 PMCID: PMC10616139 DOI: 10.1016/j.ijregi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
Objectives To improve Mpox diagnosis by identifying distinctive symptoms in confirmed vs discarded cases due to outdated case definition. Methods This is a case-control study conducted using data from the Institute of Public Health database, encompassing all suspected cases analyzed by real-time polymerase chain reaction between June 1 and September 30, 2022. We calculated means, frequencies, performed Fisher's test, and computed odds ratios (OR) using RStudio and Microsoft Excel. Results Among 1415 suspected Mpox cases, 87% were men aged 30-39 with exanthema. Confirmed cases had higher rates of lymphadenopathy (31% vs 12%), fever (42% vs 29%), myalgia (35% vs 25%), and specific lesions: pustules (36% vs 27%), scabs (25% vs 17%), and umbilicated lesions (24% vs 7%) (P <0.05). Key risk factors for Mpox included contact with a positive case (OR 2.33), multiple sexual partners (OR 3.52), and male gender (OR 29.93). Conclusion The symptomatology of confirmed Mpox cases closely aligns with that reported in the current outbreak. The primary risk factors identified include prior contact with another positive case, having multiple sexual partners, and male gender. However, to facilitate a more complete analysis, more evidence needs to be investigated.
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Affiliation(s)
- Alejandra Acevedo
- Department of Epidemiology and Health Studies. Universidad de los Andes, Santiago, Chile
| | - Marcela Garrido
- Department of Epidemiology and Health Studies. Universidad de los Andes, Santiago, Chile
- Clínica Universidad de los Andes, Santiago, Chile
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Núñez I, Ceballos-Liceaga SE, de la Torre A, García-Rodríguez G, López-Martínez I, Sierra-Madero J, Mosqueda-Gómez JL, Valdés-Ferrer SI. Predictors of laboratory-confirmed mpox in people with mpox-like illness. Clin Microbiol Infect 2023; 29:1567-1572. [PMID: 37524303 DOI: 10.1016/j.cmi.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES We aimed to identify predictors of confirmed monkeypox (mpox) among people with mpox-like illness and to develop a multivariable model for confirmed mpox. METHODS We performed an observational study using national epidemiologic surveillance data in Mexico from May to November 2022. People with mpox-like illness were reported to the Mexican Ministry of Health and real-time polymerase chain reaction was performed in clinical samples to confirm mpox. Sociodemographic and clinical data were collected with a case report form. We performed univariable logistic regressions to estimate the predictive capability of individual characteristics, reported with ORs and 95% CIs. Variables of interest were included in multivariable logistic regression models and Akaike information criterion was used to retain variables for the final model. Discrimination and calibration of the model were estimated in bootstrap resamples. RESULTS A total of 5078 people were reported with mpox-like illness. Of 5078 people, 3291 (64.8%) had confirmed mpox. The strongest clinical predictors of confirmed mpox in univariable models were proctitis (OR 6.54, 5.93-7.21), inguinal adenopathy (OR 5.91, 5.36-6.52), and anogenital lesions (OR 5.45, 4.94-6.02). The final model included being a man who has sex with men (8.75, 7.37-10.38), HIV diagnosis (3.04, 2.51-3.69), inguinal adenopathy (2.24, 1.81-2.77), anogenital lesions (2.32, 1.97-2.74), and pustules (1.55, 1.32-1.81). Discrimination capability was excellent (c-statistic 0.88, 95% CI 0.87-0.89) and it was well calibrated (calibration slope 1, 95% CI 0.95-1.05). DISCUSSION A third of people with mpox-like illness do not have mpox. Factors such as being a man who has sex with men, HIV diagnosis, inguinal adenopathy, pustules, and anogenital lesions are associated with confirmed mpox.
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Affiliation(s)
- Isaac Núñez
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Division of Postgraduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | | | - Alethse de la Torre
- National Centre for Prevention and Control of HIV and AIDS, Mexico City, Mexico
| | | | - Irma López-Martínez
- National Institue of Diagnosis and Epidemiologic Reference, Mexico City, Mexico
| | - Juan Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan L Mosqueda-Gómez
- High Specialty Regional Hospital Bajio, Health Secretariat, León, Guanajuato, Mexico
| | - Sergio Iván Valdés-Ferrer
- National Institue of Diagnosis and Epidemiologic Reference, Mexico City, Mexico; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Garneau WM, Jones JL, Dashler GM, Mostafa HH, Judson SD, Kwon N, Hamill MM, Gilliams EA, Rudolph DS, Keruly JC, Fall A, Klein EY, Hansoti B, Gebo KA. Risk Factors for Hospitalization and Effect of Immunosuppression on Clinical Outcomes Among an Urban Cohort of Patients With Mpox. Open Forum Infect Dis 2023; 10:ofad533. [PMID: 38058459 PMCID: PMC10697423 DOI: 10.1093/ofid/ofad533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
Background During the 2022 mpox outbreak most patients were managed as outpatients, but some required hospitalization. Uncontrolled human immunodeficiency virus (HIV) has been identified as a risk factor for severe mpox. Methods Patients with mpox diagnosed or treated within the Johns Hopkins Health System between 1 June and 15 December 2022 were included. The primary outcome of interest was risk of hospitalization. Demographic features, comorbid conditions, treatment, and clinical outcomes were determined. Results A total of 353 patients were tested or treated for mpox; 100 had mpox diagnosed or treated (median age, 35.3 years; 97.0% male; 57.0% black and 10.0% Hispanic; 46.0% people with HIV [PWH]). Seventeen patients (17.0%) required hospitalization, 10 of whom were PWH. Age >40 years, race, ethnicity, HIV status, insurance status, and body mass index >30 (calculated as weight in kilograms divided by height in meters squared) were not associated with hospitalization. Eight of 9 patients (88.9%) with immunosuppression were hospitalized. Immunosuppression was associated with hospitalization in univariate (odds ratio, 69.3 [95% confidence interval, 7.8-619.7]) and adjusted analysis (adjusted odds ratio, 94.8 [8.5-1060.1]). Two patients (11.8%) who were hospitalized required intensive care unit admission and died; both had uncontrolled HIV infection and CD4 T-cell counts <50/µL. Median cycle threshold values for the first positive mpox virus sample did not differ between those who were hospitalized and those who were not. Conclusions Immunosuppression was a significant risk factor for hospitalization with mpox. PWH with CD4 T-cell counts <50/µL are at high risk of death due to mpox infection. Patients who are immunosuppressed should be considered for early and aggressive treatment of mpox, given the increased risk of hospitalization.
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Affiliation(s)
- William M Garneau
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joyce L Jones
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabriella M Dashler
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seth D Judson
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nathan Kwon
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew M Hamill
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A Gilliams
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David S Rudolph
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeanne C Keruly
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amary Fall
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Departent of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
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Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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22
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O'Shea JG, Bonacci RA, Cholli P, Kimball A, Brooks JT. HIV and mpox: a rapid review. AIDS 2023; 37:2105-2114. [PMID: 37877274 PMCID: PMC10962215 DOI: 10.1097/qad.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV.
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Affiliation(s)
- Jesse G O'Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Essajee NM, Oddo-Moise H, Hagensee ME, Lillis RA, Maffei J, Butler I, Lovett A, Sokol T, Clement ME. Characteristics of Mpox Infections in Louisiana in the 2022 Outbreak. AIDS Res Hum Retroviruses 2023; 39:587-592. [PMID: 37424520 PMCID: PMC10621655 DOI: 10.1089/aid.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
The 2022 outbreak of mpox in Louisiana was limited to just >300 cases, perhaps an unexpected outcome given the state's high rates of HIV and other sexually transmitted infections (STIs). We aimed to describe the local outbreak within two health centers in the New Orleans region, partnering with the Louisiana Department of Health to offer additional statewide data. We reviewed charts of persons testing positive for mpox in New Orleans from July to November 2022 at two local health centers that together accounted for half of local cases. We abstracted data on HIV status, immune function [CD4 count, viral load (VL)], antiretroviral therapy regimen, symptoms and severity of infection, vaccination status, and whether tecovirimat was administered. We present local data relative to statewide data (July 2022-January 2023). Of 103 individuals in our network for whom charts were reviewed, 96 (93%) identified as male, 52 (50%) were Black, and 69 (67%) had HIV, including 12 (17%) with uncontrolled HIV (CD4 < 200 cells/mm3 or VL >200 copies/mL). The most common presenting symptoms were rash (n = 71, 69%), fever (n = 36, 35%), and rectal pain (n = 33, 32%). Of six (6%) patients hospitalized, four (67%) were persons with HIV (PWH). Two were hospitalized for severe mpox infection with >100 lesions at presentation; both were PWH, and one had uncontrolled infection. Across the state, 307 cases have been identified and 24 have been hospitalized. Of those hospitalized, 18 (75%) were PWH, including 9 (50%) with uncontrolled HIV. The demographic data from Louisiana, a state with high prevalence of STIs and HIV/AIDS, are consistent with prior reports describing the 2022 mpox outbreak. Our results contribute to accumulating data on the severity of infection in individuals with HIV-related immunocompromise.
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Affiliation(s)
- Nabil M. Essajee
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Hope Oddo-Moise
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Michael E. Hagensee
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rebecca A. Lillis
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Joanne Maffei
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Isolde Butler
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Aish Lovett
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Theresa Sokol
- Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana, USA
| | - Meredith E. Clement
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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24
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Musharbash M, DiLorenzo M, Genes N, Mukherjee V, Klinger A. Mpox in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2023; 7:210-214. [PMID: 38353186 PMCID: PMC10855293 DOI: 10.5811/cpcem.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1-August 1, 2022. Case Series We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2-16 hours, median 4 hours) and test turnaround time (range 1-11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat. Conclusion Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.
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Affiliation(s)
- Michael Musharbash
- New York University School of Medicine, Department of Emergency Medicine, New York
| | - Madeline DiLorenzo
- New York University School of Medicine, Department of Internal Medicine, New York
| | - Nicholas Genes
- New York University School of Medicine, Department of Emergency Medicine, New York
| | - Vikramjit Mukherjee
- New York University School of Medicine, Department of Internal Medicine, New York
| | - Amanda Klinger
- New York University School of Medicine, Department of Internal Medicine, New York
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25
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Xu T, Zhang L. Rising prevalence of mpox in China, Japan, and Republic of Korea. J Infect 2023; 87:e73-e74. [PMID: 37532030 DOI: 10.1016/j.jinf.2023.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Ting Xu
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China; Department of Pathogen Biology, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China; Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Leiliang Zhang
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China; Department of Pathogen Biology, School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China; Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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26
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Groves JA, Tonnetti L, Self D, Yadav MC, Livezey K, Linnen JM, Stramer SL. Nucleic acid testing for monkeypox in United States blood donor specimens. Transfusion 2023; 63:1797-1802. [PMID: 37533364 DOI: 10.1111/trf.17500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The 2022 multi-country outbreak of monkeypox (mpox) resulted in blood collection and public health agencies closely monitoring for changes in transmission dynamics that could pose a threat to the blood supply. While mpox virus (MPXV) is not known to be transfusion transmissible, there have been several studies demonstrating the detection of MPXV in blood. We evaluated the performance characteristics of a research use only (RUO) nucleic acid amplification test for MPXV. The assay was developed to detect MPXV DNA in plasma and serum specimens from human blood donors. METHODS AND MATERIALS The sensitivity of the RUO MPXV Assay was determined using a synthetic DNA sequence, purified full-length genomic DNA, and a chemically inactivated virus. Specificity was determined using fresh plasma samples collected from blood donors during the outbreak. Plasma samples collected from donors considered at increased risk for exposure to mpox were also tested. RESULTS For sensitivity, the 95% limit of detection (LOD) ranged from 0.26 copies/mL (inactivated virus) to 31.65 copies/mL (synthetic DNA) to 166.61 copies/mL (for full-length DNA). All donor samples tested with the RUO MPXV Assay were nonreactive, resulting in a specificity of 100% (95% CI, 99.93%-100.00%). DISCUSSION The RUO MPXV Assay was developed as a potential blood donation screening assay in response to the outbreak. While not directly comparable, the 95% LOD fiducial limits obtained from partial- and full-length DNA analysis were similar to other manufacturers' MPXV assays. Additionally, this assay demonstrated high specificity for screening blood donors.
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Affiliation(s)
- Jamel A Groves
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Laura Tonnetti
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Deanna Self
- Grifols Diagnostic Solutions Inc., San Diego, California, USA
| | - Manisha C Yadav
- Grifols Diagnostic Solutions Inc., San Diego, California, USA
| | - Kristin Livezey
- Grifols Diagnostic Solutions Inc., San Diego, California, USA
| | | | - Susan L Stramer
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
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27
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Kim M, Acevedo Martinez E, Suárez Moscoso NP, Niu J, Abbo LM, Rosa R, Cifuentes R, Eckardt PA. A retrospective study on 198 mpox cases in South Florida: Clinical characteristics and outcomes with focus on human immunodeficiency virus status. Int J STD AIDS 2023; 34:884-889. [PMID: 37353475 DOI: 10.1177/09564624231185812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND Men who have sex with men (MSM) and persons living with human immunodeficiency virus (PLWH) were disproportionately affected by global mpox outbreak in 2022. In this retrospective review, we describe epidemiology and clinical characteristics of mpox infection in South Florida with a focus on human immunodeficiency virus (HIV) status. METHODS This was a retrospective observational study of 198 adult patients with confirmed diagnosis of mpox between 01 January 2020, and 10 September 2022, in two large health systems in South Florida. A descriptive analysis was performed to summarize demographic, clinical and laboratory characteristics, and outcomes of the patients. RESULTS Young male patients and PLWH were disproportionately represented among patients with mpox. HIV positive patients were less likely to have adenopathy and myalgia and were more likely to have oral or facial lesions. 22.7% of studied patients were diagnosed with one or more concurrent STI at the time of mpox diagnosis. CONCLUSIONS We suggest screening for sexually transmitted infections and HIV for patients diagnosed with mpox. We suggest prompt consultation or referral to infectious disease specialist if needed for the patients who are diagnosed with mpox especially in the severely immunocompromised host.
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Affiliation(s)
- Myeongji Kim
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Elsa Acevedo Martinez
- Department of Internal Medicine, Memorial Healthcare System, Pembroke Pines, FL, USA
| | | | - Jinali Niu
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
| | - Lilian M Abbo
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
- Infectious Diseases, Jackson Health System, Miami, FL, USA
| | - Rossana Rosa
- Infectious Diseases, Jackson Health System, Miami, FL, USA
| | - Renzo Cifuentes
- Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paula A Eckardt
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, FL, USA
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Yates JL, Hunt DT, Kulas KE, Chave KJ, Styer L, Chakravarthi ST, Cai GY, Bermúdez-González MC, Kleiner G, Altman D, Srivastava K, Simon V, Feihel D, McGowan J, Hogrefe W, Noone P, Egan C, Slifka MK, Lee WT. Development of a novel serological assay for the detection of mpox infection in vaccinated populations. J Med Virol 2023; 95:e29134. [PMID: 37805977 PMCID: PMC10686281 DOI: 10.1002/jmv.29134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
In 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 104 nonendemic locations worldwide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.
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Affiliation(s)
- Jennifer L Yates
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Danielle T Hunt
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Karen E Kulas
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Karen J Chave
- Scientific Cores, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Linda Styer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Sandhya T Chakravarthi
- Scientific Cores, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Gianna Y Cai
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Maria C Bermúdez-González
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Giulio Kleiner
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Deena Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Komal Srivastava
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Viviana Simon
- Center for Vaccine Research and Pandemic Preparedness, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dennis Feihel
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joseph McGowan
- Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | | | - Christina Egan
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
| | - Mark K Slifka
- Najit Technologies, Inc., Beaverton, Oregon, USA
- Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, USA
| | - William T Lee
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, The School of Public Heath, The University at Albany, Albany, New York, USA
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Moore C, Marcucci V, Torres P, Liu E, Parker GS. A 40-Year-Old Man with Anemia, Proctitis, Rectal Bleeding, and a Perianal Rash Due to Mpox (Monkeypox) Infection. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940177. [PMID: 37660250 PMCID: PMC10483884 DOI: 10.12659/ajcr.940177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 07/08/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND A recently described zoonotic viral infection, mpox (monkeypox), is an Orthopoxvirus transmitted by close contact, which causes symptoms similar to smallpox, although less severe. This report presents the case of a 40-year-old man with anemia, proctitis, rectal bleeding, and a perianal rash due to mpox infection. CASE REPORT A 40-year-old man with a medical history of human immunodeficiency virus (HIV) and syphilis presented multiple times with progressive and painful perianal lesions. On initial presentation, swabbing of the lesions and polymerase chain reaction (PCR) testing confirmed a diagnosis of mpox infection, and treatment with a 14-day course of Tecovirimat was started. Nine days after initiating Tecovirimat, the patient presented again with worsening perianal pain and associated hematochezia resulting in acute symptomatic anemia. Despite a blood transfusion to treat his anemia, the patient's status declined as his viral symptoms progressed. Computed tomography (CT) investigation demonstrated significant proctitis with interval development of small perianal abscesses. A multidisciplinary approach for medical management and treatment was instituted. The resolution of the patient's anemia and mpox proctitis was confirmed on follow-up. CONCLUSIONS Despite treatment with antiviral agents, mpox infection can progress quickly; thus, swift management with a multidisciplinary approach and close follow-up is needed to treat and prevent secondary complications such as anemia and proctitis. Further data collection regarding the sexual practices of those with diagnoses of mpox as well as seminal, anorectal, and genital swabbing would be valuable to confirm the mode of transmission and cause of mpox proctitis.
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Affiliation(s)
- Colton Moore
- Department of General Surgery, University of Florida School of Medicine, Jacksonville, FL, USA
| | - Vincent Marcucci
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Patricia Torres
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Edward Liu
- Department of Medicine, St. George’s University, St. George’s, Grenada
| | - Glenn S. Parker
- Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, USA
- Department of Medicine, St. George’s University, St. George’s, Grenada
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Popescu SV, Leach R. Building Sustainable Infection Prevention in the Era of COVID-19. Health Secur 2023; 21:379-383. [PMID: 37289770 DOI: 10.1089/hs.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Saskia V Popescu
- Saskia V. Popescu, PhD, MPH, MA, CIC, is an Assistant Professor, Department of Epidemiology and Public Health, University of Maryland Medical School, Baltimore, MD
| | - Rebecca Leach
- Rebecca Leach, MPH, RN, BSN, CIC, is System Manager of Infection Prevention, CommonSpirit Health, Phoenix, AZ
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31
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Sharpe JD, Charniga K, Byrd KM, Stefanos R, Lewis L, Watson J, Feldpausch A, Pavlick J, Hand J, Sokol T, Ortega E, Pathela P, Hennessy RR, Dulcey M, McHugh L, Pietrowski M, Perella D, Shah S, Maroufi A, Taylor M, Cope A, Belay ED, Ellington S, McCollum AM, Zilversmit Pao L, Guagliardo SAJ, Dawson P. Possible Exposures Among Mpox Patients Without Reported Male-to-Male Sexual Contact - Six U.S. Jurisdictions, November 1-December 14, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:944-948. [PMID: 37651279 DOI: 10.15585/mmwr.mm7235a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The extent to which the 2022 mpox outbreak has affected persons without a recent history of male-to-male sexual contact (MMSC) is not well understood. During November 1-December 14, 2022, CDC partnered with six jurisdictional health departments to characterize possible exposures among mpox patients aged ≥18 years who did not report MMSC during the 3 weeks preceding symptom onset. Among 52 patients included in the analysis, 14 (27%) had a known exposure to a person with mpox, including sexual activity and other close intimate contact (eight) and household contact (six). Among 38 (73%) patients with no known exposure to a person with mpox, self-reported activities before illness onset included sexual activity and other close intimate contact (17; 45%), close face-to-face contact (14; 37%), attending large social gatherings (11; 29%), and being in occupational settings involving close skin-to-skin contact (10; 26%). These findings suggest that sexual activity remains an important route of mpox exposure among patients who do not report MMSC.
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Saldana CS, Kelley CF, Aldred BM, Cantos VD. Mpox and HIV: a Narrative Review. Curr HIV/AIDS Rep 2023; 20:261-269. [PMID: 37178205 PMCID: PMC10182557 DOI: 10.1007/s11904-023-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE OF REVIEW We reviewed the available literature on mpox in People with HIV (PWH). We highlight special considerations of mpox infection related to epidemiology, clinical presentation, diagnostic and treatment considerations, prevention, and public health messaging in PWH. RECENT FINDINGS During the 2022 mpox outbreak, PWH were disproportionally impacted worldwide. Recent reports suggest that the disease presentation, management, and prognosis of these patients, especially those with advanced HIV disease, can widely differ from those without HIV-associated immunodeficiency. Mpox can often be mild and resolve on its own in PWH with controlled viremia and higher CD4 counts. However, it can be severe, with necrotic skin lesions and protracted healing; anogenital, rectal, and other mucosal lesions; and disseminated organ systems involvement. Higher rates of healthcare utilization are seen in PWH. Supportive, symptomatic care and single or combination mpox-directed antiviral drugs are commonly used in PWH with severe mpox disease. Data from randomized clinical control trials on the efficacy of therapeutic and preventive tools against mpox among PWH are needed to better guide clinical decisions.
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Affiliation(s)
- Carlos S Saldana
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA.
| | - Colleen F Kelley
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Bruce M Aldred
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Ponce de Leon Center, 341 Ponce de Leon Ave NE, Atlanta, GA, 30308, USA
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Abara WE, Sullivan P, Carpino T, Sanchez T, Atkins K, Delaney K, Edwards OW, Marissa H, Baral S, Ogale Y, Galloway E, Lansky A. Characteristics of Mpox Vaccine Recipients Among a Sample of Men Who Have Sex With Men With Presumed Exposure to Mpox. Sex Transm Dis 2023; 50:458-461. [PMID: 36940183 PMCID: PMC10330397 DOI: 10.1097/olq.0000000000001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
ABSTRACT Mpox vaccination is recommended for persons exposed to or at risk for mpox. Approximately 25% of an online sample of men who have sex with men (MSM) with presumed mpox exposure were vaccinated (≥1 dose). Vaccination was higher among younger MSM, MSM concerned about mpox, or MSM reporting sexual risk behaviors. Incorporating mpox vaccination into routine sexual health care and increasing 2-dose vaccination uptake is essential to preventing mpox acquisition, improving MSM sexual health, and averting future mpox outbreaks.
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Affiliation(s)
- Winston E. Abara
- Mpox Response Team, U.S. Centers for Disease Control and Prevention, Atlanta GA
| | | | - Tom Carpino
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta GA
| | - Kait Atkins
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Kevin Delaney
- Mpox Response Team, U.S. Centers for Disease Control and Prevention, Atlanta GA
| | | | - Hannah Marissa
- Department of Epidemiology, Emory University, Atlanta GA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Yasmin Ogale
- Mpox Response Team, U.S. Centers for Disease Control and Prevention, Atlanta GA
| | - Eboni Galloway
- Mpox Response Team, U.S. Centers for Disease Control and Prevention, Atlanta GA
| | - Amy Lansky
- Mpox Response Team, U.S. Centers for Disease Control and Prevention, Atlanta GA
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34
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Deputy NP, Deckert J, Chard AN, Sandberg N, Moulia DL, Barkley E, Dalton AF, Sweet C, Cohn AC, Little DR, Cohen AL, Sandmann D, Payne DC, Gerhart JL, Feldstein LR. Vaccine Effectiveness of JYNNEOS against Mpox Disease in the United States. N Engl J Med 2023; 388:2434-2443. [PMID: 37199451 PMCID: PMC10962869 DOI: 10.1056/nejmoa2215201] [Citation(s) in RCA: 73] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States, more than 30,000 cases of mpox (formerly known as monkeypox) had occurred as of March 1, 2023, in an outbreak disproportionately affecting transgender persons and gay, bisexual, and other men who have sex with men. In 2019, the JYNNEOS vaccine was approved for subcutaneous administration (0.5 ml per dose) to prevent mpox infection. On August 9, 2022, an emergency use authorization was issued for intradermal administration (0.1 ml per dose); however, real-world effectiveness data are limited for either route. METHODS We conducted a case-control study based on data from Cosmos, a nationwide Epic electronic health record (EHR) database, to assess the effectiveness of JYNNEOS vaccination in preventing medically attended mpox disease among adults. Case patients had an mpox diagnosis code or positive orthopoxvirus or mpox virus laboratory result, and control patients had an incident diagnosis of human immunodeficiency virus (HIV) infection or a new or refill order for preexposure prophylaxis against HIV infection between August 15, 2022, and November 19, 2022. Odds ratios and 95% confidence intervals were estimated from conditional logistic-regression models, adjusted for confounders; vaccine effectiveness was calculated as (1 - odds ratio for vaccination in case patients vs. controls) × 100. RESULTS Among 2193 case patients and 8319 control patients, 25 case patients and 335 control patients received two doses (full vaccination), among whom the estimated adjusted vaccine effectiveness was 66.0% (95% confidence interval [CI], 47.4 to 78.1), and 146 case patients and 1000 control patients received one dose (partial vaccination), among whom the estimated adjusted vaccine effectiveness was 35.8% (95% CI, 22.1 to 47.1). CONCLUSIONS In this study using nationwide EHR data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. (Funded by the Centers for Disease Control and Prevention and Epic Research.).
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Affiliation(s)
- Nicholas P Deputy
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Joseph Deckert
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Anna N Chard
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Neil Sandberg
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Danielle L Moulia
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Eric Barkley
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Alexandra F Dalton
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Cory Sweet
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Amanda C Cohn
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - David R Little
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Adam L Cohen
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Danessa Sandmann
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Daniel C Payne
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Jacqueline L Gerhart
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
| | - Leora R Feldstein
- From the Mpox Emergency Response Team, Centers for Disease Control and Prevention, Atlanta (N.P.D., A.N.C., D.L.M., A.F.D., A.C.C., A.L.C., D.C.P., L.R.F.); the Public Health Service Commissioned Corps, Rockville, MD (N.P.D., A.N.C., A.C.C., A.L.C., L.R.F.); and Epic Research, Epic Systems, Verona, WI (J.D., N.S., E.B., C.S., D.R.L., D.S., J.L.G.)
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35
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Srivastava S, Kumar S, Jain S, Mohanty A, Thapa N, Poudel P, Bhusal K, Al-Qaim ZH, Barboza JJ, Padhi BK, Sah R. The Global Monkeypox (Mpox) Outbreak: A Comprehensive Review. Vaccines (Basel) 2023; 11:1093. [PMID: 37376482 DOI: 10.3390/vaccines11061093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 06/29/2023] Open
Abstract
Monkeypox (Mpox) is a contagious illness that is caused by the monkeypox virus, which is part of the same family of viruses as variola, vaccinia, and cowpox. It was first detected in the Democratic Republic of the Congo in 1970 and has since caused sporadic cases and outbreaks in a few countries in West and Central Africa. In July 2022, the World Health Organization (WHO) declared a public-health emergency of international concern due to the unprecedented global spread of the disease. Despite breakthroughs in medical treatments, vaccines, and diagnostics, diseases like monkeypox still cause death and suffering around the world and have a heavy economic impact. The 85,189 reported cases of Mpox as of 29 January 2023 have raised alarm bells. Vaccines for the vaccinia virus can protect against monkeypox, but these immunizations were stopped after smallpox was eradicated. There are, however, treatments available once the illness has taken hold. During the 2022 outbreak, most cases occurred among men who had sex with men, and there was a range of 7-10 days between exposure and the onset of symptoms. Three vaccines are currently used against the Monkeypox virus. Two of these vaccines were initially developed for smallpox, and the third is specifically designed for biological-terrorism protection. The first vaccine is an attenuated, nonreplicating smallpox vaccine that can also be used for immunocompromised individuals, marketed under different names in different regions. The second vaccine, ACAM2000, is a recombinant second-generation vaccine initially developed for smallpox. It is recommended for use in preventing monkeypox infection but is not recommended for individuals with certain health conditions or during pregnancy. The third vaccine, LC16m8, is a licensed attenuated smallpox vaccine designed to lack the B5R envelope-protein gene to reduce neurotoxicity. It generates neutralizing antibodies to multiple poxviruses and broad T-cell responses. The immune response takes 14 days after the second dose of the first two vaccines and 4 weeks after the ACAM2000 dose for maximal immunity development. The efficacy of these vaccines in the current outbreak of monkeypox is uncertain. Adverse events have been reported, and a next generation of safer and specific vaccines is needed. Although some experts claim that developing vaccines with a large spectrum of specificity can be advantageous, epitope-focused immunogens are often more effective in enhancing neutralization.
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Affiliation(s)
- Shriyansh Srivastava
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), Sector 3 Pushp Vihar, New Delhi 110017, India
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 203201, India
| | - Sachin Kumar
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), Sector 3 Pushp Vihar, New Delhi 110017, India
| | - Shagun Jain
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), Sector 3 Pushp Vihar, New Delhi 110017, India
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur 273008, India
| | - Neeraj Thapa
- Nepal Medical College, Jorpati, Kathmandu 44600, Nepal
| | | | - Krishna Bhusal
- Lumbini Medical College, Tansen-11, Pravas, Palpa 32500, Nepal
| | - Zahraa Haleem Al-Qaim
- Department of Anesthesia Techniques, Al-Mustaqbal University College, Hilla 51001, Iraq
| | - Joshuan J Barboza
- Escuela de Medicina, Universidad César Vallejo, Trujillo 13007, Peru
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune 411018, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, India
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Kota KK, Chesson H, Hong J, Zelaya C, Spicknall IH, Riser AP, Hurley E, Currie DW, Lash RR, Carnes N, Concepción-Acevedo J, Ellington S, Belay ED, Mermin J. Progress Toward Equitable Mpox Vaccination Coverage: A Shortfall Analysis - United States, May 2022-April 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:627-632. [PMID: 37289660 DOI: 10.15585/mmwr.mm7223a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
More than 30,000 monkeypox (mpox) cases were reported in the United States during the 2022 multinational outbreak; cases disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Substantial racial and ethnic disparities in incidence were also reported (1). The national mpox vaccination strategy* emphasizes that efforts to administer the JYNNEOS mpox vaccine should be focused among the populations at elevated risk for exposure to mpox (2). During May 2022-April 2023, a total of 748,329 first JYNNEOS vaccine doses (of the two recommended) were administered in the United States.† During the initial months of the outbreak, lower vaccination coverage rates among racial and ethnic minority groups were reported (1,3); however, after implementation of initiatives developed to expand access to mpox vaccination,§ coverage among racial and ethnic minority groups increased (1,4). A shortfall analysis was conducted to examine whether the increase in mpox vaccination coverage was equitable across all racial and ethnic groups (5). Shortfall was defined as the percentage of the vaccine-eligible population that did not receive the vaccine (i.e., 100% minus the percentage of the eligible population that did receive a first dose). Monthly mpox vaccination shortfalls were calculated and were stratified by race and ethnicity; monthly percent reductions in shortfall were also calculated compared with the preceding month's shortfall (6). The mpox vaccination shortfall decreased among all racial and ethnic groups during May 2022-April 2023; however, based on analysis of vaccine administration data with race and ethnicity reported, 66.0% of vaccine-eligible persons remained unvaccinated at the end of this period. The shortfall was largest among non-Hispanic Black or African American (Black) (77.9%) and non-Hispanic American Indian or Alaska Native (AI/AN) (74.5%) persons, followed by non-Hispanic White (White) (66.6%) and Hispanic or Latino (Hispanic) (63.0%) persons, and was lowest among non-Hispanic Asian (Asian) (38.5%) and non-Hispanic Native Hawaiian and other Pacific Islander (NH/OPI) (43.7%) persons. The largest percentage decreases in the shortfall were achieved during August (17.7%) and September (8.5%). However, during these months, smaller percentage decreases were achieved among Black persons (12.2% and 4.9%, respectively), highlighting the need for a focus on equity for the entirety of a public health response. Achieving equitable progress in JYNNEOS vaccination coverage will require substantial decreases in shortfalls among Black and AI/AN persons.
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Islam MR, Haque MA, Ahamed B, Tanbir M, Khan MR, Eqbal S, Rahman MA, Shahriar M, Bhuiyan MA. Assessment of vaccine perception and vaccination intention of Mpox infection among the adult males in Bangladesh: A cross-sectional study findings. PLoS One 2023; 18:e0286322. [PMID: 37289746 PMCID: PMC10249809 DOI: 10.1371/journal.pone.0286322] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/13/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Mpox (monkeypox) infection has become a global concern for healthcare authorities after spreading in multiple non-endemic countries. Following the sudden multi-country outbreak of Mpox, the World Health Organization (WHO) declared a public health emergency of international concern. We do not have any vaccines approved for the prevention of Mpox infection. Therefore, international healthcare authorities endorsed smallpox vaccines for the prevention of Mpox disease. Here we intended to perform this cross-sectional study among the adult males in Bangladesh to assess the Mpox vaccine perception and vaccination intention. METHODS We conducted this web-based survey among the adult males in Bangladesh from September 1, 2022, to November 30, 2022, using Google Forms. We assessed the Mpox vaccine perception and vaccination intention. We performed a chi-square test to compare vaccine perception and vaccination intention levels. Also, we performed multiple logistic regression analyses to determine the association between the study parameters and the sociodemographic profile of the participants. RESULTS According to the present study, the Mpox vaccine perception was high among 60.54% of the respondents. Also, 60.05% of respondents showed medium vaccination intention. Mpox vaccine perception and vaccination intention were strongly associated with the sociodemographic profiles of the participants. Furthermore, we discovered a significant association between the level of education and vaccination intention among the respondents. Also, age and marital status played a role in the Mpox vaccine perception and vaccination intention. CONCLUSION Our findings showed a significant association between sociodemographic characteristics and the Mpox vaccine perception/vaccination intention. Along with the country's long experience in mass immunization, campaigns about Covid-19 vaccines and high vaccination rates might play a role in Mpox vaccine perception and vaccination intention. We recommend more social awareness and educational communications or seminars for the target population to bring more positive changes in their attitude towards Mpox prevention.
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Affiliation(s)
- Md. Rabiul Islam
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Md. Anamul Haque
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Bulbul Ahamed
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Md. Tanbir
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Md. Robin Khan
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Saba Eqbal
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
| | - Md. Ashrafur Rahman
- Department of Pharmaceutical Sciences, Wilkes University, Wilkes Barre, PA, United States of America
| | - Mohammad Shahriar
- Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
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Zelaya CE, Smith BP, Riser AP, Hong J, Distler S, O'Connor S, Belay E, Shoeb M, Waltenburg MA, Negron ME, Ellington S. Urban and Rural Mpox Incidence Among Persons Aged 15-64 Years - United States, May 10-December 31, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:574-578. [PMID: 37227985 DOI: 10.15585/mmwr.mm7221a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
During May 10-December 31, 2022, a total of 29,980 confirmed and probable† U.S. monkeypox (mpox) cases were reported to CDC, predominantly in cisgender adult men reporting recent same-gender sexual partners (1). Urban-rural differences in health (2) and diagnosis of HIV (3,4) and other sexually transmitted infections (5) are well documented nationally. This report describes urban-rural differences in mpox incidence (cases per 100,000 population) among persons aged 15-64 years, by gender and race and ethnicity. Urbanicity was assessed using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties (2). Substantial differences in incidence by urbanicity, gender, and race and ethnicity were observed; most (71.0%) cases occurred in persons residing in large central urban areas. Among the cases in large central urban areas, most (95.7%) were in cisgender men. The overall incidence of mpox in the United States was 13.5 per 100,000 persons aged 15-64 years and peaked in August in both urban and rural areas. Among cisgender men, incidence in rural areas was approximately 4% that in large central urban areas (risk ratio [RR] = 0.04). Among cisgender women, incidence in rural areas was approximately 11% that in large central urban areas (RR = 0.11). In both urban and rural areas, incidence among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) persons was consistently higher than that among non-Hispanic White (White) persons; RRs between Black and White persons were highest in rural areas. Support and maintenance of mpox surveillance and prevention efforts including vaccinations should focus on urban areas with the highest incidence of mpox during the 2022 outbreak; however, surveillance and prevention efforts should include all genders, persons of color, and persons residing in both urban and rural areas who are at increased risk for mpox.
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McQuiston JH, Braden CR, Bowen MD, McCollum AM, McDonald R, Carnes N, Carter RJ, Christie A, Doty JB, Ellington S, Fehrenbach SN, Gundlapalli AV, Hutson CL, Kachur RE, Maitland A, Pearson CM, Prejean J, Quilter LAS, Rao AK, Yu Y, Mermin J. The CDC Domestic Mpox Response - United States, 2022-2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:547-552. [PMID: 37200231 DOI: 10.15585/mmwr.mm7220a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).
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Yates JL, Hunt DT, Kulas KE, Chave K, Styer L, Chakravarthi ST, Cai GY, Bermúdez-González MC, Kleiner G, Altman D, Srivastava K, Simon V, Feihel D, McGowan J, Hogrefe W, Noone P, Egan C, Slifka MK, Lee WT. Development of a Novel Serological Assay for the Detection of Mpox Infection in Vaccinated Populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.18.23288419. [PMID: 37162953 PMCID: PMC10168407 DOI: 10.1101/2023.04.18.23288419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 103 non-endemic locations world-wide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay (MIA) using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important diagnostic tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.
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Kota KK, Hong J, Zelaya C, Riser AP, Rodriguez A, Weller DL, Spicknall IH, Kriss JL, Lee F, Boersma P, Hurley E, Hicks P, Wilkins C, Chesson H, Concepción-Acevedo J, Ellington S, Belay E, Mermin J. Racial and Ethnic Disparities in Mpox Cases and Vaccination Among Adult Males - United States, May-December 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:398-403. [PMID: 37053122 PMCID: PMC10121252 DOI: 10.15585/mmwr.mm7215a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of December 31, 2022, a total of 29,939 monkeypox (mpox) cases* had been reported in the United States, 93.3% of which occurred in adult males. During May 10-December 31, 2022, 723,112 persons in the United States received the first dose in a 2-dose mpox (JYNNEOS)† vaccination series; 89.7% of these doses were administered to males (1). The current mpox outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and racial and ethnic minority groups (1,2). To examine racial and ethnic disparities in mpox incidence and vaccination rates, rate ratios (RRs) for incidence and vaccination rates and vaccination-to-case ratios were calculated, and trends in these measures were assessed among males aged ≥18 years (males) (3). Incidence in males in all racial and ethnic minority groups except non-Hispanic Asian (Asian) males was higher than that among non-Hispanic White (White) males. At the peak of the outbreak in August 2022, incidences among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) males were higher than incidence among White males (RR = 6.9 and 4.1, respectively). Overall, vaccination rates were higher among males in racial and ethnic minority groups than among White males. However, the vaccination-to-case ratio was lower among Black (8.8) and Hispanic (16.2) males than among White males (42.5) during the full analytic period, indicating that vaccination rates among Black and Hispanic males were not proportionate to the elevated incidence rates (i.e., these groups had a higher unmet vaccination need). Efforts to increase vaccination among Black and Hispanic males might have resulted in the observed relative increased rates of vaccination; however, these increases were only partially successful in reducing overall incidence disparities. Continued implementation of equity-based vaccination strategies is needed to further increase vaccination rates and reduce the incidence of mpox among all racial and ethnic groups. Recent modeling data (4) showing that, based on current vaccination coverage levels, many U.S. jurisdictions are vulnerable to resurgent mpox outbreaks, underscore the need for continued vaccination efforts, particularly among racial and ethnic minority groups.
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Riser AP, Hanley A, Cima M, Lewis L, Saadeh K, Alarcón J, Finn L, Kim M, Adams J, Holt D, Feldpausch A, Pavlick J, English A, Smith M, Rehman T, Lubelchek R, Black S, Collins M, Mounsey L, Blythe D, Avalos MH, Lee EH, Samson O, Wong M, Stokich BD, Salehi E, Denny L, Waller K, Talley P, Schuman J, Fischer M, White S, Davis K, Caeser Cuyler A, Sabzwari R, Anderson RN, Byrd K, Gold JAW, Kindilien S, Lee JT, O’Connor S, O’Shea J, Salmon-Trejo LAT, Velazquez-Kronen R, Zelaya C, Bower W, Ellington S, Gundlapalli AV, McCollum AM, Zilversmit Pao L, Rao AK, Wong KK, Guagliardo SAJ. Epidemiologic and Clinical Features of Mpox-Associated Deaths - United States, May 10, 2022-March 7, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:404-410. [PMID: 37053126 PMCID: PMC10121256 DOI: 10.15585/mmwr.mm7215a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States,† predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age = 34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR = 50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).
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Sam-Agudu NA, Martyn-Dickens C, Ewa AU. A global update of mpox (monkeypox) in children. Curr Opin Pediatr 2023; 35:193-200. [PMID: 36809304 DOI: 10.1097/mop.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Human mpox disease (formerly monkeypox) was first diagnosed in an infant in the Democratic Republic of the Congo in 1970. Mpox was rarely reported outside West and Central Africa until the global outbreak in May 2022. On 23 July 2022, the WHO declared mpox a public health emergency of international concern. These developments warrant a global update on pediatric mpox. RECENT FINDINGS Mpox epidemiology in endemic African countries has changed from predominantly affecting children under 10 years to adults 20-40 years old. This shift also applies to the global outbreak, where 18-44-year-old adult men who have sex with men are disproportionately affected. Furthermore, the proportion of children affected in the global outbreak is less than 2%, while children under 18 years constitute nearly 40% of cases in African countries. The highest mortality rates remain among both children and adults in African countries. SUMMARY Mpox epidemiology has shifted to adults and is affecting relatively few children in the current global outbreak. However, infants, immunocompromised children and African children are still at high risk of severe disease. Mpox vaccines and therapeutic interventions should be accessible to at-risk and affected children globally, especially to those living in endemic African countries.
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Affiliation(s)
- Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast
| | - Charles Martyn-Dickens
- Paediatric Infectious Diseases Unit, Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Atana U Ewa
- Respiratory/Infectious Diseases Unit, Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
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Vasquez-Perez A, Magan T, Volpe G, Osborne SF, McFaul K, Vahdani K. Necrotizing Blepharoconjunctivitis and Keratitis in Human Monkeypox. JAMA Ophthalmol 2023; 141:285-288. [PMID: 36757718 PMCID: PMC9912162 DOI: 10.1001/jamaophthalmol.2022.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/13/2022] [Indexed: 02/10/2023]
Abstract
Importance Ophthalmic manifestations occur in less than 5% of patients with human mpox (monkeypox), most commonly presenting with self-limiting conjunctivitis and keratitis. Cases with severe ophthalmic complication are uncommon. Objective To present a case of human mpox with sight-threatening necrotizing blepharoconjunctivitis. Design, Setting, and Participants This is a report of a patient who developed necrotizing conjunctivitis due to the monkepox virus at a large university hospital. Data were collected from July to October 2022. Main Outcomes and Measures Description of the progression and clinical evaluation of the ocular condition and the management. Results A 63-year-old HIV-positive man presented initially with conjunctivitis and eyelid swelling and developed skin lesions from monkeypox virus 2 days later. Despite remaining stable systemically, after 4 days, his ophthalmic condition evolved to necrotizing blepharoconjunctivitis for which systemic antiviral treatment with tecovirimat was given along with topical trifluoridine, 1%, eye drops. In addition, he required repeated tissue debridement with amniotic membrane grafting to preserve the eye integrity. Conclusions and Relevance The severity of this observation was associated with a coexisting immunocompromised state and appeared similar to findings associated with other orthopoxviruses. Ophthalmic manifestations could be the initial presentation of human mpox and could also be severe. Early recognition and intervention may limit the likelihood of substantial ocular morbidity.
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Affiliation(s)
| | - Tejal Magan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Giulio Volpe
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah F. Osborne
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Katie McFaul
- St George’s Hospital NHS Foundation Trust, London, United Kingdom
| | - Kaveh Vahdani
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Farrar JL, Lewis NM, Houck K, Canning M, Fothergill A, Payne AB, Cohen AL, Vance J, Brassil B, Youngkin E, Glenn B, Mangla A, Kupferman N, Saunders K, Meza C, Nims D, Soliva S, Blouse B, Henderson T, Banerjee E, White B, Birn R, Stadelman AM, Abrego M, McLafferty M, Eberhart MG, Pietrowski M, De León SM, Creegan E, Diedhiou A, Wiedeman C, Murray-Thompson J, McCarty E, Marcinkevage J, Kocharian A, Torrone EA, Ray LC, Payne DC. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022. Am J Transplant 2023; 23:298-303. [PMID: 36695684 DOI: 10.1016/j.ajt.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | | | | | | | - Amy Fothergill
- CDC Mpox Emergency Response Team; Epidemic Intelligence Service, CDC
| | | | | | - Joshua Vance
- California Department of Public Health; Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Erin Youngkin
- Colorado Department of Public Health and Environment
| | - Bailey Glenn
- Connecticut Department of Public Health; Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | | | | | | | | | - Dawn Nims
- Illinois Department of Public Health
| | | | | | | | | | | | - Rachael Birn
- Council of State and Territorial Epidemiologists, Atlanta, Georgia; Nebraska Department of Health and Human Services
| | - Anna M Stadelman
- Epidemic Intelligence Service, CDC; New Mexico Department of Health
| | | | | | | | - Michael Pietrowski
- City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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Liu Q, Fu L, Wang B, Sun Y, Wu X, Peng X, Li Y, Lin YF, Fitzpatrick T, Vermund SH, Zou H. Clinical Characteristics of Human Mpox (Monkeypox) in 2022: A Systematic Review and Meta-Analysis. Pathogens 2023; 12:146. [PMID: 36678494 PMCID: PMC9861547 DOI: 10.3390/pathogens12010146] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
Since May 2022, large numbers of human mpox (previously known as monkeypox) cases have been reported in non-endemic regions. We conducted a systematic review and meta-analysis to elucidate clinical characteristics of the current mpox outbreak. Our systematic review and meta-analysis were undertaken according to PRISMA and MOOSE guidelines. We searched PubMed, EMBASE, and Web of Science for publications between 1 January and 11 November 2022. Random-effects models were used to pool results. Heterogeneity was assessed using I2. This study is registered with PROSPERO, CRD42022355590. Skin lesions (95.2%, 95% CI [93.3-96.9%]), fever (58.4%, [54.9-61.8%]) and lymphadenopathy (53.0%, [48.7-57.3%]) were the most common symptoms. The most common dermatological manifestations were anogenital lesions (65.7%, [57.8-73.0%]), and the most common lymphadenopathy was inguinal (46.8%, [40.6-53.0%]). There were no differences in symptoms including malaise, fever, headache, and genital, anal, and oropharyngeal lesions according to HIV infection status. Median age of patients varied from 15 to 57.5 years (median, 35 years). The median proportion of men who had sex with men (MSM) was 100.0% (20.6-100.0%). The median proportion of patients who reported recent sexual exposure was 99.2% (14.3-100.0%). The median proportion of PLHIV was 42.2% (0.0-100.0%). Skin lesions, fever, inguinal lymphadenopathy, and anogenital lesions were the most common symptoms of mpox reported in the current outbreak. Existing guidelines should be updated to reflect these clinical manifestations and groups at highest risk of infection, MSM in particular.
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Affiliation(s)
- Qi Liu
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Xin Peng
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
| | | | - Sten H. Vermund
- Yale School of Public Health, Yale University, New Haven, CT 06520, USA
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen 518107, China
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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Farrar JL, Lewis NM, Houck K, Canning M, Fothergill A, Payne AB, Cohen AL, Vance J, Brassil B, Youngkin E, Glenn B, Mangla A, Kupferman N, Saunders K, Meza C, Nims D, Soliva S, Blouse B, Henderson T, Banerjee E, White B, Birn R, Stadelman AM, Abrego M, McLafferty M, Eberhart MG, Pietrowski M, De León SM, Creegan E, Diedhiou A, Wiedeman C, Murray-Thompson J, McCarty E, Marcinkevage J, Kocharian A, Torrone EA, Ray LC, Payne DC. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1610-1615. [PMID: 36580416 PMCID: PMC9812445 DOI: 10.15585/mmwr.mm715152a2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States.* Among U.S. cases to date, 95% have occurred among males (1). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox. JYNNEOS vaccine was approved by the Food and Drug Administration (FDA) in 2019 as a 2-dose series (0.5 mL per dose, administered subcutaneously) to prevent smallpox and mpox disease.† On August 9, 2022, FDA issued an emergency use authorization to allow administration of JYNNEOS vaccine by intradermal injection (0.1 mL per dose) (2). A previous report on U.S. mpox cases during July 31-September 3, 2022, suggested that 1 dose of vaccine offers some protection against mpox (3). This report describes demographic and clinical characteristics of cases occurring ≥14 days after receipt of 1 dose of JYNNEOS vaccine and compares them with characteristics of cases among unvaccinated persons with mpox and with the vaccine-eligible vaccinated population in participating jurisdictions. During May 22-September 3, 2022, among 14,504 mpox cases reported from 29 participating U.S. jurisdictions,§ 6,605 (45.5%) had available vaccination information and were included in the analysis. Among included cases, 276 (4.2%) were among persons who had received 1 dose of vaccine ≥14 days before illness onset. Mpox cases that occurred in these vaccinated persons were associated with lower percentage of hospitalization (2.1% versus 7.5%), fever, headache, malaise, myalgia, and chills, compared with cases in unvaccinated persons. Although 1 dose of JYNNEOS vaccine offers some protection from disease, mpox infection can occur after receipt of 1 dose, and the duration of protection conferred by 1 dose is unknown. Providers and public health officials should therefore encourage persons at risk for acquiring mpox to complete the 2-dose vaccination series and provide guidance and education regarding nonvaccine-related prevention strategies (4).
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Blackburn D, Roth NM, Gold JA, Pao LZ, Olansky E, Torrone EA, McClung RP, Ellington SR, Delaney KP, Carnes N, Dawson P. Epidemiologic and Clinical Features of Mpox in Transgender and Gender-Diverse Adults - United States, May-November 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1605-1609. [PMID: 36580418 PMCID: PMC9812441 DOI: 10.15585/mmwr.mm715152a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As of November 9, 2022, a total of 28,730 cases of monkeypox (mpox) had been reported in the United States,* primarily among adult cisgender men reporting recent male-to-male sexual contact (1). Transgender and gender-diverse persons, who constitute an estimated 0.5% of the U.S. adult population,† face unique health disparities and barriers to care (2-4). However, data on the epidemiologic and clinical features of Monkeypox virus infections in this population are limited (5). CDC analyzed U.S. case surveillance data on mpox cases in transgender and gender-diverse adults reported during May 17-November 4, 2022. During this period, 466 mpox cases in transgender and gender-diverse adults were reported, accounting for 1.7% of reported cases among adults. Most were in transgender women (43.1%) or gender-diverse persons (42.1%); 14.8% were in transgender men. Among 374 (80.3%) mpox cases in transgender and gender-diverse adults with information available on sexual or close intimate contact, 276 (73.8%) reported sexual or close intimate contact with a cisgender male partner during the 3 weeks preceding symptom onset. During the ongoing outbreak, transgender and gender-diverse persons have been disproportionately affected by mpox. Members of this population frequently reported recent sexual or close intimate contact with cisgender men, who might be in sexual networks experiencing the highest incidence of mpox. These findings highlight the importance of tailoring public health prevention and outreach efforts to transgender and gender-diverse communities and could guide strategies to reduce mpox transmission.
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Kyaw NTT, Kipperman N, Alroy KA, Baumgartner J, Crawley A, Peterson E, Ross A, Fowler RC, Ruiz VE, Leelawong M, Hughes S, Juste-Tranquille M, Lovingood K, Joe CD, Chase M, Shinall A, Ackelsberg J, Bergeron-Parent C, Badenhop B, Slavinski S, Reddy V, Lee EH. Notes from the Field: Clinical and Epidemiologic Characteristics of Mpox Cases from the Initial Phase of the Outbreak - New York City, May 19-July 15, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1631-1633. [PMID: 36580429 PMCID: PMC9812443 DOI: 10.15585/mmwr.mm715152a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Vallée A. Sexual behaviors, cannabis, alcohol and monkeypox infection. Front Public Health 2022; 10:1054488. [PMID: 36733281 PMCID: PMC9887129 DOI: 10.3389/fpubh.2022.1054488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
The emergence of the monkeypox virus (MPXV) outbreak in 2022 is a worldwide health issue. The rapid increase of monkeypox cases caused the WHO to designate the escalating global monkeypox outbreak a Public Health Emergency of International Concern on July 23, 2022. The WHO has called on the group currently most affected by the virus, men who have sex with men (MSM), to limit their sexual partners. The diminution in number of sexual partners not only decreases the proportion of infected MSM but could also increases the number of days needed to reach a given infection level among the general population. Several behavioral factors could be associated with high levels of different sexual partners, such as cannabis use and alcohol consumption. Firstly, this review focuses on the association between cannabis and alcohol consumption and the number of sexual partners, and their possible impact on the current MPXV outbreak by impairing the immune responses. Secondly, this review investigated in the UK Biobank cohort the relationship between alcohol and cannabis use and the number of sexual partners. Among the 115,604 participants, 1.8% declared to be MSM, 1.9% to be WSW (women having sex with women), 43.3% men heterosexuals and 53.0% women heterosexuals. MSM and WSW showed higher lifetime sexual partners (N = 17.4 (SD:17.52) and N = 13.65 (SD: 13.21), respectively) compared to heterosexual men (N = 6.89 (SD: 9.47) and women (N = 5.19 (SD:6.56), p < 0.001. After adjustment for age, body mass index, lifetime sexual activity, educational and income levels, tobacco and cardiovascular diseases, cannabis use and alcohol consumption remained significantly associated with increase in the number of different sexual partners in all four subgroups. Thus, cannabis use and alcohol consumption may have two detrimental effects on the MPXV outbreak: by participating in the increase of the number of sexual partners which are mainly responsible for the augmentation of the number of new MPXV infected cases and by impairing the immune response to a viral infection. Health and safety policies should address the factors and practices, including chemsex, leading to an increase in risk of sexual behaviors responsible for MPXV dissemination in the worldwide population.
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