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Richterman A, O'Brien C, Ghadimi F, Sumners E, Ford A, Houston N, Tate S, Aitcheson N, Nkwihoreze H, Jemmott JB, Momplaisir F. Acceptability, facilitators, and barriers to a hypothetical HIV vaccine in the pre-exposure prophylaxis era. AIDS Care 2024:1-7. [PMID: 38961850 DOI: 10.1080/09540121.2024.2372715] [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: 03/20/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
Little is known about the pre-implementation context for a preventive HIV vaccine. We conducted interviews of individuals in Philadelphia recruited at Penn clinics and community-based organizations serving LGBTQ-identifying persons of color who 1) were cisgender men who had sex with men, or were transgender-identified, 2) had a sexually transmitted infection in the last 12 months, or sex with multiple partners within the last two weeks. We assessed acceptability, facilitators, and barriers to a hypothetical HIV vaccine using an integrated analysis approach. We interviewed 30 individuals between 2/2023-9/2023. Participants were supportive of an HIV vaccine and reported that they would strongly consider receiving one if one became available. Participants contextualized a hypothetical vaccine with the current HIV prevention context, primarily pre-exposure prophylaxis (PrEP), indicating that they would evaluate any future vaccine in comparison to their experience within the PrEP landscape.Reported facilitators for a hypothetical HIV vaccine included vaccine access, knowledge, and understanding; their risk for HIV exposure; and perceived benefits of the vaccine. Barriers included lack of understanding of the purpose of a vaccine, stigma surrounding HIV and sexual practices that may surface towards people who seek vaccination, and potential issues with effectiveness, side effects, or lack of availability.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Caroline O'Brien
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andre Ford
- The COLOURS Organization, Philadelphia, PA, USA
| | | | - Sebrina Tate
- Bebashi-Transition to Hope, Philadelphia, PA, USA
| | - Nancy Aitcheson
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Hervette Nkwihoreze
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John B Jemmott
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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Bakshi A, McClure J, Sokol T, Mendoza L, Adhikari A, Zhao N, Kar S, Gale J, Charles JD, Freese K, Kudia O, Brown S. Pivoting COVID-19 Resources for an Equitable Mpox Vaccine Response in Louisiana. AJPM FOCUS 2024; 3:100204. [PMID: 38883694 PMCID: PMC11180367 DOI: 10.1016/j.focus.2024.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Introduction The first case of mpox in Louisiana was identified 2 months ahead of Southern Decadence Festival in New Orleans, the largest LGBTQ+ Pride festival in the South. With mpox case numbers reflecting racial disparities, the objective was to mount an equitable vaccination response. Methods The Louisiana Department of Health rapidly pivoted its COVID-19 resources and strategies-specifically, using vaccine strike teams and mobile events, in-state vaccine redistribution through centralized warehousing and shipping support, and community partnerships-to now control mpox transmission. Here, the authors have evaluated state-based Immunization Information System data to examine whether the vaccination response was geographically and racially equitable. Geographic equity was measured by taking into account vaccine availability as well as uptake in areas with high Social Vulnerability Index. Results A total of 113 providers were enrolled in the vaccination program, and 96 mobile vaccination events were held in locations frequented by at-risk populations. Racial disparities among vaccine recipients decreased over time, and vaccine availability and uptake were equitable in areas with high Social Vulnerability Indices. However, Black, female, and Hispanic/Latinx patients had significantly higher risk of not completing the 2-dose series than their counterparts. Conclusions The mpox vaccination response in Louisiana was geographically equitable, though some demographic disparities remained.
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Affiliation(s)
- Arundhati Bakshi
- Immunization Program, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - John McClure
- Immunization Program, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Theresa Sokol
- Infectious Disease Epidemiology, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Lee Mendoza
- Bureau of Health Informatics, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Arun Adhikari
- Bureau of Health Informatics, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Nancy Zhao
- Immunization Program, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Suryatapa Kar
- Immunization Program, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
| | - Jimmy Gale
- STD/HIV Program, Louisiana Department of Health, New Orleans, Louisiana
| | - Javone Davis Charles
- Immunization Program, Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana
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Nakamura H, Yamamoto K. Mpox in people with HIV: A narrative review. HIV Med 2024. [PMID: 38745559 DOI: 10.1111/hiv.13661] [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: 01/10/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. RECENT FINDINGS Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. CONCLUSION Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.
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Affiliation(s)
- Hideta Nakamura
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
| | - Kazuko Yamamoto
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
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Witzel TC, Ghobrial A, Palich R, Charles H, Rodger AJ, Sabin C, Sparrowhawk A, Pool ER, Prochazka M, Vivancos R, Sinka K, Folkard K, Burns FM, Saunders J. Experiences of mpox illness and case management among cis and trans gay, bisexual and other men who have sex with men in England: a qualitative study. EClinicalMedicine 2024; 70:102522. [PMID: 38685928 PMCID: PMC11056388 DOI: 10.1016/j.eclinm.2024.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
Background The 2022-2024 global mpox outbreak, occurring primarily in the sexual networks of gay, bisexual and other men who have sex with men (GBMSM), has not been accompanied by a focus on patient perspectives of illness. We explore the experiences of GBMSM diagnosed with mpox in England to understand needs for social and clinical support. Methods In-depth interviews (March/July 2023) were conducted with 22 GBMSM diagnosed with mpox in 2022, randomly selected from a national mpox surveillance database, and 4 stakeholders from clinical/community-based organisations. Interviews covered experiences of illness, testing, diagnosis, treatment and contact tracing, and were recorded, transcribed and analysed with a thematic framework. Findings Media coverage drawing on homophobic stereotypes around sex between men contributed to feelings of stigma and shame. GBMSM living with HIV appeared to cope better with mpox stigma, drawing on their experiences of being diagnosed with HIV for resilience. Younger GBMSM with less experience of stigmatising illness found mpox diagnosis more traumatic and sometimes required support beyond what was provided. Accessing testing could be complicated when healthcare professionals did not recognise mpox symptoms. Men felt information on course of illness, isolation and vaccination after recovery was often inconsistent and contradictory. GBMSM described that care from sexual health and infectious disease units usually better met their emotional and medical needs. This was frequently linked by men to these services having skills in working with the GBMSM community and managing infection risk sensitively. General hospital services and centralised contact tracing could increase feelings and experiences of stigma as some staff were perceived to lack skills in supporting GBMSM and, sometimes, clinical knowledge. Long-term impacts described by men included mental health challenges, urethral/rectal symptoms and life-changing disability. Interpretation In this study stigma was a central feature of mpox illness among GBMSM and could be exacerbated or lessened depending on the clinical and social support provided. Involving communities affected by outbreaks in co-producing, planning and delivering care (including contact-tracing) may help improve support provided. Funding TCW, AJR, AS and FMB received support from the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Ref: NIHR202038). CS and JS receive support from the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with UKHSA; RV receives support from the NIHR HPRU in Emerging and Zoonotic Infections and NIHR HPRU in Gastrointestinal Infections. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency, World Health Organization or the Department of Health and Social Care.
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Affiliation(s)
- T Charles Witzel
- Institute for Global Health, University College London, London, UK
| | - Andrew Ghobrial
- Institute for Global Health, University College London, London, UK
| | - Romain Palich
- Institute for Global Health, University College London, London, UK
- AP-HP.Sorbonne Université, Paris, France
| | | | - Alison J. Rodger
- Institute for Global Health, University College London, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in Partnership with (UKHSA), London, UK
| | | | - Erica R.M. Pool
- Institute for Global Health, University College London, London, UK
| | | | - Roberto Vivancos
- UK Health Security Agency (UKHSA), London, UK
- NIHR HPRU in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
- NIHR HPRU in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK
| | - Katy Sinka
- UK Health Security Agency (UKHSA), London, UK
| | | | - Fiona M. Burns
- Institute for Global Health, University College London, London, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK
- UK Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in Partnership with (UKHSA), London, UK
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Wick JM, Pelliccione A, Tran HN, Skarbinski J. Concurrent Sexually Transmitted Infections with Mpox Infections: A Brief Review. Perm J 2024; 28:42-45. [PMID: 38192218 PMCID: PMC10940232 DOI: 10.7812/tpp/23.072] [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: 01/10/2024]
Abstract
Mpox is a viral zoonotic infection endemic to countries in Central and West Africa. The outbreak that began in May 2022 is novel for its global spread and transmission through sexual encounters. Research of this outbreak shows a high rate of concurrent sexually transmitted infections (STIs) in patients with mpox, highlighting the need to consider STIs in mpox management, and to raise awareness of historically high levels of STIs caused by inadequacies in sexual health care. It is critical to prioritize sexual health and address health disparities to control current transmission of infections and prevent future outbreaks.
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Affiliation(s)
- Jenna M Wick
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Alex Pelliccione
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - H Nicole Tran
- Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jacek Skarbinski
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Sugarman J, Taylor HA, Bachmann LH, Barbee LA, Cahill S, Celum C, Luetkemeyer AF, Mayer KH, Mena L, Mermin J, Upshur R, Aral S. Ethical Considerations in Implementing Doxycycline Postexposure Prophylaxis for the Prevention of Bacterial Sexually Transmitted Infections. Sex Transm Dis 2024; 51:135-138. [PMID: 38079243 PMCID: PMC10922428 DOI: 10.1097/olq.0000000000001907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Jeremy Sugarman
- Johns Hopkins University, Berman Institute of Bioethics, Baltimore, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute and Harvard Medical School, Boston, USA
| | - Connie Celum
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, USA
| | | | | | - Leandro Mena
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Sevgi Aral
- Centers for Disease Control and Prevention, Atlanta, 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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Carroll JC, Herbert SMC, Nguyen TQ, Schork CJ, Kampas LN, Rebitch CB. Vaccination equity and the role of community pharmacy in the United States: A qualitative study. Vaccine 2024; 42:564-572. [PMID: 38195264 DOI: 10.1016/j.vaccine.2023.12.063] [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: 09/06/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To identify strategies community pharmacists utilized to support equitable vaccination in their communities. STUDY DESIGN Qualitative, descriptive design. METHODS Key informant interviews were conducted virtually via teleconference using a mix of purposeful and snowball sampling of Pennsylvania community pharmacy personnel who participated in COVID-19 vaccination efforts. Interviews were conducted from March until August 2022 when thematic saturation was reached. A qualitative, inductive thematic data analysis was utilized to identify major themes and strategies that emerged from the data. RESULTS Pharmacists utilized three philosophies: (1) prioritizing trust, (2) meeting people where they are at, and (3) building capacity within their teams and communities to create "safe spaces" for people to receive vaccinations. Nine discrete strategies used in practice exemplify how respondents implemented these philosophies: (1) Build Community Partnerships; (2) Establish Trust to Build Credibility; (3) Address Transportation Issues; (4) Provide Patient Education and Address Health Literacy Barriers; (5) Address Language Barriers; (6) Create a Safe and Accessible Space for Those with Individualized Needs; (7) Provide Patient-Centered and Culturally-Sensitive Care; (8) Train Staff on Health Equity and Patient Engagement; and (9) Advocate for Community Pharmacy Policy and Payment Reform. Definitions for these philosophies and key examples that illustrate how each strategy was employed in practice are provided. CONCLUSION The findings highlight unique strategies respondent community-based pharmacy teams use to contribute to equitable vaccination efforts in communities and further emphasizes the importance of their role in public health initiatives.
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Affiliation(s)
- Joni C Carroll
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Sophia M C Herbert
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Thai Q Nguyen
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Caleb J Schork
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Lindsey N Kampas
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
| | - Catherine B Rebitch
- University of Pittsburgh School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, United States.
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Bautista GJ, Madera-Garcia V, Carter RJ, Schwitters A, Byrkit R, Carnes N, Prejean J. Reducing Vaccination Disparities During a National Emergency Response: The US Mpox Vaccine Equity Pilot Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:122-129. [PMID: 37678261 PMCID: PMC10843777 DOI: 10.1097/phh.0000000000001818] [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: 09/09/2023]
Abstract
CONTEXT In response to the first reported mpox cases in May 2022, the US government implemented plans to bring testing, treatment, and vaccines to communities disproportionately affected by mpox-including the population of men who have sex with men (MSM) and Black/African American and Hispanic/Latino men, 2 subpopulations experiencing vaccination disparities. We describe the development and implementation of the US Mpox Vaccine Equity Pilot Program (MVEPP), characteristics of completed vaccination projects, and challenges that occurred. We also discuss opportunities for reducing vaccination disparities in future outbreaks. PROGRAM To address reported vaccination disparities, the US government launched MVEPP in 2 phases. Phase 1 centered around public events attended by large numbers of gay, bisexual, and other MSM, such as Pride festivals. Phase 2 asked health departments to propose mpox vaccination projects specifically aimed at reducing or eliminating racial/ethnic and other demographic disparities in mpox vaccination. IMPLEMENTATION MVEPP received 35 vaccination project proposals. We analyzed data from 22 completed projects that resulted in 25 675 doses of JYNNEOS administered. We note 3 innovative strategies that were implemented in several projects: direct collaboration with organizations providing services to MSM and transgender women; implementation of MVEPP projects in unique nonclinical community settings and at venues frequented by MSM and transgender women; and offering an array of services as part of mpox vaccination projects, rather than offering only mpox vaccination. EVALUATION MVEPP highlighted the importance of recognizing and working to eliminate racial/ethnic and other disparities in access to medical countermeasures during a public health emergency. Jurisdictions developed and implemented innovative strategies to bring mpox vaccination and related services to communities disproportionately affected by mpox-including MSM and the subpopulations of Black/African American and Hispanic/Latino MSM. Lessons learned from MVEPP may inform efforts to reduce disparities during future public health responses.
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Affiliation(s)
- Gregorio J Bautista
- CDC Mpox Emergency Response Team (Mr Bautista, Drs Madera-Garcia, Carter, Schwitters, Carnes, and Prejean, and Ms Byrkit), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (Mr Bautista and Drs Madera-Garcia, Carnes, and Prejean), Epidemic Intelligence Service (Dr Madera-Garcia), National Center for Immunization and Respiratory Diseases (Dr Carter), National Institute for Occupational Safety and Health (Dr Schwitters), and Office of Readiness and Response (Ms Byrkit), Centers for Disease Control and Prevention, Atlanta, Georgia
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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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Higgins E, Ranganath N, Mehkri O, Majeed A, Walker J, Spivack S, Bhaimia E, Benamu E, Hand J, Keswani S, Dunn D, Beam E, Razonable RR. Clinical features, treatment, and outcomes of mpox in solid organ transplant recipients: A multicenter case series and literature review. Am J Transplant 2023; 23:1972-1979. [PMID: 37516243 DOI: 10.1016/j.ajt.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: 06/02/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
In 2022, the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox generally presents as a self-limiting illness. However, immunosuppression, such as that seen with advanced HIV, has been associated with significant morbidity and mortality related to mpox infection. To evaluate the impact of immunosuppression related to solid organ transplantation on clinical features and outcomes of mpox we established a multicenter case registry. Eleven cases from 7 participating centers in the USA were submitted. All cases occurred in males. The majority were kidney transplant recipients (91%, n = 10). Median duration of symptoms at presentation was 6 days (range, 3-14 days). Rates of hospitalization were high (73%, n = 8) with a median length of stay of 4.5 days (range, 1-10 days). Mpox in solid organ transplant recipients was associated with a high burden of skin lesions and systemic symptoms. Fever, fatigue, pharyngitis, and proctitis were commonly reported. Other clinical features included headache, myalgia, epididymo-orchitis, urinary retention, hematemesis, pneumonitis, and circulatory shock. All patients received treatment with tecovirimat. There was 1 mpox-related death in the cohort. Infection was reported to have resolved at 30-day follow-up in all other cases.
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Affiliation(s)
- Eibhlin Higgins
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nischal Ranganath
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Mehkri
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aneela Majeed
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeremey Walker
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephanie Spivack
- Lewis Katz School of Medicine at Temple University, Section of Infectious Diseases, Philadelphia, Pennsylvania, USA
| | - Eric Bhaimia
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Esther Benamu
- School of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Jonathan Hand
- Ochsner Medical Center, University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Shobhit Keswani
- Ochsner Medical Center, University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana, USA
| | - Dallas Dunn
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elena Beam
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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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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Martín-Iguacel R, Pericas C, Bruguera A, Rosell G, Martínez E, Díaz Y, Alonso L, Nomah DK, Blanco JL, Domingo P, Álvarez-López P, Linares MS, Vilades Laborda C, Mera A, Calzado Isbert S, Johansen IS, Miró JM, Casabona J, Llibre JM. Mpox: Clinical Outcomes and Impact of Vaccination in People with and without HIV: A Population-Wide Study. Microorganisms 2023; 11:2701. [PMID: 38004713 PMCID: PMC10673392 DOI: 10.3390/microorganisms11112701] [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: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
We investigated differences in mpox clinical outcomes in people with HIV (PWH) and without HIV (PWoH) and the impact of vaccination in Catalonia, Spain. We used surveillance data and the PISCIS HIV cohort. We included all confirmed mpox cases (May-December 2022). Of 2122 mpox cases, the majority had mild disease, 56% were Spanish, and 24% were from Latin America. A total of 40% were PWH, with a median CD4+T-cell of 715 cells/μL; 83% had HIV-RNA < 50 copies/mL; and 1.8% CD4+T-cell < 200 cells/μL. PWH had no increased risk for complications, except those with CD4+T-cell < 200 cells/μL. PWH with CD4+T-cell < 200 cells/μL were more likely to be from Latin America, had more generalized exanthema, and required hospitalization more frequently (p = 0.001). Diagnosis of other sexually transmitted infections (STIs) was common, both at mpox diagnosis (17%) and two years before (43%). Dose-sparing smallpox intradermal vaccination was accompanied by a sharp decrease in mpox incidence in both populations (p < 0.0001). In conclusion, unless immunosuppressed, PWH were not at increased risk of severe disease or hospitalization. Mpox is a marker of high-risk sexual behavior and was associated with high HIV and STI rates, supporting the need for screening in all mpox cases. Ethnicity disparities demonstrate the need for interventions to ensure equitable healthcare access. Dose-sparing smallpox vaccination retained effectiveness.
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Affiliation(s)
- Raquel Martín-Iguacel
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark;
| | - Carles Pericas
- Epidemiology Service, Public Health Agency of Barcelona, 08023 Barcelona, Spain;
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Institute of Biomedical Research Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
| | - Andreu Bruguera
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Gemma Rosell
- Subdirecció General de Vigilància i Resposta a Alertes i Emergències de Salut Pública—ASPCAT, Teià, Cataluña, Spain;
| | - Erica Martínez
- Institute of Biomedical Research Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
- Subdirecció General de Vigilància i Resposta a Alertes i Emergències de Salut Pública—ASPCAT, Teià, Cataluña, Spain;
| | - Yesika Díaz
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Lucia Alonso
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- Fight Infections Foundation, Badalona, 08916 Barcelona, Spain
| | - Daniel Kwakye Nomah
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- Fundació Institut D’investigació en Ciències de la Salut Germans Trias I Pujol (IGTP), 08916 Badalona, Spain
| | - Jose Luis Blanco
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, 08916 Barcelona, Spain; (J.L.B.)
| | - Pere Domingo
- Infectious Diseases Unit, Hospital Universitari de la Santa Creu i Sant Pau, 08916 Barcelona, Spain;
| | - Patricia Álvarez-López
- Department of Infectious Diseases, Hospital Universitari de la Vall d’Hebron, 08916 Barcelona, Spain;
| | - Maria Saumoy Linares
- HIV and STD Unit, Infectious Disease Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, 08916 Barcelona, Spain;
| | - Consuelo Vilades Laborda
- Department of Internal Medicine, Hospital Universitari Tarragona Juan XXIII, Universitat Rovira i Virgili, Tarragona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Arantxa Mera
- Department of Internal Medicine, Hospital de Palamós, 17230 Girona, Spain;
| | - Sonia Calzado Isbert
- Department of Infectious Diseases, Parc Taulí University Hospital, Sabadell, 08916 Barcelona, Spain;
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark;
| | - José M. Miró
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, 08916 Barcelona, Spain; (J.L.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, 08916 Badalona, Spain; (A.B.); (Y.D.); (L.A.); (D.K.N.); (J.C.)
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Department of Internal Medicine, Hospital de Palamós, 17230 Girona, Spain;
| | - Josep M. Llibre
- Fight Infections Foundation, Badalona, 08916 Barcelona, Spain
- Infectious Diseases Department, University Hospital Germans Trias i Pujol, Badalona, 08916 Barcelona, Spain;
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Ramchandani MS, Berzkalns A, Cannon CA, Dombrowski JC, Brown E, Chow EJ, Barash E, Pogosjans S, Smith D, Golden MR. Effectiveness of the Modified Vaccinia Ankara Vaccine Against Mpox in Men Who Have Sex With Men: A Retrospective Cohort Analysis, Seattle, Washington. Open Forum Infect Dis 2023; 10:ofad528. [PMID: 37942460 PMCID: PMC10629355 DOI: 10.1093/ofid/ofad528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 11/10/2023] Open
Abstract
Background Data on modified Vaccinia Ankara (MVA) vaccine effectiveness against mpox in real-world settings are limited. Methods We performed a retrospective cohort analysis using Cox proportional hazards regression to estimate the association between vaccination and laboratory-confirmed mpox incidence. Study subjects included all men who have sex with men seen in a sexual health clinic in Seattle, Washington, between 1 January 2020 and 31 December 2022. Subjects' receipt of vaccine and diagnosis with mpox were ascertained from public health vaccine registry and surveillance data. Analyses were adjusted for demographic factors, human immunodeficiency virus (HIV) status, and sexual risk behaviors. Results The incidence of mpox per 100 person-years was 8.83 among patients with 0 doses, 3.32 among patients with 1 dose, and 0.78 among patients with 2 doses of MVA vaccine. Mpox diagnosis was significantly associated with age category 30-39 and 40-51 years, HIV positivity, syphilis diagnosis in the prior year, >10 sex partners in the last year, and having a clinic visit in the last year. In the multivariate model adjusting for these factors, vaccine effectiveness was 81% for 1 dose and 83% for 2 doses. Conclusions These data support the effectiveness of the MVA vaccine-including a single dose of the vaccine-in preventing mpox disease and highlight the appropriateness of risk factor-based prioritization of immunization early in the epidemic. The durability of MVA vaccine-induced immunity is unknown, and at-risk persons should receive 2 doses of MVA.
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Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Anna Berzkalns
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Chase A Cannon
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Elizabeth Brown
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Eric J Chow
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Communicable Disease Epidemiology and Immunizations, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Elizabeth Barash
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Sargis Pogosjans
- Communicable Disease Epidemiology and Immunizations, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Daniel Smith
- Communicable Disease Epidemiology and Immunizations, Public Health–Seattle & King County, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health–Seattle & King County, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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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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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A. Community-engaged Mpox vaccination provides lessons for equitable health care in the United States. Nat Med 2023; 29:2160-2161. [PMID: 37468666 DOI: 10.1038/s41591-023-02447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA.
- School of Nursing, Duke University, Durham, NC, USA.
- School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC, USA.
- Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA.
- CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment, US Department of Health and Human Services, Atlanta, GA, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
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Grosenbach DW, Russo AT, Blum ED, Hruby DE. Emerging pharmacological strategies for treating and preventing mpox. Expert Rev Clin Pharmacol 2023; 16:843-854. [PMID: 37592723 DOI: 10.1080/17512433.2023.2249820] [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: 05/08/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Since May 2022, there have been nearly 87,000 documented cases of mpox worldwide, with 119 deaths. Pharmacological interventions for mpox include the MVA-BN smallpox vaccine, tecovirimat, cidofovir, its pro-drug brincidofovir, and vaccinia immune globulin intravenous (VIGIV). AREAS COVERED The literature search and information gathering for this review included the PubMed database focusing on mpox and monkeypox, in combination with tecovirimat, brincidofovir, cidofovir, VIGIV, and smallpox vaccine. WHO.int, CDC.gov, FDA.gov, and ClinicalTrials.gov websites were accessed for the most recent information on the mpox outbreak. Mechanisms for deployment and access to treatment including expanded access, emergency use, and clinical trials will be discussed. Treatment outcomes with safety data will be presented. EXPERT OPINION The vaccine as a preventive measure, along with numerous treatment options, largely controlled the outbreak, although deployment of each could be improved upon to hasten and broaden access. More widespread coverage by the vaccine is necessary to prevent future resurgence of mpox. Tecovirimat has emerged as a safe frontline treatment for mpox, while brincidofovir use has been limited by safety concerns. VIGIV and cidofovir should be reserved for the most severe cases in which other options are not fully effective.
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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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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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