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Liu H, Wang W, Zhang Y, Wang F, Duan J, Huang T, Huang X, Zhang T. Global perspectives on smallpox vaccine against monkeypox: a comprehensive meta-analysis and systematic review of effectiveness, protection, safety and cross-immunogenicity. Emerg Microbes Infect 2024; 13:2387442. [PMID: 39082272 PMCID: PMC11332295 DOI: 10.1080/22221751.2024.2387442] [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: 05/29/2024] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024]
Abstract
A large outbreak of monkeypox occurred in 2022, and most people lack immunity to orthopoxvirus. Smallpox vaccination is essential for preventing further smallpox outbreaks. This study evaluated the effectiveness, protection, safety, and cross-immunogenicity of smallpox vaccine in preventing monkeypox infection. PubMed, Embase, Scopus, and Web of Science were searched from database inception to 10 March 2024. We included studies involving "monkeypox virus" and "vaccinations", and excluded reviews, animal studies, and articles with missing or duplicate data. A total of 37 studies with 57,693 participants were included in the final analysis. The effectiveness data showed that monkeypox infection rates were lower in the smallpox-vaccinated group than in the unvaccinated group (risk ratio [RR]: 0.46; 95% confidence interval [CI]: 0.31-0.68). The protection data showed that smallpox vaccination effectively reduced the risk of severe monkeypox infection (RR: 0.61; 95% CI: 0.42-0.87). Third-generation vaccines showed greater efficacy (RR: 0.36, 95% CI: 0.22-0.56) than first-generation vaccines. The number of doses of smallpox vaccine has no significant effect on monkeypox. Safety data showed that adverse reactions after smallpox vaccination were mainly mild and included local erythema, swelling, induration, itching, and pain. Meanwhile, we found that smallpox vaccination could induce the production of neutralizing antibodies against monkeypox. Our findings offer compelling evidence supporting the clinical application of the smallpox vaccine for preventing monkeypox and advocate that high-risk groups should be prioritized for receiving one dose of the smallpox vaccine if the vaccine stockpile is low.
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Affiliation(s)
- Hao Liu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yang Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, People’s Republic of China
| | - Fuchun Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Junyi Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tao Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing, People’s Republic of China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Institute of Sexually Transmitted Disease Prevention and Control, Beijing, People’s Republic of China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing, People’s Republic of China
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Rodríguez-Aldama JC, Pérez-Barragán E, Hernández-Silva G, Lezama-Mora JI, Olin-López AK, González-Flores B, Cruz-Flores RA, Crabtree-Ramírez B. Immune Reconstitution Inflammatory Syndrome Related to Antiretroviral Therapy Initiation in People With HIV and Mpox: An Observational Retrospective Study. Open Forum Infect Dis 2024; 11:S133-S136. [PMID: 39415829 PMCID: PMC11476891 DOI: 10.1093/ofid/ofae374] [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: 10/19/2024] Open
Abstract
The study aims to compare the outcomes of initiating antiretroviral therapy early vs late in people with HIV and mpox. No worse outcomes were found associated with mpox-related immune reconstitution inflammatory syndrome among those who started antiretroviral treatment early, suggesting initiation as soon as possible.
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Affiliation(s)
| | - Edgar Pérez-Barragán
- Department of Infectious Diseases, Clínica Especializada Condesa Iztapalapa, Mexico City, Mexico
| | | | | | - Ana Karen Olin-López
- Department of Infectious Diseases, Clínica Especializada Condesa Iztapalapa, Mexico City, Mexico
| | - Berenice González-Flores
- Department of Infectious Diseases, Clínica Especializada Condesa Iztapalapa, Mexico City, Mexico
| | | | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
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Prévost J, Sloan A, Deschambault Y, Tailor N, Tierney K, Azaransky K, Kammanadiminti S, Barker D, Kodihalli S, Safronetz D. Treatment Efficacy of Cidofovir and Brincidofovir against Clade II Monkeypox Virus isolates. Antiviral Res 2024; 231:105995. [PMID: 39243894 DOI: 10.1016/j.antiviral.2024.105995] [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: 07/31/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
While historically confined to endemic areas, Monkeypox virus (MPXV) infection has increasingly garnered international attention due to sporadic outbreaks in non-endemic countries in the last two decades and its potential for human-to-human transmission. In 2022, a multi-country outbreak of mpox disease was declared by the World Health Organization (WHO) and nearly 100,000 mpox cases have been reported since the beginning of this pandemic. The clade II variant of the virus appears to be responsible for the vast majority of these infections. While there are no antiviral drugs currently approved to treat mpox specifically, the use of tecovirimat (TPOXX®) and brincidofovir (Tembexa®) is recommended by the Centers for Disease Control and Prevention (CDC) for compassionate use in severe mpox cases, since both are FDA-approved for the treatment of the closely related smallpox disease. Given the emergence of multiple tecovirimat-resistant infections, we aimed to evaluate the treatment efficacy of brincidofovir and its active compound, cidofovir, against MPXV clade II strains. Following intranasal infection, we show that cidofovir and brincidofovir can strongly reduce the viral replication of MPXV clade IIa and IIb viruses in the respiratory tract of susceptible mice when administered systemically and orally, respectively. The high antiviral activity of both compounds against historical and currently circulating MPXV strains supports their therapeutic potential for clinical application.
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Affiliation(s)
- Jérémie Prévost
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Angela Sloan
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Yvon Deschambault
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nikesh Tailor
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kevin Tierney
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kimberly Azaransky
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | - Douglas Barker
- Emergent BioSolutions Canada Inc., Winnipeg, Manitoba, Canada
| | | | - David Safronetz
- Special Pathogens Program, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
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4
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Waddell CJ, Pellegrini GJ, Persad N, Filardo TD, Prasad N, Carson WC, Navarra T, Townsend MB, Satheshkumar PS, Lowe D, Borne D, Okoye N, Janssen J, Bejarano A, Mosites E, Marx GE. Minimally Invasive Blood Collection for an Mpox Serosurvey among People Experiencing Homelessness. J Appl Lab Med 2024; 9:1014-1019. [PMID: 38842196 DOI: 10.1093/jalm/jfae035] [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: 12/27/2023] [Accepted: 03/25/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND People experiencing homelessness (PEH) are underrepresented in public health and clinical research. Study methods that can improve participation by this group are needed. METHODS In late 2022, the Centers for Disease Control and Prevention conducted an mpox serological survey using venipuncture among PEH in San Francisco, California. Blood collection by a minimally invasive device was offered if venipuncture was not possible or preferred. Participants who had a successful blood draw using the device were asked about device acceptability. RESULTS Of the 209 successful blood collections, 137 (66%) were among participants who underwent venipuncture and 72 (34%) were among participants who used the device. Use of the device increased overall blood collection participation by 53%. Participants reported high acceptability and preference for the device over venipuncture. CONCLUSIONS Minimally invasive blood collection devices may increase participation and representation of PEH in serosurveys.
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Affiliation(s)
- Caroline J Waddell
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gerald J Pellegrini
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Neela Persad
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Thomas D Filardo
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Namrata Prasad
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - William C Carson
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terese Navarra
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael B Townsend
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - David Lowe
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Deborah Borne
- San Francisco Department of Public Health, San Francisco City and County Government, CA, United States
| | - Nnenna Okoye
- San Francisco Department of Public Health, San Francisco City and County Government, CA, United States
| | - Julia Janssen
- San Francisco Department of Public Health, San Francisco City and County Government, CA, United States
| | - Anamaría Bejarano
- San Francisco Department of Public Health, San Francisco City and County Government, CA, United States
| | - Emily Mosites
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Grace E Marx
- Mpox Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Krasowski MD. Remote Blood Collection Devices Improve Study Participation from Hard to Reach Populations. J Appl Lab Med 2024; 9:874-876. [PMID: 39045866 DOI: 10.1093/jalm/jfae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Affiliation(s)
- Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Oiwoh SO, Tobin EA, Yusuff HA, Ojimba AO, Christian UC, Aremu JT, Gomerep SS, Habila KL, Awang SK, Adekanmbi O, Iroezindu M, Onukak A, Falodun O, Sunday M, Johnson SM, Olaitan A, Onyeaghala C, Alasia D, Mmerem J, Unigwe U, Kwaghe V, Adeiza MA. Mpox Epidemiology and Risk Factors, Nigeria, 2022. Emerg Infect Dis 2024; 30:1799-1808. [PMID: 39127124 PMCID: PMC11346979 DOI: 10.3201/eid3009.240135] [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: 08/12/2024] Open
Abstract
To investigate epidemiology of and risk factors for laboratory-confirmed mpox during the 2022 outbreak in Nigeria, we enrolled 265 persons with suspected mpox. A total of 163 (61.5%) were confirmed to have mpox; 137 (84.0%) were adults, 112 (68.7%) male, 143 (87.7%) urban/semi-urban dwellers, 12 (7.4%) self-reported gay men, and 3 (1.8%) female sex workers. Significant risk factors for adults were sexual and nonsexual contact with persons who had mpox, as well as risky sexual behavior. For children, risk factors were close contact with an mpox-positive person and prior animal exposure. Odds of being mpox positive were higher for adults with HIV and lower for those co-infected with varicella zoster virus (VZV). No children were HIV-seropositive; odds of being mpox positive were higher for children with VZV infection. Our findings indicate mpox affects primarily adults in Nigeria, partially driven by sexual activity; childhood cases were driven by close contact, animal exposure, and VZV co-infection.
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Nguyen M, Doan T, Seitzman GD. Ocular manifestations of mpox. Curr Opin Ophthalmol 2024; 35:423-429. [PMID: 38847744 PMCID: PMC11309912 DOI: 10.1097/icu.0000000000001066] [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: 06/09/2024]
Abstract
PURPOSE OF REVIEW To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease. RECENT FINDINGS Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes. SUMMARY Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.
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Affiliation(s)
- Minh Nguyen
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thuy Doan
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Gerami D. Seitzman
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Krause KD, Lewis K, Scrofani S, Guo TY, Goulbourne D, Halkitis PN. Health Behaviors and Experiences of LGBTQ + Individuals during 2022 Mpox Outbreak: Findings from the QVax Study. J Community Health 2024:10.1007/s10900-024-01383-0. [PMID: 39183233 DOI: 10.1007/s10900-024-01383-0] [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] [Accepted: 07/17/2024] [Indexed: 08/27/2024]
Abstract
The 2022 global outbreak of Mpox (formerly named Monkeypox) disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, with a significant impact on sexual minority men. A cross-sectional survey was conducted among LGBTQ + adults living in New Jersey and New York to examine vaccination behaviors for Mpox. We sought out to understand the health experiences and behaviors of the population during the initial outbreak. This analysis included a subset of participants (n = 253) who completed the survey after the onset of the Mpox outbreak in May 2022. We examined awareness of and concerns about Mpox, willingness to vaccinate, as well as vaccination access and vaccination uptake. Our findings indicate that white, cisgender, gay men, as well as employed individuals, had the highest rates of vaccination for Mpox. Those with higher levels of concern about the virus were both more likely to be vaccinated and to report difficulty securing an appointment. Overall, our findings reinforce the health disparities in the population, demonstrating as with many other health conditions that white and economically stable individuals have advantages in accessing care.
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Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA.
- Department of Urban-Global Health, School of Public Health, Rutgers University, Newark, NJ, USA.
| | - Kendra Lewis
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
| | - Stephan Scrofani
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
| | - Tiffany Y Guo
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Davin Goulbourne
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Public Health, Montclair State University, Montclair, NJ, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies, School of Public Health (CHIBPS), Rutgers University, One Riverfront Plaza, Suite 1020, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
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Taha AM, Elrosasy A, Mahmoud AM, Saed SAA, Moawad WAET, Hamouda E, Nguyen D, Tran VP, Pham HT, Sah S, Barboza JJ, Sah R. The effect of HIV and mpox co-infection on clinical outcomes: Systematic review and meta-analysis. HIV Med 2024; 25:897-909. [PMID: 38443319 DOI: 10.1111/hiv.13622] [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: 10/10/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Co-infection with HIV and mpox is a significant issue for public health because of the potential combined impact on clinical outcomes. However, the existing literature lacks a comprehensive synthesis of the available evidence. The purpose of this meta-analysis is to provide insight into the impact of HIV and mpox co-infection on clinical outcomes. METHODS We systematically searched major electronic databases (PubMed, Embase, Cochrane Central, and Web of Science) for pertinent studies published up to June 2023. Included were studies that described the clinical outcomes of people who had both mpox and HIV. We performed the analysis using OpenMeta and STATA 17 software. RESULTS With an overall number of participants of 35 207, 21 studies that met the inclusion criteria were considered. The greatest number of the studies (n = 10) were cohort designs, with three being cross-sectional and eight being case series studies. The meta-analysis found that people who had both HIV and mpox had a higher hospitalization rate than those who only had mpox (odds ratio [OR] 1.848; 95% confidence interval [CI] 0.918-3.719, p = 0.085, I2 = 60.19%, p = 0.020). Furthermore, co-infected patients had higher mortality rates than those who did not have HIV co-infection (OR 3.887; 95% CI 2.272-6.650, p < 0.001). Meta-regression analysis showed that CD4 levels can significantly predict the risk of hospitalization (p = 0.016) and death (p = 0.031). DISCUSSION HIV causes immunosuppression, making it difficult for the body to mount an effective immune response against pathogens such as mpox. Individuals who are co-infected are at a higher risk of severe disease and death, according to our findings. Although hospitalization rates did not differ significantly between the two groups, it is critical to prioritize interventions and improve management strategies tailored specifically for people living with HIV. CONCLUSION This meta-analysis provides substantial evidence that HIV and mpox co-infection has a negative impact on clinical outcomes. Co-infected individuals had higher hospitalization and significantly higher mortality rates. These findings highlight the significance of early diagnosis, prompt treatment initiation, and effective management strategies for people living with HIV and mpox.
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Affiliation(s)
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hoang Tran Pham
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, India
- SR Sanjeevani Hospital, Siraha, Nepal
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
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Azzam A, Khaled H, Salem H, Ahmed A, Heniedy AM, Hassan HS, Hassan A, El-Mahdy TS. The impact of immunosuppression on the mortality and hospitalization of Monkeypox: a systematic review and meta-analysis of the 2022 outbreak. Virol J 2024; 21:130. [PMID: 38840177 PMCID: PMC11155170 DOI: 10.1186/s12985-024-02392-0] [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: 02/09/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Limited data is available regarding the severity and mortality of Mpox in individuals with immunocompromised conditions. Therefore, we performed this meta-analysis to understand the impact of HIV- or non-HIV-associated immunosuppression on the severity of Mpox requiring hospitalization and mortality. METHODS A thorough literature search was performed from 2022 up to January 2024. The results were presented as odds ratios (ORs). We only included patients who required hospitalization for severity rather than isolation. RESULTS A total of 34 studies were included in this analysis. Our analysis did not find a significant difference in the hospitalization risk between HIV-positive individuals and those who were HIV-negative (OR = 1.03; P = 0.85; 7 studies; CD4 count of fewer than 200 cells/µL was less than 0.5% across all studies). Patients with a CD4 count lower than 200 cells/µL or an unsuppressed RNA viral load (> 200 copies/ml) had a significantly higher hospitalization risk (OR = 5.3, P < 0.001) and (OR = 3, P < 0.001), respectively. Most of the reported deaths were reported in patients with HIV with CD4 counts below 200 cells/µL, with some fatal cases occurring in non-HIV immunosuppressed patients, particularly organ transplant recipients. Based on the autopsy findings, Mpox was confirmed in multiple organs, particularly the digestive tract, lung, and testes. Furthermore, some studies documented cases of death that were suspected to be related to hemophagocytic lymphohistiocytosis (HLH) and immune reconstitution inflammatory syndrome (IRIS). Most of the death reports showed concomitant non-Mpox infections at the time of hospitalization and death CONCLUSIONS: Our finding shows that Mpox acts as an opportunistic pathogen in immunocompromised individuals. These individuals should be prioritized for early care and closely monitored for signs of deteriorating clinical conditions. Clinical manifestations and autopsy findings strongly suggest Mpox dissemination to multiple organs, particularly the digestive tract, and lungs. However, the presence of concomitant non-Mpox infections complicates the assessment of the attribution of Mpox to death. Caution should be exercised when interpreting data suggesting poorer outcomes in individuals with non-HIV immunosuppression, as current evidence is scarce and further research is needed.
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Affiliation(s)
- Ahmed Azzam
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt.
| | - Heba Khaled
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Haitham Salem
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ameer Ahmed
- Faculty of Medicine, Minia University, Minya, Egypt
| | - Amira M Heniedy
- Department of Epidemiology, El-Beheira Veterinary Administration, Egyptian Ministry of Agriculture and Land Reclamation, El-Beheira, Egypt
| | | | - Ahmed Hassan
- Dermatology resident physician, Qeft Teaching Hospital, Qena, Egypt
| | - Taghrid S El-Mahdy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
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Garcia EA, Foote MMK, McPherson TD, Lash MK, Bosompem AN, Bouscaren A, Chan J, DiLorenzo MA, Feihel D, Fowler RC, Gandhi V, Jenny-Avital ER, Kopping EJ, Mazo D, McLean J, Mgbako O, Sayegh MN, Shaw RN, Su M, Meissner JS, Wang JC, Wen W, Winters JC, Zeana CB, Zucker J, Wong M. Severe Mpox Among People With Advanced Human Immunodeficiency Virus Receiving Prolonged Tecovirimat in New York City. Open Forum Infect Dis 2024; 11:ofae294. [PMID: 38868307 PMCID: PMC11168585 DOI: 10.1093/ofid/ofae294] [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: 02/20/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Severe mpox has been observed in people with advanced human immunodeficiency virus (HIV). We describe clinical outcomes of 13 patients with advanced HIV (CD4 <200 cells/μL), severe mpox, and multiorgan involvement. Despite extended tecovirimat courses and additional agents, including vaccinia immune globulin, cidofovir, and brincidofovir, this group experienced prolonged hospitalizations and high mortality.
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Affiliation(s)
- Elizabeth A Garcia
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Mary M K Foote
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Tristan D McPherson
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Maura K Lash
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Amma N Bosompem
- Human Resources Administration, New York City Department of Social Services, New York, New York, USA
| | - Alyssa Bouscaren
- Department of Homeless Services, New York City Department of Social Services, New York, New York, USA
| | - Justin Chan
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Internal Medicine and Infectious Diseases, NYC Health + Hospitals/Bellevue, New York, New York, USA
| | - Madeline A DiLorenzo
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, USA
| | - Dennis Feihel
- Lenox Hill Hospital Department of Medicine, Northwell Health, New York, New York, USA
| | - Randal C Fowler
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Vani Gandhi
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Erik J Kopping
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Dana Mazo
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jacob McLean
- Division of Infectious Diseases, New York Presbyterian Hospital, Columbia University, New York, New York, USA
| | - Ofole Mgbako
- Division of Infectious Diseases and Immunology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Internal Medicine and Infectious Diseases, NYC Health + Hospitals/Bellevue, New York, New York, USA
- New York University Langone Institute for Excellence in Health Equity, NYU Langone Health, New York, New York, USA
| | - Mark N Sayegh
- Division of Infectious Diseases, NYC Health + Hospitals/Harlem, New York, New York, USA
- Division of Infectious Diseases, Columbia University, New York, New York, USA
| | - Raphael N Shaw
- Division of Infectious Diseases, NYC Health + Hospitals/Harlem, New York, New York, USA
- Division of Infectious Diseases, Columbia University, New York, New York, USA
| | - Michelle Su
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jeanne Sullivan Meissner
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jade C Wang
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Wendy Wen
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - John C Winters
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Internal Medicine and Infectious Diseases, NYC Health + Hospitals/Elmhurst, Queens, New York, USA
| | - Cosmina B Zeana
- Division of Infectious Diseases, BronxCare Health System, Bronx, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, New York Presbyterian Hospital, Columbia University, New York, New York, USA
| | - Marcia Wong
- Division of Disease Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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12
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Mazumder A, Lim L, White CM, Van Gerwen OT. A Case of Varicella Zoster and Mpox Coinfection in a Patient Living With HIV. Sex Transm Dis 2024; 51:e14-e16. [PMID: 38301635 DOI: 10.1097/olq.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT We present a case of recurrent, cutaneous mpox with coinfection of disseminated varicella zoster in an immunocompromised patient with poorly controlled HIV. This case demonstrates the importance of maintaining a high index of suspicion for mpox despite prior infection and vaccination, as suboptimal immune response is possible in immunocompromised patients, and also noting the potential for coinfection necessitating timely diagnosis and appropriate testing.
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Affiliation(s)
- Archisman Mazumder
- From the Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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13
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Aldred B, Scott JY, Aldredge A, Gromer DJ, Anderson AM, Cartwright EJ, Colasanti JA, Hall B, Jacob JT, Kalapila A, Kandiah S, Kelley CF, Lyles RH, Marconi VC, Nguyen ML, Rebolledo PA, Sheth AN, Szabo B, Titanji BK, Wiley Z, Workowski K, Cantos VD. Associations Between HIV and Severe Mpox in an Atlanta Cohort. J Infect Dis 2024; 229:S234-S242. [PMID: 38001044 DOI: 10.1093/infdis/jiad505] [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: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In the Southeastern United States, the 2022 mpox outbreak disproportionately impacted people who are black and people with HIV (PWH). METHODS We analyzed a cohort of 395 individuals diagnosed with mpox across 3 health care systems in Atlanta, Georgia between 1 June 2022 and 7 October 2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the US Centers for Disease Control and Prevention definition) and, among PWH, the associations between CD4+ T-cell count and HIV load with severe mpox. RESULTS Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV load, 90 (35.0%) had > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% confidence interval [CI], 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV load > 200 copies/mL had 2.10 (95% CI, 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T-cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis. CONCLUSIONS PWH with nonsuppressed HIV loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with nonsuppressed HIV loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.
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Affiliation(s)
- Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Jane Y Scott
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amalia Aldredge
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Daniel J Gromer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Emily J Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Betsy Hall
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Robert H Lyles
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kimberly Workowski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
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14
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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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15
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Ritter JM, Martines RB, Bhatnagar J, Rao AK, Villalba JA, Silva-Flannery L, Lee E, Bullock HA, Hutson CL, Cederroth T, Harris CK, Hord K, Xu Y, Brown CA, Guccione JP, Miller M, Paddock CD, Reagan-Steiner S. Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox. J Infect Dis 2024; 229:S219-S228. [PMID: 38243606 DOI: 10.1093/infdis/jiad574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Pathology and Monkeypox virus (MPXV) tissue tropism in severe and fatal human mpox is not thoroughly described but can help elucidate the disease pathogenesis and the role of coinfections in immunocompromised patients. METHODS We analyzed biopsy and autopsy tissues from 22 patients with severe or fatal outcomes to characterize pathology and viral antigen and DNA distribution in tissues by immunohistochemistry and in situ hybridization. Tissue-based testing for coinfections was also performed. RESULTS Mucocutaneous lesions showed necrotizing and proliferative epithelial changes. Deceased patients with autopsy tissues evaluated had digestive tract lesions, and half had systemic tissue necrosis with thrombotic vasculopathy in lymphoid tissues, lung, or other solid organs. Half also had bronchopneumonia, and one-third had acute lung injury. All cases had MPXV antigen and DNA detected in tissues. Coinfections were identified in 5 of 16 (31%) biopsy and 4 of 6 (67%) autopsy cases. CONCLUSIONS Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings.
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Affiliation(s)
| | | | | | - Agam K Rao
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Elizabeth Lee
- Infectious Diseases Pathology Branch
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Christina L Hutson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kristin Hord
- Office of Chief Medical Examiner, New York City, New York
| | - Ya Xu
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Cameron A Brown
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Jack P Guccione
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Matthew Miller
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Zoonotic and Emerging Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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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: 2] [Impact Index Per Article: 2.0] [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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17
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Paredes MI, Ahmed N, Figgins M, Colizza V, Lemey P, McCrone JT, Müller N, Tran-Kiem C, Bedford T. Underdetected dispersal and extensive local transmission drove the 2022 mpox epidemic. Cell 2024; 187:1374-1386.e13. [PMID: 38428425 PMCID: PMC10962340 DOI: 10.1016/j.cell.2024.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Abstract
The World Health Organization declared mpox a public health emergency of international concern in July 2022. To investigate global mpox transmission and population-level changes associated with controlling spread, we built phylogeographic and phylodynamic models to analyze MPXV genomes from five global regions together with air traffic and epidemiological data. Our models reveal community transmission prior to detection, changes in case reporting throughout the epidemic, and a large degree of transmission heterogeneity. We find that viral introductions played a limited role in prolonging spread after initial dissemination, suggesting that travel bans would have had only a minor impact. We find that mpox transmission in North America began declining before more than 10% of high-risk individuals in the USA had vaccine-induced immunity. Our findings highlight the importance of broader routine specimen screening surveillance for emerging infectious diseases and of joint integration of genomic and epidemiological information for early outbreak control.
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Affiliation(s)
- Miguel I Paredes
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Nashwa Ahmed
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Molecular and Cellular Biology Program, University of Washington, Seattle, WA, USA
| | - Marlin Figgins
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - John T McCrone
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Nicola Müller
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Cécile Tran-Kiem
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Trevor Bedford
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Howard Hughes Medical Institute, Seattle, WA, USA
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18
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Aldred B, Lyles RH, Scott JY, Gromer DJ, Aldredge A, Workowski KA, Wiley Z, Titanji BK, Szabo B, Sheth AN, Rebolledo PA, Nguyen ML, Marconi VC, Kelley CF, Kandiah S, Kalapila A, Jacob JT, Hall B, Colasanti JA, Cartwright EJ, Cantos VD. Early Tecovirimat Treatment for Mpox Disease Among People With HIV. JAMA Intern Med 2024; 184:275-279. [PMID: 38190312 PMCID: PMC10912958 DOI: 10.1001/jamainternmed.2023.7696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 01/10/2024]
Abstract
Importance Despite a lack of effectiveness data in humans, tecovirimat was widely prescribed to people with HIV (PWH) with mpox during the 2022 mpox epidemic, particularly PWH with low CD4+ T-cell counts or severe mpox clinical manifestations. Objective To evaluate if PWH with mpox who were treated with tecovirimat within 7 days of symptom onset were less likely to have mpox disease progression. Design, Setting, and Participants This cohort study included PWH diagnosed with mpox at 4 hospitals in Atlanta, Georgia, between June 1 and October 7, 2022. Patients were grouped according to whether they were treated with tecovirimat within 7 days of mpox symptom onset (early tecovirimat cohort) or they did not receive tecovirimat or received the drug 7 or more days after symptom onset (late or no tecovirimat cohort). Multivariable logistic regression models were used to identify factors associated with progression of mpox disease. The 2 cohorts were then matched 1:1 using propensity scores based on the identified factors, and mpox disease progression was compared. Exposures Treatment with tecovirimat within 7 days of mpox symptom onset. Main Outcome and Measures Progression of mpox disease, defined as the development of at least 1 severe mpox criterion established by the US Centers for Disease Control and Prevention, after symptom day 7. Results After propensity score matching, a total of 112 PWH were included in the analysis; 56 received tecovirimat within 7 days of mpox symptom onset (early tecovirimat group) and 56 were either treated later or did not receive tecovirimat (late or no tecovirimat group). In the early tecovirimat group, the median (IQR) age was 35 (30-42) years; 54 individuals (96.4%) were cisgender men, 46 (82.1%) were Black individuals, and 10 (17.9%) were individuals of other races (American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or White) or unknown race. In the late or no tecovirimat group, the median (IQR) age was 36 (32-43) years; 54 (96.4%) were cisgender men, 49 (87.5%) were Black individuals, and 7 (12.5%) were individuals of other races or unknown race. Mpox disease progression occurred in 3 PWH (5.4%) in the early tecovirimat group and in 15 PWH (26.8%) in the late or no tecovirimat group (paired odds ratio, 13.00 [95% CI, 1.71-99.40]; P = .002). Conclusion and Relevance Results of this cohort study support starting tecovirimat in all PWH as soon as an mpox diagnosis is suspected. Additional research is warranted to confirm these findings.
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Affiliation(s)
- Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Robert H. Lyles
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jane Y. Scott
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel J. Gromer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Amalia Aldredge
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Kimberly A. Workowski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Boghuma K. Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Paulina A. Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Vincent C. Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Colleen F. Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Betsy Hall
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily J. Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria D. Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
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19
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Karmarkar EN, Golden MR, Kerani RP, Pogosjans S, Chow EJ, Bender Ignacio RA, Ramchandani MS, Kay MK, Cannon CA, Dombrowski JC. Association of Tecovirimat Therapy With Mpox Symptom Improvement: A Cross-sectional Study-King County, Washington, May-October 2022. Open Forum Infect Dis 2024; 11:ofae029. [PMID: 38456195 PMCID: PMC10919389 DOI: 10.1093/ofid/ofae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background Data on tecovirimat effectiveness for human mpox are limited. We conducted a retrospective cross-sectional interview-based study to identify associations between tecovirimat treatment and the mpox clinical course. Methods Using public health surveillance data from King County, Washington, we recruited and interviewed persons diagnosed with mpox during May-October 2022. We calculated descriptive statistics on demographics, vaccination status, comorbidities, and symptoms including 3 self-reported dates (symptom onset, first date of symptom improvement, and illness resolution). We used multivariable linear regression, stratified by illness severity, to evaluate the association of tecovirimat treatment with time to symptom improvement and time to illness resolution. We compared individuals who did not receive tecovirimat to participants who started tecovirimat early (≤5 days from symptom onset) and late (>5 days and ≤28 days from symptom onset) in their illness. Results Of 465 individuals diagnosed with mpox, 115 (25%) participated in this study. Eighty participants (70%) received tecovirimat and 43 (37%) initiated tecovirimat early. Sixty-eight (59%) reported severe symptoms during their illness, including proctitis (n = 38 [33%]), rectal bleeding (n = 27 [24%]), or severe pain (n = 24 [21%]). In the multivariable analysis, early tecovirimat was associated with shorter time to symptom improvement (-5.5 days, P = .04) among participants with severe illness but not among those with nonsevere illness (0.9 day, P = .66). Early tecovirimat was not associated with faster illness resolution, regardless of severity. Conclusions Our small study suggests that early tecovirimat initiation may hasten subjective symptomatic improvement in people with severe mpox. Larger randomized trials are needed to evaluate this finding.
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Affiliation(s)
- Ellora N Karmarkar
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Roxanne P Kerani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sargis Pogosjans
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Eric J Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Rachel A Bender Ignacio
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Meena S Ramchandani
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Meagan K Kay
- Communicable Disease Epidemiology and Immunization Section, Public Health - Seattle & King County, Seattle, Washington, USA
| | - Chase A Cannon
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
| | - Julia C Dombrowski
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health - Seattle & King County HIV/STI/Hepatitis C Program, Seattle, Washington, USA
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20
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Zucker J, Fischer WA, Wilkin T. Tecovirimat for Mpox-Promise and Limitations. JAMA Intern Med 2024; 184:279-280. [PMID: 38190299 DOI: 10.1001/jamainternmed.2023.7693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - William A Fischer
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
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21
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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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22
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Silva MST, Coutinho C, Torres TS, Peixoto EM, Bastos MO, Mesquita MB, Tavares ICF, Andrade HB, Reges PPS, Martins PS, Echeverría-Guevara A, Moreira RI, Lessa FCS, Hoagland B, Nunes EP, Cardoso SW, Veloso VG, Grinsztejn B. Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil. AIDS 2024; 38:105-113. [PMID: 37812389 PMCID: PMC10715691 DOI: 10.1097/qad.0000000000003748] [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: 06/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization. DESIGN We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV. METHODS This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons, we used chi-squared, Fisher's exact and the Moods median tests whenever appropriate. RESULTS From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people with HIV (PWH). PWH presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% ( n = 43), especially for pain control. Among hospitalized participants, PWH had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4 + cell counts. All deaths ( n = 2) occurred in PWH with CD4 + less than 50 cells/μl. CONCLUSION HIV-related immunosuppression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.
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Affiliation(s)
- Mayara S T Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Manguinhos, Rio de Janeiro, Brazil
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23
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Shishido AA, Street S. Optimal management of severe mpox in patients with uncontrolled human immunodeficiency virus. J Med Virol 2023; 95:e29277. [PMID: 38078663 DOI: 10.1002/jmv.29277] [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: 09/20/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023]
Abstract
In May 2022, a cluster of nontravel-related cases of human mpox were reported in the United Kingdom. The outbreak has since spread worldwide infecting over 85 000 patients and causing over 100 deaths. Recent data clearly suggest that patients infected with human immunodeficiency virus (HIV) with CD4 counts less than 200 cells per mm 3 suffer significantly worse outcomes than immunocompetent patients. The available countermeasures lack robust clinical data and are deployed based on in vitro and animal studies as well as extrapolations from use against other poxviruses. In many cases, despite administration of these available treatments, initiation of antiretroviral therapy (ART), and management of suspected immune reconstitution inflammatory syndrome after initiating ART, patients die. This review summarizes available data, identifies knowledge gaps and proposes recommendations on the management of severe mpox in people living with HIV.
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Affiliation(s)
- Akira A Shishido
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Stacy Street
- Division of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, Virginia, USA
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24
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Zucker J, Hazra A, Titanji BK. Mpox and HIV-Collision of Two Diseases. Curr HIV/AIDS Rep 2023; 20:440-450. [PMID: 37994953 DOI: 10.1007/s11904-023-00682-w] [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] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The global outbreak of mpox has brought renewed attention to a previously neglected disease which is particularly severe in people with underlying untreated HIV co-infection. For this population, the disease is progressive, severe, and often lethal. In this review, we examine the pathogenesis of mpox disease and its collision with co-existent HIV infection and discuss key considerations for management as well as emerging clinical dilemmas and areas for future research. RECENT FINDINGS Co-existent untreated HIV infection characterized by severe immunocompromise potentiates the nefarious effects of monkeypox virus infection leading to severe manifestations of mpox. Treating mpox in the context of HIV requires mpox-directed therapies, supportive care, and HIV-specific treatment to restore immune function. Preventative measures for PWH are like those in healthy individuals, but the effectiveness and durability of protection conferred by existing vaccines in PWH remain to be fully characterized. Mpox is an important opportunistic infection in PWH. Clinicians should be aware of the unique features of the disease in this population and approaches to care and management of mpox in PWH.
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Affiliation(s)
- Jason Zucker
- Department of Infectious Diseases, Columbia University, New York, NY, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Health Sciences Research Building I, Emory University School of Medicine, 1760 Haygood Drive NE, W300, Rm 327, Atlanta, GA, USA.
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25
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Rajme-López S, Corral-Herrera EA, Tello-Mercado AC, Tepo-Ponce KM, Pérez-Meléndez RE, Rosales-Sotomayor Á, Figueroa-Ramos G, López-López K, Domínguez-Cherit JG, San-Martín-Morante O, Saeb-Lima M, Gamboa-Domínguez A, Ponce-de-León A, Crabtree-Ramírez B, Ramos-Cervantes P, Ruíz-Palacios GM. Clinical, molecular, and histological characteristics of severely necrotic and fatal mpox in HIV-infected patients. AIDS Res Ther 2023; 20:85. [PMID: 38012656 PMCID: PMC10683144 DOI: 10.1186/s12981-023-00580-6] [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: 07/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This case series of 5 patients with severely necrotic mpox highlights the predominantly necrotic nature of lesions seen in cases of severe mpox as shown by skin and lung biopsy, as well as the extensive dissemination of the infection, as shown by polymerase chain reaction (PCR) assessment in different body sites. CASE PRESENTATIONS Patients were male, the median age was 37, all lived with HIV (2 previously undiagnosed), the median CD4+ cell count was 106 cells/mm3, and 2/5 were not receiving antiretroviral treatment. The most common complication was soft tissue infection. Skin and lung biopsies showed extensive areas of necrosis. Mpox PCR was positive in various sites, including skin, urine, serum, and cerebrospinal fluid. The initiation of antiretroviral treatment, worsened the disease, like that seen in immune reconstitution syndrome. Three patients died due to multiple organ failure, presumably associated with mpox since coinfections and opportunistic pathogens were ruled out. CONCLUSIONS Severely necrotic manifestations of mpox in people living with advanced and untreated HIV are related to adverse outcomes.
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Affiliation(s)
- Sandra Rajme-López
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Ever A Corral-Herrera
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Andrea C Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Karen M Tepo-Ponce
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Raúl E Pérez-Meléndez
- Internal Medicine Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Ángela Rosales-Sotomayor
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Grecia Figueroa-Ramos
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Karla López-López
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Judith G Domínguez-Cherit
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Oswaldo San-Martín-Morante
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Brenda Crabtree-Ramírez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México
| | - Pilar Ramos-Cervantes
- Virology and Molecular Biology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Guillermo M Ruíz-Palacios
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán" Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México, 14080, México.
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26
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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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27
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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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Christodoulidou MM, Mabbott NA. Efficacy of smallpox vaccines against Mpox infections in humans. IMMUNOTHERAPY ADVANCES 2023; 3:ltad020. [PMID: 37886620 PMCID: PMC10598838 DOI: 10.1093/immadv/ltad020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
The Mpox virus (MPXV) is endemic in certain countries in Central and West Africa, where several mammalian species, especially rodents, are natural reservoirs. However, the MPXV can infect nonhuman primates and cause zoonotic infections in humans after close contact with an infected animal. Human-to-human transmission of MPXV can also occur through direct close contact with an infected individual or infected materials. In May 2022 an initial cluster of human Mpox cases was identified in the UK, with the first case confirmed in a patient who had recently travelled to Nigeria. The infection subsequently spread via human-to-human transmission within the UK and Mpox cases began to appear in many other countries around the world where the MPXV is not endemic. No specific treatments for MPXV infection in humans are available. However, data from studies undertaken in Zaire in the 1980s revealed that those with a history of smallpox vaccination during the global smallpox eradication campaign also had good cross-protection against MPXV infection. However, the vaccines used during the global eradication campaign are no longer available. During the 2022 global Mpox outbreak over a million doses of the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) smallpox vaccine were offered either as pre or postexposure prophylaxis to those at high risk of MPXV infection. Here, we review what has been learned about the efficacy of smallpox vaccines in reducing the incidence of MPXV infections in high-risk close contacts.
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Affiliation(s)
| | - Neil A Mabbott
- The Roslin Institute & Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, UK
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Cahill S. Lessons Learned from the U.S. Public Health Response to the 2022 mpox Outbreak. LGBT Health 2023; 10:489-495. [PMID: 37527421 DOI: 10.1089/lgbt.2022.0274] [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: 08/03/2023] Open
Abstract
In mid-2022, an mpox outbreak occurred in the United States and more than 100 countries, disproportionately affecting men who have sex with men (MSM). Initially, the U.S. public health system failed to deploy tests, treatment, and vaccines effectively. Key federal policy changes in August 2022, along with risk reduction among many MSM, led to a steady reduction in new diagnoses by December 2022. Mpox outbreaks occurred among MSM in Chicago and France in May 2023, and vaccination rates remain low. This perspective analyzes the U.S. response to the 2022 outbreak, and it identifies the lessons learned that may guide mpox management moving forward.
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Affiliation(s)
- Sean Cahill
- Health Policy Research, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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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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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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Eustaquio PC, Salmon-Trejo LA, McGuire LC, Ellington SR. Epidemiologic and Clinical Features of Mpox in Adults Aged >50 Years - United States, May 2022-May 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:893-896. [PMID: 37590262 PMCID: PMC10441827 DOI: 10.15585/mmwr.mm7233a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
During May 2022-May 2023, approximately 30,000 mpox cases were reported in the United States, predominantly among young adult men. Persons aged >50 years might experience more severe mpox disease because of a higher prevalence of comorbidities. Conversely, they could have residual protection from childhood smallpox vaccination against monkeypox virus infection and severe mpox, as has been suggested by investigation of some previous mpox outbreaks. To examine the characteristics of mpox cases among adults aged >50 years, analysts compared mpox epidemiology and clinical outcomes among all adults aged ≥18 years, by age group. Further, outcomes were compared among adults aged >50 years by JYNNEOS vaccination status. During May 10, 2022-May 17, 2023, among 29,984 adults with probable or confirmed mpox reported to CDC, 2,909 (9.7%) were aged >50 years, 96.3% of whom were cisgender men. Compared with adults aged 18-50 years, adults aged >50 years had higher prevalences of immunocompromising conditions (p<0.001) and HIV infection (p<0.001). Among adults with mpox aged >50 years, 27.6% had received JYNNEOS vaccination; this group had lower prevalences of constitutional symptoms (p<0.001), pruritus (p<0.001), and hospitalization (p = 0.002) compared with those who had not received JYNNEOS vaccine. Currently recommended JYNNEOS vaccination among all adults at risk for mpox should be encouraged, irrespective of childhood smallpox vaccination status.
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Mourad A, Alavian N, Woodhouse EW, Niehaus E, Cunningham H, Zavala S, Kohler P, Pappas S, Yarrington M, Okeke NL, Wolfe CR, Cox GM, Dicks KV, Stout JE. Concurrent Sexually Transmitted Infection Testing Among Patients Tested for Mpox at a Tertiary Healthcare System. Open Forum Infect Dis 2023; 10:ofad381. [PMID: 37539060 PMCID: PMC10394722 DOI: 10.1093/ofid/ofad381] [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: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Coinfection with sexually transmitted infections (STIs) and mpox is common. We evaluated concurrent STI testing among Duke Health patients tested for mpox. We found that most patients tested for mpox were not comprehensively tested for STIs, despite concurrent STIs being diagnosed in 15% of patients when testing was performed.
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Affiliation(s)
- Ahmad Mourad
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Naseem Alavian
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Edwin W Woodhouse
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily Niehaus
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Hayley Cunningham
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Sofia Zavala
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Patricia Kohler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven Pappas
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Yarrington
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Gary M Cox
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Kristen V Dicks
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jason E Stout
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Karan A, Contag C, Barry M. Health inequities continue to drive the public health threat of mpox. BMJ 2023; 381:1391. [PMID: 37353231 DOI: 10.1136/bmj.p1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
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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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