Black, Hispanic MSM are disproportionately affected by monkeypox

Black, Hispanic MSM are disproportionately affected by monkeypox

A recently published study in the Morbidity and Mortality Weekly Report described the epidemiological characteristics of the monkeypox (MPX) outbreak in the United States (US).

The first suspected case of MPX in the United States was identified in May 2022, and the Centers for Disease Control and Prevention (CDC) initiated an emergency response. To date, more than 29,900 cases of MPX have been reported to the CDC, with daily case counts peaking in August. In the present study, researchers described the epidemiological characteristics of the ongoing MPX outbreak and the public health response in the United States.

Learn: Epidemiologic characteristics of the monkeypox outbreak and the public health response - United States, May 17-October 6, 2022. Photo credit: NIAID

Epidemiology of MPX cases

The Council of State and Territorial Epidemiologists approved the designation of MPX as a nationally notifiable disease on June 23, 2022. Approximately 26,384 MPX cases were reported to the US CDC between May 17 and October 6, 2022. The authors described and compared MPX case characteristics before and after July 18, when testing capacity and access increased significantly.

The average age of the patients was 34 years. The proportion of MPX cases among 18- to 29-year-olds increased from 20% to 27% after July 18, while the proportion of 30- to 39-year-olds fell to 41%. Information on ethnicity and race was available for 21,211 patients; 32% of cases were black, 31% were Hispanic, and 30% were white.

The proportion of blacks with MPX increased from 21% to 35% after July 18, while the proportion of Hispanics and whites with MPX decreased to 31% (from 33%) and 28% (from 39%), respectively. Gender information was available for 25,569 MPX cases, with 95% of cases identified as cisgender men. More than 10,400 cisgender men reported having male-to-male sexual contact (MMSC) in the past 21 days after symptom onset.

The proportion of cisgender men reporting recent MMSC decreased over time. 13,871 MPX cases had a skin rash, most commonly seen on the face, genitals, and arms. Data on human immunodeficiency virus (HIV) infection were available for 5017 cases; Of these, 57% were HIV positive. More than 1,800 MPX cases have been hospitalized and six deaths have been documented. MPX or smallpox vaccination status was available for 9,197 patients, with 2,882 cases vaccinated.

Public health response

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The US CDC initiated an emergency response to MPX within a week of identifying the first suspected case. In addition to increased surveillance, emergency response efforts focused on expanding laboratory testing, medical countermeasures for post-exposure prophylaxis and treatment, and disseminating information to the public and health care providers.

A US Food and Drug Administration (FDA)-approved polymerase chain reaction (PCR) test for the detection of non-Variola orthopoxviruses was available prior to the MPX outbreak as a result of smallpox preparedness efforts. The CDC provided technical assistance to increase testing capacity. In addition, the JYNNEOS vaccine, which was stockpiled for use in immunocompromised individuals in the event of a smallpox outbreak, was available to combat the MPX outbreak.

The intradermal JYNNEOS vaccine was authorized for emergency use on August 9, 2022. As of October 10, 2022, more than 931,100 MPX vaccine doses have been administered. While there are no FDA-approved therapeutic products for MPX, tecovirimat for smallpox in 2018, was recommended for use in patients at risk for or with severe MPX. A randomized controlled clinical trial is currently underway to assess the effectiveness of tecovirimat in MPX treatment.

CDC uses numerous mechanisms to disseminate information about MPX to health care providers and the public. The CDC issued the first Health Alert Network Health Advisory on May 20, 2022, with four subsequent releases. In addition, CDC hosts calls for outreach and communication activities for clinicians, where subject matter experts present the latest information and thinking. Around 10,000 healthcare professionals took part in the first call of its kind.

Concluding remarks

Prior knowledge of sexually transmitted infections and MPX, diagnostic/laboratory support, medical countermeasures, and public outreach were instrumental in CDC's response to MPX. CDC continues to analyze emerging evidence and interventions for MPX prevention and control. Prevention efforts must focus on vaccinating at-risk groups. Efforts are needed to reduce the stigma of MPX and ensure equitable access to testing, treatment and vaccination.

Reference:

• Kava CM, Rohraff DM, Wallace B, et al. Epidemiologische Merkmale des Affenpockenausbruchs und die Reaktion der öffentlichen Gesundheit – Vereinigte Staaten, 17. Mai–6. Oktober 2022. MMWR Morb Mortal Wkly Rep, 2022, DOI: 10.15585/mmwr.mm7145a4, https://www.cdc.gov/mmwr/volumes/71/wr/mm7145a4.htm

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