#17,471
Sixteen days ago the city of Chicago issued a HAN (Health Alert Network) alert on a cluster of recent Mpox cases (n=13), a large percentage (69%) which were fully vaccinated with the JYNNEOS vaccine. While this vaccine was never expected to be 100% protective, this outbreak has raised concerns over a new surge in cases this summer.
Six days later the CDC released a nationwide HAN Update (see CDC HAN: Potential Risk for New Mpox Cases), and followed up with a live webinar 3 days later (see COCA Call : Mpox Update on Testing, Treatment, and Vaccination).
Over the past week the CDC has also published 5 MMWR reports (3 on May 19th and 2 yesterday) on the potential for additional Mpox outbreaks, and the apparent effectiveness of the vaccine.
You'll find links and summaries from these reports below, but you'll want to follow the links to read them in their entirety.
I'll have a brief postscript after the break.
The CDC Domestic Mpox Response — United States, 2022–2023
Weekly / May 19, 2023 / 72(20);547–552
Jennifer H. McQuiston, DVM1; Christopher R. Braden, MD2; Michael D. Bowen, PhD1; Andrea M. McCollum, PhD1; Robert McDonald, MD3; Neal Carnes, PhD4; Rosalind J. Carter, PhD5; Athalia Christie, DrPH6; Jeffrey B. Doty, MS1; Sascha Ellington, PhD7; S. Nicole Fehrenbach, MPP8; Adi V. Gundlapalli, MD, PhD9; Christina L. Hutson, PhD1; Rachel E. Kachur, MPH3; Aaron Maitland, PhD10; Christine M. Pearson1; Joseph Prejean, PhD4; Laura A. S. Quilter, MD3; Agam K. Rao, MD1; Yon Yu, PharmD8; Jonathan Mermin, MD11
Summary
What is already known about this topic?
After being detected in May 2022, U.S. monkeypox (mpox) cases increased rapidly, peaking in August. Infection was primarily spread by sexual contact among gay, bisexual, and other men who have sex with men.
What is added by this report?
Rapid adaptation of smallpox preparedness systems and tools, and prioritized communication expertise from HIV prevention programs, were leveraged to reach communities at risk. In 1 year, more than 30,000 cases were reported and >1 million JYNNEOS vaccine doses were administered. Black and Hispanic persons represented 33% and 31% of cases, respectively; 87% of 42 fatal cases occurred in Black persons.
What are the implications for public health practice?
The U.S. risk for future mpox outbreaks remains. Ongoing surveillance, vaccination, and communication are important prevention tools, especially for Black and Hispanic persons in groups at risk.
Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection — New York, 2022
Weekly / May 19, 2023 / 72(20);559–563Eli S. Rosenberg, PhD1,2,3; Vajeera Dorabawila, PhD1; Rachel Hart-Malloy, PhD1,2,3; Bridget J. Anderson, PhD1; Wilson Miranda, MPH1; Travis O’Donnell1; Charles J. Gonzalez, MD1,3; Meaghan Abrego, MPH1; Charlotte DelBarba, MPH1; Cori J. Tice, MPH1; Claire McGarry, MPH1; Ethan C. Mitchell, MPH1; Michele Boulais, MPA1; Bryon Backenson, MS1,2; Michael Kharfen1; James McDonald, MD1; Ursula E. Bauer, PhD1
Summary
What is already known about this topic?
The JYNNEOS vaccine was deployed in a national and state vaccination campaign during the 2022 monkeypox (mpox) outbreak. Postexposure prophylaxis and vaccination of persons at highest risk (primarily men who have sex with men) were prioritized. Evidence of vaccine effectiveness (VE) from controlled studies has been limited.
What is added by this report?
A comparison of men aged ≥18 years who received a diagnosis of mpox during July 24–October 31 in New York to controls with rectal gonorrhea or primary syphilis, based on systematically collected surveillance data, found adjusted combined 1-dose (received ≥14 days earlier) or 2-dose VE of 75.7%.
What are the implications for public health practice?
These findings support recommended 2-dose JYNNEOS vaccination consistent with CDC and New York State Department of Health guidance.
Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study — United States, August 19, 2022–March 31, 2023
Weekly / May 19, 2023 / 72(20);553–558
Alexandra F. Dalton, PhD1,*; Alpha Oumar Diallo, PhD1,*; Anna N. Chard, PhD1; Danielle L. Moulia, MPH1; Nicholas P. Deputy, PhD1; Amy Fothergill, PhD1; Ian Kracalik, PhD1; Christopher W. Wegner, MPH2; Tiffanie M. Markus, PhD3; Preeti Pathela, DrPH4; William L. Still, MS5; Sam Hawkins, MPH6; Anil T. Mangla, PhD5; Nivedita Ravi, DVM7; Erin Licherdell, MPH8; Amber Britton, MPH9,10; Ruth Lynfield, MD11; Melissa Sutton, MD6; AmberJean P. Hansen, MPH12; Gabriela S. Betancourt, DrPH4; Jemma V. Rowlands, MPH13; Shua J. Chai, MD2,14; Rebecca Fisher, MPH15; Phoebe Danza, MPH15; Monica Farley, MD9,10; Jennifer Zipprich, PhD11; Gregory Prahl16; Karen A. Wendel, MD17; Linda Niccolai, PhD12; Jessica L. Castilho, MD18; Daniel C. Payne, PhD1; Amanda C. Cohn, MD1; Leora R. Feldstein, PhD1; CDC Multijurisdictional Mpox Case-Control Study Group
Summary
What is already known about this topic?
Real-world vaccine effectiveness (VE) estimates for JYNNEOS vaccine against monkeypox (mpox) are limited. To date, no VE estimates by route of administration or for immunocompromised persons have been published.
What is added by this report?
In this study, adjusted VE was 75% for 1 dose and 86% for 2 doses of JYNNEOS vaccine, indicating substantial protection against mpox, irrespective of route of administration or immunocompromise status.
What are the implications for public health practice?
Persons at high risk for mpox exposure should be vaccinated with the recommended 2-dose JYNNEOS series.
Yesterday (May 25th) the following two reports were published:
Urban and Rural Mpox Incidence Among Persons Aged 15–64 Years — United States, May 10–December 31, 2022
Weekly / May 26, 2023 / 72(21);574–578
Carla E. Zelaya, PhD1,*; Brandi P. Smith, PhD1,*; Aspen P. Riser, MPH1; Jaeyoung Hong, PhD1; Samantha Distler, MPH1; Siobhán O’Connor, MD1; Ermias Belay, MD1; Mohammad Shoeb, PhD1; Michelle A. Waltenburg, DVM1; Maria E. Negron, DVM, PhD1; Sascha Ellington, PhD1
Summary
What is already known about this topic?
Monkeypox (mpox) has disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Information on urbanicity of mpox cases during the 2022 outbreak is limited.
What is added by this report?
During May–December 2022, U.S. mpox incidence was 13.5 per 100,000 persons peaking in August. Among cisgender men and cisgender women, incidence in rural areas was 4% and 11% of incidence in large central urban areas, respectively. Incidence among Black or African American and Hispanic or Latino persons was higher than among White persons.
What are the implications for public health practice?
National mpox surveillance should be continued to ensure persons at risk for mpox get tested and treated. Prevention efforts should be focused on MSM in urban areas.
Potential for Recurrent Mpox Outbreaks Among Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2023
Weekly / May 26, 2023 / 72(21);568–573
Emily D. Pollock1; Patrick A. Clay1; Adrienne Keen2; Dustin W. Currie3; Rosalind J. Carter4; Laura A. S. Quilter1; Adi V. Gundlapalli5; Jonathan Mermin1; Ian H. Spicknall1
Summary
What is already known about this topic?
Monkeypox (mpox) has disproportionately affected gay, bisexual, and other men who have sex with men (MSM); the percentage of MSM with immunity due to vaccination or infection varies among jurisdictions.
What is added by this report?
Mathematical modeling suggests that the risk for future outbreaks depends linearly on the level of immunity in the population at risk; cumulative incidence, on the other hand, has multiple thresholds. More than 592,000 MSM live in jurisdictions with risk for mpox recurrences capable of sustained transmission if a cluster of infectious cases were reintroduced.
What are the implications for public health practice?
Increasing vaccination coverage among MSM at risk and in jurisdictions with low immunity has the potential to reduce the risk for and potential size of future mpox outbreaks.
Although the WHO discontinued their PHEIC (Public Health Emergency of International Concern) status for Mpox just over two weeks ago, concerns over the future spread, and evolution, of this virus remain.
Like all viruses, Monkeypox continues to evolve and diversify, as discussed in the 2014 EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo, where the authors cautioned:
Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.
And in a 2020 report, published by the Bulletin of the World Health Organization, researchers warned that our waning immunity to smallpox put society at greater risks of seeing Monkeypox epidemics (see WHO: Modelling Human-to-Human Transmission of Monkeypox).
Last September The Lancet published a correspondence also warning of the dangers of failing to contain this virus:
Evolutionary consequences of delaying intervention for monkeypox
Philip L F Johnson, Carl T Bergstrom, Roland R Regoes, Ira M Longini, M Elizabeth Halloran, Rustom Antia
Published:September 21, 2022
DOI:https://doi.org/10.1016/S0140-6736(22)01789-5
While most of the public seems to view mpox as a `niche' or `lifestyle' disease - and unlikely to affect them - the longer the virus circulates, the more opportunities it will have to widen its base and possibly evolve into something worse.
We underestimate its potential at our own peril.
