Core Concepts
Mpox-associated deaths in the U.S. predominantly affect cisgender men with HIV, emphasizing the need for integrated testing and early treatment.
Abstract
Abstract and Introduction:
- 30,235 confirmed and probable mpox cases in the U.S.
- 38 mpox-associated deaths reported.
- Majority occurred in cisgender men with HIV.
- Median interval from symptom onset to death was 68 days.
- Public health actions include integrated testing and early treatment for mpox and HIV.
Data Collection and Analysis:
- Data collected from May 10, 2022, to March 7, 2023.
- Descriptive statistics on demographics and clinical characteristics.
- 38 mpox-associated deaths, 73.1% of reported deaths.
- 65.8% of deaths occurred during October–November 2022.
Clinical Characteristics:
- Median age of decedents was 34 years.
- Higher proportion of decedents were Black.
- HIV infection more prevalent among decedents.
- Median interval from symptom onset to death was 68 days.
Treatment Information:
- 92.6% of decedents received mpox-directed medical therapeutics.
- Tecovirimat, vaccinia immunoglobulin intravenous (VIGIV), cidofovir, and brincidofovir used.
- Lesions described as necrotic, diffuse, or worsened after treatment.
- Steroids used for mpox complications or concerns about IRIS.
HIV Infection and Treatment:
- Nearly all decedents with complete data on HIV infection were HIV-positive.
- CD4 counts <200 cells/mm3 in all decedents with HIV.
- ART initiated for most decedents not on treatment.
- ART delayed or interrupted for some decedents due to concerns about IRIS.
Stats
During May 10, 2022–March 7, 2023, 38 deaths among persons with probable or confirmed mpox (1.3 per 1,000 mpox cases) were reported to CDC.
Among 33 decedents with available information, 93.9% were immunocompromised because of HIV.
38 deaths (73.1%) were classified as mpox-associated, three (5.8%) were non–mpox-associated, and 11 (21.2%) deaths remain under investigation.
Quotes
"Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV."
"Deaths were classified as mpox-associated if mpox was listed on Part I or Part II of the death certificate."