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Epidemiologic and Clinical Features of Mpox-Associated Deaths in the United States

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 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.
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.
"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."

Key Insights Distilled From

by Aspen P. Ris... at 06-26-2023
Epidemiologic and Clinical Features of Mpox-Associated Deaths

Deeper Inquiries

How can public health initiatives be improved to address the disproportionate impact of mpox on cisgender men with HIV?

To address the disproportionate impact of mpox on cisgender men with HIV, public health initiatives should focus on targeted outreach and education within communities most affected. This can involve increasing access to testing and early diagnosis for both mpox and HIV, especially among high-risk populations. Implementing culturally sensitive and inclusive messaging to reduce stigma and encourage testing and treatment adherence is crucial. Collaboration between public health agencies, healthcare providers, and community organizations can help ensure comprehensive care and support services are available to those in need. Additionally, promoting vaccination against mpox and providing resources for HIV prevention and treatment can help mitigate the impact of these diseases on cisgender men with HIV.

What are the potential challenges in ensuring equitable access to both mpox and HIV prevention and treatment?

Ensuring equitable access to both mpox and HIV prevention and treatment faces several challenges. One major obstacle is the existing disparities in healthcare access and resources, which can limit the availability of testing, treatment, and preventive measures for marginalized populations. Stigma surrounding mpox and HIV may also deter individuals from seeking care, leading to delayed diagnosis and treatment. Additionally, socioeconomic factors such as poverty, lack of insurance, and transportation barriers can hinder access to healthcare services. Limited awareness about available resources and the importance of early intervention can further impede equitable access to care. Addressing these challenges requires a multi-faceted approach that includes community engagement, policy changes to improve healthcare access, and targeted interventions to reach underserved populations.

How can the healthcare system better support individuals with HIV to prevent complications like IRIS during mpox treatment?

To better support individuals with HIV and prevent complications like Immune Reconstitution Inflammatory Syndrome (IRIS) during mpox treatment, healthcare providers should prioritize comprehensive care and close monitoring of patients. This includes early initiation of antiretroviral therapy (ART) for those with HIV, as well as regular follow-up appointments to assess treatment response and potential side effects. Education about the signs and symptoms of IRIS, as well as strategies to manage it, should be provided to both patients and healthcare providers. Collaboration between infectious disease specialists, HIV specialists, and primary care providers can ensure coordinated care and timely interventions to prevent and manage complications. Additionally, promoting adherence to treatment regimens and addressing any barriers to care can help reduce the risk of IRIS and other complications in individuals with HIV undergoing mpox treatment.