Connecticut Epidemiologist Newsletter • May 2023 • Volume 43, No 4
Mpox in Connecticut, 2022
Mpox (formerly known as monkeypox) is a rash illness caused by infection with monkeypox virus, an Orthopoxvirus closely related to the virus that causes smallpox. Beginning in May 2022, an unprecedented increase in mpox cases occurred in countries where the virus is not endemic and among persons without traditional risk factors for mpox virus infection (1). Effective July 1, 2022, mpox was made reportable in Connecticut (2). This article describes mpox cases in Connecticut residents during 2022.
During 2022, a total of 145 mpox cases were reported to the Connecticut Department of Public Health (CT DPH), with most cases occurring July–September (Figure 1). Almost all cases were in males (142, 98%) and the median age was 34 years (range 16–69 years) (Table 1). The incidence rate was 8.85 per 100,000 population among non-Hispanic Black persons, 6.74 among Hispanic persons, and 2.36 among non-Hispanic White persons. Among 106 case patients for which data were available, 95 (90%) identified as lesbian, gay, bisexual, transgender, queer, or another diverse identity (LGBTQ+).
Thirty-three (32%) case patients self-identified as HIV positive and 19 (18%) reported being on HIV pre-exposure prophylaxis among 104 case patients with data available. The most common symptoms were rash, fever, and lymphadenopathy, with rash most often reported on the trunk, arms, and genitals. Twenty-one (19%) of 113 case patients with data available were hospitalized. There were no reported deaths. Forty-eight (33%) of 145 case patients received tecovirimat, an antiviral drug used to treat smallpox and mpox.
Two case patients were fully vaccinated at the time of symptom onset, defined as having received two JYNNEOS vaccine doses at least 14 days prior. Twenty-six other case patients had received at least one vaccine dose. Four received their first vaccine dose more than two weeks before symptom onset, nine received their first dose within two weeks prior to symptom onset, and nine received their first dose after symptom onset. The timing of vaccination was not reported for four people.
Discussion
Prior to 2022, mpox cases in people outside of Africa were linked to international travel to countries where the disease is endemic or to contact with imported animals (1). In 2022, more than 29,000 mpox cases were reported in the US, including 145 in CT (3). Mpox can spread to anyone through close, often skin-to-skin contact, including direct contact with mpox rash and scabs (1). During this outbreak, mpox spread primarily through sexual or close intimate contact, with most cases among men and disproportionately affecting people who identify as LGBTQ+ (4).
To prevent further spread, mpox education and vaccination should be integrated into routine sexual health care for people at risk. In Connecticut, the JYNNEOS vaccine continues to be available for prevention of mpox in people at risk and for post-exposure prophylaxis within 14 days after exposure to mpox. Evidence that some people may transmit mpox one to four days prior to symptom onset underscores the importance of vaccination for persons at risk (4). Vaccination is particularly important for people at risk who are living with HIV or have another condition that weakens the immune system. An estimated 53% of US cases and 32% of cases in Connecticut have been in persons living with HIV and most severe mpox cases in the US have occurred in people living with untreated HIV (3,5). CDC recommends that patients with suspected mpox be evaluated and treated as indicated for HIV and sexually transmitted diseases (5).
To reduce the spread of mpox and combat stigma, CT DPH educated providers and the public about mpox, and collaborated with local health departments and community partners to conduct equity-focused outreach and provide mobile vaccine clinics for disproportionately affected communities. Moving forward, CT DPH will continue mpox surveillance and work with local partners to destigmatize mpox, integrate mpox into routine sexual health care, and promote vaccination for those at risk.
Reported by
Bailey Glenn, MPH; Sydney A. Jones PhD
Referances
1. WHO. Monkeypox. Updated May 19, 2022. Accessed Mar 7, 2023, from https://www.who.int/news-room/fact-sheets/detail/monkeypox.
2. Changes to the List of Reportable Diseases, Emergency Illnesses and Health Conditions, and the List of Reportable Laboratory Findings. Connecticut Epidemiologist Newsletter. 2022:42(3) Accessed March 7, 2023, from https://portal.ct.gov/-/media/DPH/EEIP/CTEPI/Vol42/July-2022/CTEPI-July-2022-7122.pdf.
3. Centers for Disease Control and Prevention (CDC).Epidemiology of Mpox during the Current Outbreak. Feb 23, 2023. Accessed Mar 7, 2023, from https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-02/slides-02-22/mpox-02-ellington-508.pdf.
4. Centers for Disease Control and Prevention (CDC). Science Brief: Detection and Transmission of Mpox (Formerly Monkeypox) Virus During the 2022 Clade IIb Outbreak. Updated Feb 2, 2023. Accessed Mar 7, 2023, from https://www.cdc.gov/poxvirus/mpox/about/science-behind-transmission.html.
5. Centers for Disease Control and Prevention (CDC). Severe Manifestations of Monkeypox among People who are Immunocompromised Due to HIV or Other Conditions. Sep 29, 2022. Accessed Mar 7, 2023, from https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_475.pdf.
This page last updated 05/31/2023.