Researchers warn of severe monkeypox in some patients

ICU sign in hospital
ICU sign in hospital

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Today in Morbidity and Mortality Weekly Report, researchers from the Centers for Disease Control and Prevention (CDC) and their state colleagues detail clinical consultations for 57 hospitalized patients with severe manifestations of monkeypox, most of whom were Black men with AIDS.

The 57 patients included 12 men who died, and the CDC attributes 5 of those deaths directly to the virus.

Patients were seen from Aug 10 through Oct 10, 2022, and 47 (82%) had HIV infection, 4 (9%) of whom were receiving antiretroviral therapy before monkeypox diagnosis. Most patients were male (95%), and 68% were Black. Seventeen patients (30%) received intensive care unit–level care.

Two patients (4%), one of whom had HIV, were undergoing chemotherapy for a hematologic malignancy, 3 (5%) were solid organ transplant recipients, and 3 (5%) were pregnant. In addition, 13 patients (23%) were homeless.

The authors detailed three cases of men with HIV and monkeypox, one of whom, an Hispanic man in his 20s, died. Two others—a Black man in his 30s and White man in his 40s, both with AIDS—are still receiving tecovirimat (Tpoxx) antiviral treatment.

Treatment delay in some

Notably, the authors found a significant delay in antiviral treatments for patients with severe infections. "Most patients eventually received tecovirimat, but some experienced delays of up to 4 weeks between initial care-seeking for monkeypox symptoms and initiation of monkeypox-directed therapy," the authors wrote.

"For patients with suspected or laboratory-diagnosed monkeypox who are at risk for severe disease (particularly those with AIDS and other types of severe immunocompromise), health care providers should consider starting monkeypox-directed therapy early, potentially before receipt of monkeypox testing results or before severe manifestations are observed," the authors said.

"Monkeypox and HIV have collided, with tragic effects," said CDC Monkeypox Incident Commander Jonathan Mermin, MD, MPH, in a CDC statement emailed to reporters. "Today's report reminds all of us that access to monkeypox and HIV prevention and treatment matters—for people's lives and for public health."

The CDC said healthcare providers should consider prompt monkeypox treatment for all patients who have probable or confirmed monkeypox and are at risk for severe disease, especially those with advanced HIV. And all patients with suspected monkeypox should be tested for both HIV and monkeypox.

The agency added, "The high proportion of people with severe monkeypox who were experiencing homelessness (23%) underscores a need for innovative, creative solutions for providing health services to people who are unstably housed."

Also today, the CDC reported 57 more monkeypox cases, raising the national total to 28,061.

Cases continue to decline in Europe

In global news, the European Centre for Disease Prevention and Control (ECDC) reported that cases are decreasing in 12 countries and rising in only 1: Belgium.

As of yesterday, 20,675 cases of monkeypox have been confirmed from 29 European Union countries, with most cases reported from Spain (7,317), France (4,084), Germany (3,662), the Netherlands (1,235), and Portugal (932).

Five deaths have been reported in the region, including two in Spain and one each in Belgium and Czechia.

African countries have reported 32 new cases and 1 deaths over the past week, according to the World Health Organization African region's latest weekly infectious disease update. The death was reported in Mozambique, a newly affected country.

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