In a recent case series posted to the medRxiv* preprint server, researchers presented a summary of their experience of identifying, managing and vaccinating mpox (MPX) virus (MPXV)-infected individuals in New York during the summer season of 2022.
Study: Monkeypox in the New York metropolitan area, Summer 2022. Image Credit: FOTOGRIN/Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
The 2022 MPXV outbreak was initiated in May 2022 and has affected several nations across the globe. In the United States of America (USA), MPX case counts began to rise swiftly in New York before the onset of outbreaks of the virus in the urban regions of Texas, California, Florida, and Illinois. Studies conducted on MPX epidemiology can aid policy-making and improve global MPX preparedness.
About the case series
In the present case series, researchers presented their experience managing MPX cases at their level 1.0 trauma care center, comprising 700 beds and serving a considerable proportion of New York state’s metropolitan region, including New York City and the Hudson River valley (lower region) residents.
The initial MPXV-positive individual was identified in the center in June of 2022, and the patient recently attended a social event conducted in Florida for bisexual and gay males. All MPXV-positive individuals were identified and managed in outpatient settings comprising clinics specializing in MPXV isolation clinics and remotely provided telemedicine care. A large proportion of infected individuals referred to the centers were under HIV (human immunodeficiency virus) acquired immunodeficiency syndrome (AIDS) treatment or were being followed up for pre-exposure prophylaxis (PrEP).
All the patients were male, of which 21 and two were MSM individuals and heterosexuals, respectively. Ten, two, and one individual reported a history of HIV AIDS, and diabetes and were on tumor necrosis factor-alpha (TNF-α) medications, respectively. Three individuals were co-infected with chlamydia (n=1), gonorrhea (n=1), and syphilis (n=1).
Genital ulcers, anal ulcers, oral ulcers, abscesses, urethritis, proctitis, and fever were reported among ten, six, four, two, two, four, and ten MPX patients, respectively. Two MPX patients with fever and severe proctitis were hospitalized. Ten individuals were provided 11 tecovirimat courses, each course for 14 days, within three days of initiating tecovirimat treatment, the indications for which included proctitis and anal ulcers. Tecovirimat reduced anorectal bleeding and pain within three days among four patients.
An HIV-infected patient responded slowly to his initial course of the drug, and recurrence of symptoms was observed after terminating tecovirimat treatment. Physical examination showed novel ulcers in the anal region, the swabs of which were positive for MPXV and negative for HSV (herpes simplex virus)-1 and 2. Resolution of symptoms was observed after the subsequent course of tecovirimat.
For curtailing MPXV transmission in community-based settings, the team jointly installed a drive-through vaccination center with the county’s health department with a structure similar to that used for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination drive. The vaccination drive focused on high-risk individuals (identified based on New York state’s Department of Health) and provided >1,800 Jynneos vaccine doses to 1,103 individuals.
Among Jynneos vaccine recipients, 734, 117, and 53 individuals resided in the state of New York outside New York City, within New York City, and out of the state, respectively, and the residential addresses of 199 individuals were unavailable. Among the vaccine recipients, 107, 82, 418, 21, 70, and 405 were African American, Hispanic, White, Asian, mixed/other races, and unknown races, respectively.
Among the Jynneos vaccinees, 105, 547, 371, and 80 were aged below 24 years, 25 years to 44 years, 45 years to 64 years, and above 65 years, respectively. Five individuals had been administered the initial Jynneos vaccination within seven days before the onset of symptoms. Overall, mixed responses to the drug under investigation (i.e., tecovirimat) were observed among the patients, with a few showing swift clinical responses. In contrast, the other patients demonstrated poor responses or no responses.
A challenge faced by the team was the scarcity of testing resources for high-risk individuals presenting with MPX symptoms and non-cutaneous clinical presentations because of existing limitations on specimen types eligible for MPXV infection testing. As observed during the SARS-CoV-2 pandemic, a rapidly progressing, profound-impact MPXV outbreak was observed in New York city’s metropolitan region, needing urgent distribution of health resources and coordinated efforts of the local-level and state-level health departments.
However, population health outreach, engaging at-risk individuals, timely and accurate diagnostics, investigational drug availability, and actively performing mass-scale vaccinations enabled control of the ongoing MPXV outbreak.
Conclusion
Based on the case series findings, global cooperation and continued MPXV surveillance efforts are critical for controlling MPXV transmission. Further research is required to develop and test drugs that can widen the therapeutic landscape of MPX.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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