Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response — United States, May 17–October 6, 2022

Abstract

On May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity, † 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact, § 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity, ¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex * https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html † Persons whose reported sex differed from their gender or who reported being transgender were classified as transgender. Among cases with reported information on sex but not gender, sex was used to categorize persons as cisgender women or men. Among cases with reported information on gender but not sex, gender was used to categorize persons as cisgender women or men. Among 25,001 adults with information on sex or gender, 3,589 (14%) only had information on sex, and 6,142 (25%) only had information on gender. § Sexual or close intimate contact is defined as engaging in any sex (e.g., vaginal, oral, or anal) or close intimate contact (e.g., cuddling, kissing, touching partner's genitals or anus, or sharing sex toys) during the 21 days before symptom onset. ¶ Persons who indicated Hispanic ethnicity, regardless of race, were categorized as Hispanic or Latino. Persons missing data on ethnicity were assumed to be non-Hispanic.

Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons — 29 U.S. Jurisdictions, May 22–September 3, 2022

“…In this analysis of 276 mpox cases in persons who received 1 dose of JYNNEOS vaccine ≥14 days before illness onset and 6,329 cases in unvaccinated persons during the 2022 U.S. outbreak, vaccinated patients reported signs and symptoms similar to those described earlier in the outbreak ( 1 ); however, some symptoms were reported less frequently among vaccinated than among unvaccinated mpox patients. In addition, the percentage of vaccinated patients who were hospitalized (2%) was lower than that among unvaccinated patients (8%), and the odds of systemic signs and symptoms, such as fever and chills, were lower among vaccinated patients.…”

“…As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States. * Among U.S. cases to date, 95% have occurred among males ( 1 ). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox.…”

Epidemiologic and Clinical Features of Mpox in Transgender and Gender-Diverse Adults — United States, May–November 2022

“…Based on the estimated percentage of U.S. adults who identify as transgender or gender-diverse (0.5%), this population has been overrepresented among mpox cases during the ongoing outbreak ( 2 ). Among transgender and gender-diverse persons with available sexual and close intimate contact information, a commonly reported potential exposure was recent sexual or close intimate contact with a cisgender man (73.8%); these cisgender men might be in sexual networks experiencing the highest prevalence of mpox ( 1 ). These findings are similar to those from an analysis of mpox cases occurring in 62 transgender women in Europe and the Americas during May–October 2022 ( 6 ); in that study, the likeliest route of transmission for most transgender women (89%) was sexual contact, with a majority reporting having had a male sexual partner during the preceding month.…”

“…As of November 9, 2022, a total of 28,730 cases of monkeypox (mpox) had been reported in the United States, * primarily among adult cisgender men reporting recent male-to-male sexual contact ( 1 ). Transgender and gender-diverse persons, who constitute an estimated 0.5% of the U.S. adult population, † face unique health disparities and barriers to care ( 2 – 4 ).…”

Notes from the Field: Clinical and Epidemiologic Characteristics of Mpox Cases from the Initial Phase of the Outbreak — New York City, May 19–July 15, 2022

“…New York City (NYC) quickly became one of the major foci of the 2022 outbreak after the first case in a NYC resident was diagnosed on May 19. * Epidemiologic profiles and clinical characteristics of mpox cases in the United States during this outbreak have been described ( 2 , 3 ), but previous summaries were limited by incomplete data or inclusion of only a subset of cases ( 2 , 3 ). Most case investigation data from mpox cases reported to the NYC Department of Health and Mental Hygiene (DOHMH) surveillance system have a high degree of completeness for gender, race or ethnicity, sexual orientation, and clinical signs and symptoms.…”