Background
In May 2022, mpox cases were reported in non-endemic countries, including the United States. We examined mpox infections in the Veterans Health Administration (VHA).
Methods
Mpox diagnostic and whole genome sequencing (WGS) results, demographics, risk factors, hospitalizations, exposures, deaths, pharmacy, and immunization data were obtained from VHA data sources (5/23/22-5/31/23).
Results
Of 1,144 Veterans tested, 251 (21.9%) were presumptive positive for Non Variola Orthopox (NVO) or NVO and Monkeypox virus (MPXV) confirmed positive. Incidence rate was 7.5 per 100,000 Veterans in care, with highest rate observed in Veterans aged 25-34 (13.83 cases per 100,000). Higher odds of NVO or NVO/MPXV positivity was associated with maleness, non-Hispanic Black race/ethnicity, syphilis or HIV positivity, or genital/rectal sample site, while older age and vaccination with JYNNEOS or vaccinia (smallpox) had lower odds. Among 209 with confirmatory testing, 90.4% reported intimate contact and/or an epi link; 84.5% were men who have sex with men (MSM); 24.2% received tecovirimat; and 8.1% were hospitalized with 1 death. Eighty-six sequenced samples had evaluable WGS results. All were clade IIb, representing 10 different lineages from 20 states and the District of Columbia.
Conclusion
Mpox affected younger, MSM, non-Hispanic Black and HIV+/syphilis + males among US Veterans. Viral diversity was noted across geographic regions. At risk Veterans would benefit from vaccination and risk reduction strategies for mpox and other STIs.