Background/Objective(s): Mpox contact investigation in Santa Clara County began in June 2022. Contacts were categorized into risk levels, with high-risk contacts prioritized for investigation. This study describes exposure type, vaccination status, and case conversion data stratified by risk level to identify trends that can inform departmental response to future outbreaks.

Methods: Exposure risk was categorized into high, intermediate, or low levels at the time of contact identification following CDC definitions. Vaccination status and case conversion were verified using existing databases.

Results: 301 mpox contacts were included in this study. Most were male (61.8%), between 25-34 years old (27.9%), and Hispanic or Latino (38.2%). The most common exposure was living in the same household, including household sexual contacts (37.5%), followed by non-household sexual contact (20.3%). About half (50.8%) were categorized as high-risk. Seven contacts (2.3%) became cases; all were high-risk sexual contacts. One of the seven received one dose of the mpox vaccine prior to exposure. Two received one dose of post-exposure prophylaxis (PEP) within 5 to 14 days after exposure and one received PEP greater than 14 days from exposure.

Conclusion: Seven mpox contacts (2.3%) converted into cases and all had high-risk sexual encounters. We found that one of the case conversions had received some mpox vaccination prior to exposure and none had post-exposure prophylaxis within 4 days from exposure, highlighting the importance of designing communications to reach communities with greatest risk of disease. Case self-reporting must be encouraged for quick contact identification and ring vaccination to prevent case conversion.

Background: Recent reports show that coinfection with STIs/HIV occurs between 33-44% in the current U.S. mpox outbreak.

Objective(s): Data regarding new STI/HIV infections and diagnostic setting are scant. We aim to examine newly diagnosed STIs/HIV among mpox cases to inform prevention and care program planning.

Methods: In this retrospective descriptive study in Santa Clara County (SCC) from July 2022 to January 2023, mpox, STI, and HIV surveillance case data were matched and analyzed to identify mpox cases who were concurrently diagnosed with a new STI/HIV infection within 7 days of their mpox onset date.

Results: Of the 213 mpox cases in SCC, 29 (14%) cases were newly diagnosed with a concurrent STI/HIV, 28% being with chlamydia, 24% gonorrhea, 24% syphilis, 10% HIV, 10% chlamydia and gonorrhea, and 4% chlamydia and HIV. Comparatively, among those with or without a new STI/HIV diagnosis, 52% and 28% presented to the ED, respectively, 14% and 27% to primary care, 20% and 26% to urgent care, 7% and 8% to an STI/ID Clinic, and 7% and 11% to another/unknown location.

Conclusion: Data shows that the communities disproportionately impacted by STIs/HIV are similar to those during the SCC mpox outbreak. Coinfected cases had coordinated care from the public health, HIV, and gender-affirming clinics to reduce patient exhaustion and prioritize HIV evaluation and care. If those co-infected with mpox are more likely to transmit or acquire STIs/HIV, clinical education and guidelines can target access to testing, prophylaxis, and treatment to the most vulnerable individuals in our communities.

Background

Recent reports on the 2022 mpox outbreak have described risk factors, clinical outcomes, and association with HIV; additional research is needed to elucidate the landscape of this outbreak in a Southern US urban population, where HIV burden is high.

Objective

To better describe demographic and clinical characteristics of people diagnosed with mpox in Atlanta, GA through analysis of public health data.

Methods

The study population includes adults residing in DeKalb and Fulton Counties, who tested positive for mpox between June 2022 and January 2023. Demographic data (including gender, race/ethnicity) and clinical characteristics (including symptoms, hospitalization, HIV status) were collected in the State Electronic Notifiable Disease Surveillance System (SendSS) and analyzed.

Results

Overall, 415 and 817 individuals tested positive for mpox in DeKalb and Fulton Counties, respectively. More than 97% of cases were in males, >78% in Blacks, and >70% reported intimate contact or sex (>90% male sexual partners). Among mpox cases whose HIV status was available (n=876), more than 45% were living with HIV, of which 77% reported an undetectable viral load. Rash was the most frequent symptom reported (>75%), followed by fever (>45%). Hospitalization for mpox-related complications occurred in 9.3% of people living with HIV compared to 4.9% of HIV-negative individuals.

Conclusions

This study showed that mpox disproportionately affected men who have sex with men and people living with HIV. In our cohort, Blacks were also overrepresented, highlighting ongoing health disparities between black and white MSM in Atlanta. Hospitalizations were also more common in people living with HIV.

Background:

On December 30, 2022, epidemiologists at a local health department identified an mpox case who worked while infectious as a physical therapy (PT) aide at a long-term care facility (LTCF).

Objectives:

Objectives included identifying close contacts, determining if any contacts needed post-exposure prophylaxis (PEP), and monitoring contacts for symptoms.

Methods:

Epidemiologists interviewed the case to determine exposure risk (e.g., what personal protective equipment was worn during PT sessions, length of sessions, amount of direct contact with patients) and consulted the Centers for Disease Control and Prevention for guidance due to the unique nature of the exposure (provider exposed patients) and high-risk setting. LTCF staff reviewed patient charts and employee schedules to identify contacts. Contacts were considered high-risk if they were severely immunocompromised, had large wounds or open sores, or had breaks in the skin due to a dermatological condition (e.g., plaque psoriasis). High-risk contacts were offered PEP. All contacts were enrolled in symptom monitoring for 14 days.

Results:

Twenty residents and eight LTCF staff were identified as close contacts of the index case. Three resident contacts were identified as high-risk and offered PEP. After discussing the risks and benefits of PEP with the LTCF’s medical director and primary care provider, none of the high-risk contacts elected to receive PEP. At the end of the 14-day monitoring period, none of the contacts had developed symptoms.

Conclusion:

No additional mpox infections were identified at the LTCF even though the index case worked while infectious for multiple days.