Document text
Epidemiology of Mpo x
during the Curre nt
Outbreak
Sascha Ellington, PhD, MSPH
Epidemiology Task Force
2022 Multinational Mpox Response
Centers for Disease Control and Prevention
February 22, 2023
Epidemiology of the Current Outbreak
21
en
l,
n2022-2023 Spread of Mpox in U.S.
• The first U.S. case was confirmed in
May 2022.
• At first, spread was associated with
international travel.
• More than 30,000 U.S. cases have be reported; new cases are declining.
• Most cases have been in gay, bisexua
& other men who have sex with men.
• Cases have also been reported in me who do not have sex with men,
cisgender and transgender women,
transgender men, gender-diverse
people, children, and teens.
Data as of February 8, 2023
U.S. Mpox Case Trends as of February 9,
2023
* Sex / Gender Cases Percent
Cisgender men 28,010 95.1%
Cisgender women 854 2.9%
Transgender men 76 0.3%
Transgender women 266 0.9%
Another sex/gender 235 0.8%
Missing gender 728 -
Mpox cases reported to CDC by age and
sex/gender
*Sex/Gender is available for 97.6% of cases
Data as of February 8, 2023
Median Min Max
34 < 1 89
Mpox cases reported to CDC by race and
ethnicity
Race / Ethnicity*+ Count Percent
Black or African
American 9,331 33.1%
Hispanic or Latino 8,773 31.1%
White 8,258 29.3%
Asian 789 2.8%
Other Race 690 2.4%
Multiple Races 151 0.5%
American Indian or Alaska Native (AI/AN) 111 0.4%
Native Hawaiian or Other Pacific Islander 68 0.2%
(NH/OPI)
Missing 1,998 -
*All cases reporting Hispanic ethnicity are classified into
the Hispanic or Latino category
+Race/Ethnicity available for 93.4% of cases
Data as of February 8, 2023
Clinical Characteristics of Mpox Cases
Reported to CDC as February 9 , 2023
Characteristic Percentage
HIV Status*
HIV Positive 53%
HIV Negative 47%
Rash location**
Genitals or perianal area 65%
Trunk or limbs 62%
Head, face, mouth 54%
Palms or soles of feet 24%
Hospitalized Yes 7.7%
No 92%
*HIV status available for 9,039 (30%) of mpox cases
**Rash location available for 14,902 (49%) of mpox cases 32 mpox associated
deaths (0.1% of all cases) reported in the U.S.
Detection and transmission of mpox
during the current outbreak
• Spread primarily through sexual or close intimate contact
• Other routes of transmission have been reported
Household transmission
Injury with contaminated sharp instrument in clinical setting
Piercing and tattooing
Perinatal transmission
• Some people can spread mpox virus to others 1-4 days before symptom onset reported (i.e. pre-symptomatic transmission)
• No evidence that people who are infected but never develop symptoms can spread mpox
https://www.cdc.gov/poxvirus/monkeypox/about/science-behind-transmission.html
Detection and transmission of mpox
during the current outbreak
Mpox Virus in Human Samples and Implications for Transmission
Exposure source Mpox virus DNA detected by PCR Replication-competent virus
detected/isolated Epidemiologically supported source of infection
Skin Yes Yes Yes
Oropharynx and saliva Yes* Yes Yes
Anorectum Yes Yes Yes†
Semen Yes* Yes Insufficient data
Urine/urethra Yes Yes Insufficient data
Conjunctivae or ocular fluid Yes Yes Insufficient data
Blood/plasma/serum Yes Insufficient data Insufficient data
Feces Yes Insufficient data Insufficient data
Vagina Yes Insufficient data Insufficient data†
Breastmilk Insufficient data Insufficient data Insufficient data
Contaminated sharp‡ Insufficient data Insufficient data Yes
* DNA has been detected at Ct values <35 in recovered patients more than 30 days after illness onset in an upper respiratory tract swab, saliva, and semen.
† The preponderance of existing data support exposure to anorectal and vulvovaginal tissues and %uids as capable of transmitting infection; however, it is difficult with current evidence to definitively isolate these exposures
from other concomitant exposures (see text).
‡ Includes body modi+cation with piercings and tattooing.
https://www.cdc.gov/poxvirus/monkeypox/about/science-behind-transmission.html
MMSC* among
Men** Cases Percent
Men, recent MMSC 14,143 75.4%
Men, no recent MMSC 4,612 24.6%
Missing 9,331 -
Mpox cases among men reported to CDC by
sexual contact history
*MMSC= male-male sexual contact
**Sexual contact history and gender
available for 66.8% of cases among men
Data as of February 8, 2023
Epidemiology of Mpox in Less Affected
Populations
30
Percentage among
Cisgender wom en
(n=769) Characteristic
Age
Median (Range) 32 (15–89)
Race and ethnicity
Black, non-Hispanic 44%
White, non-Hispanic 25%
Hispanic or Latino 23%
HIV Status*
HIV positive 8%
HIV negative 92%
Recent sexual or close intimate partner** 71%
Mpox in Cisgender Women in the United
States, May 11–November 7, 2022
2.7% of all cases
reported to CDC were among cisgender women
*HIV status available for 17 3 (22%) cisgender women
**Define d as within last 3 weeks; data available for 463 (60%) cisgender women
Source: http://dx.doi.org/10.15585/mmwr.mm7201a2
Mpox in Pregnant and Recently Pregnant
People in the U.S.
• From May 11-November 7, 2022, 21 cases of mpox reported to CDC occurred in pregnant
people and 2 reported cases occurred in people who were recently pregnant (within 3 weeks of delivery)
• Among those with exposure data (n=12): 9 with sexual contact and 3 with household contact
• Similar signs and symptoms of mpox as those in non-pregnant people
4 cases with genital lesions during pregnancy
• Tecovirimat provided to 48% of people with mpox during pregnancy with no adverse events
reported
• None received post-exposure prophylaxis with JYNNEOS
• Outcomes
Four hospitalizations for mpox indications. All discharged while still pregnant.
No pregnant patients required intensive care, intubation, or unplanned delivery
3 pregnancy outcomes: 2 uncomplicated live births (no transmission to the infant); 1 first trimester spontaneous
abortion
Two recently pregnant persons experienced symptoms within 3 days of delivery and their newborns developed lesions within a week
Source: http://dx.doi.org/10.15585/mmwr.mm7201a2
Percentage among
transgender and gender-
Characteristic diverse persons
Age
Median (Range)
Race and ethnicity
Bl
ack, non-Hispanic
White, non-Hispanic
Hispanic or Latino
HIV Status
HIV positive
HIV negative
Recent sexual or close
intimate partner 32 (18–71)
28%
28%
37%
48%
52%
84%
Mpox in Transgender and Gender-Diverse
Adults — United States, May 17–November 4, 2022
Gender identity of transgender and
gender-diverse adults with mpox (n=466)
43%
15% 42% Transgende r women
Transgende r men
Gender-divers e persons
96% of gender-diverse adults were assigned male sex at birth.
Source: http://dx.doi.org/10.15585/mmwr.mm715152a1 *HIV status available for 166 (36%) transgender and gender-diverse adults
**Defined as within last 3 weeks; data available for 378 (80%) transgender and gender-
diverse adults
%by age group, yrs
0–4 5–12 13–17
Characteristic (n =16) (n =12) (n =55)
Sex
Male 75% 50% 89%
Female 25% 50% 11%
Race or ethnicity
Black, non-Hispanic 44% 42% 49%
Hispanic or Latino 31% 42% 34%
White, non-Hispanic 19% 17% 9%
Asian, non-Hispanic — — 4%
American Indian or Alaska Native, non-Hispanic — — 2%
Native Hawaiian or other Pacific Islander, non-Hispanic 6% — —
Other, non-Hispanic — — 2%
Exposure setting and route
Sexual contact — — 97%
Household contact 93% 100% —
Other 7% — 3% Epidemiologic Characteristics of Pediatric Cases
in the U.S., May 17–September 24, 2022
Source: http://dx.doi.org/10.15585/mmwr.mm7144a4
Vaccine Administration
35
120,000Doses administered 100,000
80,000
60,000
40,000
20,000
0 Total JYNNEOS Vaccine Doses Administered
and Reported to CDC by week
1,185,907 doses administered and reported to CDC since May 20, 2022
First doses
Second doses 5/22-5/28
5/29-6/4
6/5-6/11
6/12-6/18
6/19-6/25
6/26-7/2
7/3-7/9
7/10-7/16 7/17-7/23
7/24-7/30
7/31-8/6
8/7-8/13
8/14-8/20
8/21-8/27
8/28-9/3
9/4-9/10
9/11-9/17
9/18-9/24
9/25-10/1
10/2-10/8
10/9-10/15
10/16-10/22 10/23-10/29
10/30-11/5
11/6-11/12
11/13-11/19
11/20-11/26
11/27-12/3
12/4-12/10
12/11-12/17
12/18-12/24
12/25-12/31
1/1-1/7
1/8-1/14
1/15-1/21
1/22-1/28
1/29-2/6
Data as of February 7, 2023
Mpox Cases and Vaccine Recipients by Race
and Ethnicity
100% 0.2%
90%
80% 70% 60%
50%
40%
30% 20% 10%
0% 2.4%
2.8%
29% 0.4%
0.5% 2.7%
3.6% 0.3%
0.4%
7.3%
52%
31%
22%
33%
13%
Mpox Cases (N=28,171*) Mpox Vaccine Recipients** (N=704,728) Nativ e Hawaiia n or Other Pacific
Islander
America n India n or Alaska Native
Multipl e Races
Othe r Race
Asian
White Hispani c o r Latino
Blac k o r Africa n American
*
Race and ethnicity available for 93% of mpox cases reported
**Based on 1st dose; Data as of February 9, 2023; race and ethnicity available for 91% of first doses administered