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CDPH Alert: Severe Monkeypox (MPX) Infection in People w/ Untreated HIV

CDPH Alert - November 08, 2022
Severe Monkeypox (MPX) Infection in People with Untreated HIV and a Weakened Immune System

Dear California Healthcare Providers,

The monkeypox (MPX) outbreak has slowed in California thanks to the leadership of community members, healthcare providers, public health officials, and local health departments. As efforts continue to increase MPX vaccine access, a new CDC report highlights the potential severity of MPX infection in people with a weakened immune system, particularly in those with untreated HIV. The report describes cases of 57 patients hospitalized with severe MPX complications. Twelve of the 57 patients died; the contribution of MPX to death is still under investigation for some cases. Almost all of the severe cases had a severely weakened immune systems, most often related to untreated HIV infection. Most patients were male (95%) and Black (68%), and delays in initiation of MPX treatment of up to 4 weeks were observed.

This CDC report serves as a reminder that consequences of MPX can be severe for immunocompromised people. While new clinical data evolves on the level of protection provided by JYNNEOS vaccine in the current outbreak, vaccination is considered an important intervention to reduce severity of illness. Ensuring people at risk for MPX infection, including all people with HIV, get vaccinated is critical. Healthcare providers should consider prompt MPX treatment with tecovirimat for all patients with probable or confirmed MPX who have severe MPX disease or involvement of anatomic areas which might result in serious sequelae that include scarring or strictures. Additionally, treatment should be considered for patients who are at risk for severe disease, including: pediatric populations (particularly patients younger than 8 years of age), pregnant or breastfeeding people, people with a condition affecting skin integrity, and people currently experiencing severe immunocompromise – especially those with untreated HIV. For more information on treatment and treatment considerations, refer to the CDPH Health Care Professionals page. Healthcare providers are strongly encouraged to test all patients with suspected MPX for HIV and bacterial sexually transmitted infections (STIs) at the time of testing for MPX, as well as provide HIV treatment as soon as possible.

The California Department of Public Health (CDPH) continues to support and work with community stakeholders, local health departments, and healthcare providers to provide
access to MPX vaccine, treatment guidance, and to address disparities in California. To prevent MPX transmission in California, we need to build on our successes to date and address health equity gaps involving access to MPX vaccine and treatment for people to obtain optimal care.

Tomás J. Aragón, MD, DrPH 
Director and State Public Health Officer
California Department of Public Health

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