National Center for Emerging and Zoonotic Infectious Diseases

2022/2023 Mpox Outbreak: Situational Awaand UpdatesACIP MeetingOctober 25, 2023Faisal Syed Minhaj, PharmD, MPH, DABATEpidemiologistPoxvirus and Rabies BranchDivision of High Consequence Pathogens and Patholog

y
United States Mpox Case Counts May 2022–Se

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

May-23

Jun-6

Jun-20

Jul-4

Jul-18

Aug-1

Aug-15

Aug-29

Sep-12

Sep-26

Oct-10

Oct-24

Nov-7

Nov-21

Dec-5

Dec-19

Jan-2

Jan-16

Jan-30

Feb-13

Feb-27

Mar-13

Mar-27

Apr-10

Apr-24

May-8

May-22

Jun-5

Jun-19

Jul-3

Jul-17

J

0

100200300400500600700

Case Count7-day Average

2022 2023

N = 30,681
United States Mpox Case Counts Jan 1–Sept 2

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

N = 785

7-day average of daily cases reported
United States Mpox Case Counts Jan 1–Sept 2

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

5–7

N = 785

7-day average of daily cases reported

X

7-day daily average case range
United States Mpox Case Counts Jan 1–Sept 2

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

5–7 1–3

N = 785

7-day average of daily cases reported

X

7-day daily average case range
United States Mpox Case Counts Jan 1–Sept 2

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

5–7 1–3 2–5

N = 785

7-day average of daily cases reported

X

7-day daily average case range
United States Mpox Case Counts Jan 1–Sept 2

https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html

5–7 1–3 2–5 

N = 785

7-day average of daily cases reported

X

7-day daily average case range

Cases Following Vaccination

 Reported since the outbreak started, 

including clusters

 Generally, most have had mild illness

– Few requiring hospitalization– Many did not need any treatment– Low number of lesions 

Hazra A. Lancet Infect Dis. 2023 Sep 4:S1473-3099(23)00492-9. 
Mpox Reinfection

 Potential reinfection cases have been 

published in the literature, but only a few with convincing evidence of true reinfection

 CDC is aware of <10 cases of 

probable reinfection

 Probable reinfection cases seem to 

be milder than initial infection

Hazra A. Lancet Infect Dis. 2023 Sep 4:S1473-3099(23)00492-9. 
CDC Continues to Consult on Severe Mpox C

Deaths

https://www.cdc.gov/mmwr/volumes/71/wr/mm7144e1.htm

 CDC’s mpox clinical consult service continues to consult on 2-

monthly over the last 6 months

 Repeat consultations are more frequent, and include severe c

infections ongoing for months

 54 people have died from mpox in the United States since Ma

just this September 

 Black persons, people living with HIV (mostly advanced HIV [A

experiencing homelessness are disproportionately affected
Mpox Cases Reported to CDC by Age and Gen

17, 2022–Sept 28, 2023

https://www.cdc.gov/poxvirus/mpox/response/2022/demographics.html

Datof c
Mpox Cases Reported to CDC by Race and Eth

May 17, 2022–Jun 14, 2023

57 1095 9233 10965 4739 1748 686 297 159 61 57 43 90 108 105 82 21 Count within columns

https://www.cdc.gov/poxvirus/mpox/response/2022/demographics.html

Subject to reportiirregularities

Do
Mpox Cases Globally Apr–Sept 2023

15
https://worldhealthorg.shinyapps.io/mpx_global/
First and Second Doses of JYNNEOS Vaccine 

Administra=ons−United States, May 2022−Se

Overall vaccine cov

1-dose: 38.8% and 2-d

*Coverage is the estimated proportion who have received vaccination divided by the population recommended to receive the vacciusing 2021 data for MSM with HIV pre-exposure prophylaxis (PrEP) indications and 2020 data for HIV prevalence among MSM from estimates are increased by 25% to account for additional vaccine eligible people not captured by these data sources totaling approx
Shift in Vaccine Administration Sites From Pu

Health Clinics to Medical Centers

• Public health providers a

vaccines through Mar 20

• Medical care providers a

increasing proportion of of the outbreak

• Pharmacies consistently 

vaccines

Public Health 

Provider or

Clinic

Medical

Center

Provider

Commercial 

Vaccination 

Service

Provider

Pharmacy Other

Percentage of Doses Administered
Categories of Medical Providers Administerin

From 2022 to 2023, there wsignificant increases in vacc• Primary care offices• Federally qualifying heal• Other health centers

Primary 

Care

Hospital FQHC Health 

Center -

Other

Health 

Center -

STD/HIV

Percentage of Doses Administered
Modeling
Estimating Averted Cases from Vaccination a

Behavioral Adaptation in DC

https://www.medrxiv.org/content/10.1101/2023.02.10.23285772v1.full.pdf Lines and shaded regions reflect median and interquartile range from 120 simulations

 Estimated preva

over time with behavioral adap
Estimating Averted Cases from Vaccination a

Behavioral Adaptation in DC

https://www.medrxiv.org/content/10.1101/2023.02.10.23285772v1.full.pdf Lines and shaded regions reflect median and interquartile range from 120 simulations

 Behavioral adap

have had early icurve and flatte
Estimating Averted Cases from Vaccination a

Behavioral Adaptation in DC

https://www.medrxiv.org/content/10.1101/2023.02.10.23285772v1.full.pdf Lines and shaded regions reflect median and interquartile range from 120 simulations

 Behavioral adap

have had early icurve and flatte

 Vaccination alo

a later impact, bended the outb
Estimating Averted Cases from Vaccination a

Behavioral Adaptation in DC

https://www.medrxiv.org/content/10.1101/2023.02.10.23285772v1.full.pdf Lines and shaded regions reflect median and interquartile range from 120 simulations

 Behavioral adap

have had early icurve and flatte

 Vaccination alo

a later impact, bended the outb

 Combined, beh

and vaccination cases 1 year int
Risk for Recurrent Mpox Outbreak Lasting >3 

by Immunity Level — United States, 2023

Pollock ED. MMWR Morb Mortal Wkly Rep 2023;72:568–573.

% Risk of 

Recurrence

% Population at increased mpox risk with partial or full immunity

Risincthe higwitpro
Cumulative Monkeypox virus Infections Relat

2022, by Immunity Level — United States, 20

Pollock ED. MMWR Morb Mortal Wkly Rep 2023;72:568–573.

Cumulative 

monkeypox 

virus infections, 

relative to 2022

% Population at increased mpox risk with partial or 
Cumulative Monkeypox virus Infections Relat

2022, by Immunity Level — United States, 20

Pollock ED. MMWR Morb Mortal Wkly Rep 2023;72:568–573.

>50% 

significa

the r

ou

Cumulative 

monkeypox 

virus infections, 

relative to 2022

% Population at increased mpox risk with partial or 
Vaccine: Effectiveness and Safety Up
Vaccine effectiveness of JYNNEOS against mpox ranges 

for 1-dose vaccination and 66%–89% for 2-dose va

Cases Controls Adjusted* VE (95% CI)

1-dose JYNNEOS

Epic Cosmos case-control study 146 1000 36% (22–47)

Multi-jurisdictional case-control study 58 237 75% (61–84)

New York State case-control study 10 23 68% (25–86)

.

2-dose JYNNEOS

Epic Cosmos case-control study 25 335 66% (47–78)

Multi-jurisdictional case-control study 14 122 86% (74–89)New York State case-control study 2 19 89% (44–98)

Vaccine 

0 20 4
Vaccine effectiveness of JYNNEOS against mpox ranges 

for 1-dose vaccination and 66%–89% for 2-dose va

Cases Controls Adjusted* VE (95% CI)

1-dose JYNNEOS

Epic Cosmos case-control study 146 1000 36% (22–47)

Multi-jurisdictional case-control study 58 237 75% (61–84)

New York State case-control study 10 23 68% (25–86)

.

2-dose JYNNEOS

Epic Cosmos case-control study 25 335 66% (47–78)

Multi-jurisdictional case-control study 14 122 86% (74–89)New York State case-control study 2 19 89% (44–98)

Vaccine 

0 20 4
Vaccine effectiveness of JYNNEOS against mpox ranges 

for 1-dose vaccination and 66%–89% for 2-dose va

Cases Controls Adjusted* VE (95% CI)

1-dose JYNNEOS

Epic Cosmos case-control study 146 1000 36% (22–47)

Multi-jurisdictional case-control study 58 237 75% (61–84)

New York State case-control study 10 23 68% (25–86)

.

2-dose JYNNEOS

Epic Cosmos case-control study 25 335 66% (47–78)

Multi-jurisdictional case-control study 14 122 86% (74–89)New York State case-control study 2 19 89% (44–98)

Vaccine 

0 20 4
Multi-jurisdictional Case-Control Study: Met

– Population: Men who have sex with men; ages 18-49; 12 U.S. ju– Time Period: August 19, 2022, to September 27, 2023– Methods:

– Cases identified from jurisdictions’ probable and confirmed – Controls identified from healthcare settings providing HIV P

transmitted infection (STI) clinics

– Demographics, immunocompromised status, exposure histo

vaccination history collected using electronic surveys

– Vaccination status confirmed by state immunization registri

– Analysis: 

– VE estimated using conditional logistic regression– Adjusted for age, race/ethnicity, immunocompromising cond– Stratified by route of administration and immunocompromis
Both partial and full vaccination with JYNNEOS 

effectiveness against mpox, regardless of adminroute

*Adjusted for age, race/ethnicity, immunocompromised status, reported close contact with a confirmed/suspected mpox case in 3 weeks prior to index event
Both partial and full vaccination with JYNNEOS 

effectiveness against mpox, regardless of adminroute

*Adjusted for age, race/ethnicity, immunocompromised status, reported close contact with a confirmed/suspected mpox case in 3 weeks prior to index event
VE trended higher for immunocompetent par

compared to self-reported immunocomprom

participants

*Adjusted for age, race/ethnicity, immunocompromised status, reported close contact with a confirmed/suspected mpox case in 3 weeks prior to index event Confidence interval remains very wide More work is needed to understand VE in objectively confirmed immunocompromised pe
JYNNEOS Vaccine Safety Monitoring 

 CDC vaccine safety monitoring is ongoing using tw

surveillance systems:

– Vaccine Adverse Event Reporting System (VAER– Vaccine Safety Datalink (VSD)

 V-safe data collection for mpox vaccines was availa

November 2022 through March 21, 2023
JYNNEOS Vaccine Safety Findings Summary

 90% of VAERS reports were submitted in 2022 The adverse events most commonly reported to VAERS have 

site symptoms (redness, swelling, pain, itching)

 Myocarditis and pericarditis are adverse events of special int

– Observed rates are consistent with expected background 
JYNNEOS Vaccine Safety Conclusions

 VAERS and VSD data do not suggest an increased risk for myo

pericarditis following JYNNEOS, but the possibility of a small excluded

 The frequencies of local and systemic reactions reported to v

mpox vaccine were similar to those reported in clinical trials

 No new or unexpected safety concerns have been identified
Summary

 Mpox cases and deaths continue to be reported domestically  Need to improve our overall vaccine coverage; <25% of the e

population is fully vaccinated with 2 doses

 Modeling suggests that without vaccination, transmission of 

continue with sporadic outbreaks

 No new safety signals from VAERS or VSD VE appears stable for immunocompetent people
Acknowledgements

 Sarah Guagliardo Agam Rao Rosalind Carter Andrea McCollum Ian Kracalik Allie Tuttle Jonathan Duffy Eunice Kimunai  Katrina Byrd

 Victoria Shelus Christine Hughes Christina Hutson Ian Spicknall Patrick Clay Emily Pollock
For more information, contact CDC

1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Emerging and Zoonotic Infectious DiseasesDivision of High-Consequence Pathogens and Pathology

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