Epidemiologic and Clinical Features of Mpox in Adults Aged >50 Years

United States, May 2022-May 2023

Patrick C. Eustaquio, MD; LaTweika A.T. Salmon-Trejo, MPH; Lisa C. McGuire, PhD; Sascha R. Ellington, PhD

Morbidity and Mortality Weekly Report. 2023;72(33):893-896.

Abstract and Introduction

Abstract

During May 2022–May 2023, approximately 30,000 mpox cases were reported in the United States, predominantly among young adult men. Persons aged >50 years might experience more severe mpox disease because of a higher prevalence of comorbidities. Conversely, they could have residual protection from childhood smallpox vaccination against monkeypox virus infection and severe mpox, as has been suggested by investigation of some previous mpox outbreaks. To examine the characteristics of mpox cases among adults aged >50 years, analysts compared mpox epidemiology and clinical outcomes among all adults aged ≥18 years, by age group. Further, outcomes were compared among adults aged >50 years by JYNNEOS vaccination status. During May 10, 2022–May 17, 2023, among 29,984 adults with probable or confirmed mpox reported to CDC, 2,909 (9.7%) were aged >50 years, 96.3% of whom were cisgender men. Compared with adults aged 18–50 years, adults aged >50 years had higher prevalences of immunocompromising conditions (p<0.001) and HIV infection (p<0.001). Among adults with mpox aged >50 years, 27.6% had received JYNNEOS vaccination; this group had lower prevalences of constitutional symptoms (p<0.001), pruritus (p<0.001), and hospitalization (p = 0.002) compared with those who had not received JYNNEOS vaccine. Currently recommended JYNNEOS vaccination among all adults at risk for mpox should be encouraged, irrespective of childhood smallpox vaccination status.

Introduction

During May 10, 2022–May 17, 2023, a total of 30,401 mpox cases* were reported in the United States, predominantly among young adult men. Adults aged >50 years likely received childhood smallpox vaccination, which was given routinely to children in the United States before being discontinued in 1971^†; therefore, they might be less susceptible to monkeypox virus infection as a result of cross-protection.^[1] Childhood smallpox vaccination has been shown to provide partial protection against mpox, both in preventing monkeypox virus infection and severe mpox, in studies of earlier mpox outbreaks in the Democratic Republic of the Congo^[2] and the United States.^[3] Because adults aged >50 years are likely to have more comorbidities than are younger adults, they might experience severe mpox disease, often with indications for treatment.^[4] This analysis described age group–specific epidemiologic characteristics and clinical mpox outcomes among adults and compared characteristics and outcomes among adults aged >50 years by recent JYNNEOS vaccination status.

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Methods
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Discussion
References
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Table 1. Demographic and epidemiologic characteristics of adults with mpox, by age group (N = 29,984) — United States, May 10, 2022–May 17, 2023
Characteristic and clinical outcome	Age group, no. (column %)*		p-value^†
Characteristic and clinical outcome	18–50 yrs n = 27,075	>50 yrs n = 2,909	p-value^†
Gender identity
Cisgender men	25,681 (95.2)	2,794 (96.3)	<0.001
Cisgender women	809 (3.0)	88 (3.0)
Transgender men	55 (0.2)	0 (—)
Transgender women	220 (0.8)	9 (0.3)
Other gender identity	225 (0.8)	11 (0.4)
Missing	85	7
Race and ethnicity^§
Black or African American	8,733 (34.2)	561 (20.5)	<0.001
White	7,085 (27.8)	1,297 (47.3)
Hispanic or Latino	7,878 (30.9)	758 (27.7)
Other	1,684 (6.6)	120 (4.4)
Multiracial	134 (0.5)	4 (0.1)
Missing	1,561	169
Any sexual contact during the 3 wks preceding illness onset
Yes	15,495 (78.6)	1,618 (77.0)	0.083
No	4,216 (21.4)	484 (23.0)
Missing	7,364	807
Sexual partner among cisgender men^¶
Cisgender men only	12,561 (93.5)	1,393 (94.8)	0.201
Cisgender men and other genders	419 (3.1)	32 (2.2)
Exclude cisgender men	454 (3.4)	45 (3.1)
Missing	12,247	1,324
HIV status
HIV positive	4,798 (55.4)	552 (66.2)	<0.001
HIV negative	3,860 (44.6)	282 (33.8)
Unknown HIV status or missing	18,417	2,075
Immunocompromising condition**
Yes	1,308 (11.1)	185 (15.0)	<0.001
No	10,466 (88.9)	1,045 (85.0)
Missing	15,301	1,679
Received ≥1 dose of JYNNEOS vaccine
Yes	2,481 (21.3)	282 (27.6)	<0.001
No	9,177 (78.7)	738 (72.4)
Missing	15,417	1,889
Rash^††
Yes	6,867 (96.8)	563 (96.6)	0.72
No	224 (3.2)	20 (3.4)
Missing	2,086	155
Pruritus^††
Yes	2,972 (58.7)	221 (59.4)	0.78
No	2,092 (41.3)	151 (40.6)
Missing	4,113	366
Rectal symptoms^††,§§ or abdominal pain
Yes	2,719 (50.3)	134 (37.3)	<0.001
No	2,683 (49.7)	225 (62.7)
Missing	3,775	379
Constitutional symptoms^††,¶¶
Yes	6,103 (91.2)	424 (85.0)	<0.001
No	586 (8.8)	75 (15.0)
Missing	2,488	239
Hospitalization^††
Yes	657 (7.5)	58 (8.3)	0.459
No	8,110 (92.5)	644 (91.7)
Missing	410	36
Death^††
Yes	12 (0.2)	3 (0.6)	0.069
No	6,488 (99.8)	532 (99.4)
Missing	2,677	203

*Percentages were calculated using nonmissing data.
^†Pearson's chi-square or Fisher's exact test.
^§Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are non-Hispanic.
^¶Only among cisgender men aged 18–40 years (25,681) and >50 years (2,794).
**Excluding HIV infection and AIDS.
^††Clinical outcomes were compared by age group after excluding adults who received JYNNEOS vaccine (2,763).
^§§Includes rectal pain/bleeding, pus in the stool, proctitis, or tenesmus.
^¶¶Includes fever, headache, malaise, myalgia, chills, or lymphadenopathy.

Table 2. Characteristics, symptoms, and clinical outcomes among adults aged >50 years with mpox and known JYNNEOS vaccination status,* by vaccination status (N = 1,020) — United States, May 10, 2022–May 17, 2023
Characteristic or outcome	Received JYNNEOS vaccine, no. (column %)^†		p-value^§
Characteristic or outcome	No n = 738	Yes n = 282	p-value^§
HIV status
Positive	492 (66.8)	60 (61.9)	0.974
Negative	245 (33.2)	37 (38.1)
Unknown or missing	1,994	81
Immunocompromising condition^¶
Yes	172 (15.0)	13 (14.9)	0.356
No	971 (85.0)	74 (85.1)
Missing	1,588	91
Constitutional symptoms**
Yes	1,320 (81.3)	74 (64.9)	<0.001
No	303 (18.7)	40 (35.1)
Missing	1,108	64
Rash
Yes	1,928 (97.7)	123 (93.9)	0.895
No	45 (2.3)	8 (6.1)
Missing	758	47
Pruritus
Yes	489 (56.9)	41 (44.1)	<0.001
No	371 (43.1)	52 (55.9)
Missing	1,871	85
Rectal symptoms^†† or abdominal pain
Yes	451 (36.3)	43 (43.0)	0.486
No	791 (63.7)	57 (57.0)
Missing	1,489	78
Hospitalization
Yes	163 (7.4)	2 (1.2)	0.002
No	2,044 (92.6)	160 (98.8)
Missing	524	16
Death
Yes	5 (0.3)	0 (—)	0.446
No	1,647 (99.7)	100 (100.0)
Missing	1079	78

*A total of 1,889 (65%) mpox patients were excluded because vaccination status (1662; 57%) or date (227; 8%) was missing or unknown.
^†Percentages were calculated using nonmissing data.
^§Pearson's chi-square or Fisher's exact test.
^¶Excluding HIV infection and AIDS.
**Includes fever, headache, malaise, myalgia, chills, or lymphadenopathy.
^††Includes rectal pain/bleeding, pus in the stool, proctitis, or tenesmus.

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Epidemiologic and Clinical Features of Mpox in Adults Aged >50 Years

United States, May 2022-May 2023

Abstract and Introduction

Abstract

Introduction

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

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