The Mpox Challenge: Analyzing the Surge in Cases and Vaccination Strategies

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In a concerning turn of events, Mpox cases in the United States have surged, doubling compared to the same period last year. This spike has prompted experts to underscore the critical need for enhancing vaccination coverage as transmission risks escalate. Delving into the details, as of March 30, 2024, the US Centers for Disease Control and Prevention (CDC) has reported 664 Mpox cases this year, a stark contrast to fewer than 300 cases recorded by late March 2023. While current transmission rates remain below the staggering levels observed in 2022, when the nation grappled with tens of thousands of cases, experts caution that the US is susceptible to resurgence due to various factors.

The expiration of the public health emergency in the US over a year ago has significantly reduced federal resources available for managing public health responses. Coupled with relatively low vaccination rates across the country, this situation leaves many individuals at risk of Mpox infection.

Adding to the complexity is a health alert issued by the CDC in December, highlighting another subtype of the virus found to be more transmissible and causing more severe illness than the subtype associated with the 2022 outbreak in the US. Although this genetic clade has not been detected within the US borders, its prevalence in the Democratic Republic of Congo raises concerns about potential future spread.

Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, emphasizes the significance of vaccination as a key preventive measure. He notes that while there has been considerable participation in vaccination campaigns, a substantial portion of the at-risk population remains unvaccinated. This gap in vaccination coverage is likely to lead to outbreaks and an increase in cases across different regions.

Mpox, formerly known as monkeypox, manifests with flu-like symptoms initially and can progress to a rash with raised lesions. While anyone can contract Mpox, individuals such as men who have sex with men and those with HIV are at heightened risk of severe outcomes. The vaccine, manufactured by Bavarian Nordic under the brand name Jynneos, is recommended as a two-dose regimen, administered about a month apart.

Despite the availability of the vaccine since its emergency authorization in August 2022, CDC data indicates that less than a quarter of the at-risk population in most states has completed the two-dose series. This gap in vaccination coverage is particularly pronounced in certain regions, with some states reporting coverage below 10%.

Recent data from the CDC shows a notable increase in Mpox cases across various US regions compared to the same period last year, with the mid-Atlantic region, notably New York City, experiencing the largest disparity.

In response to this concerning trend, the Virginia health department issued a notice to raise awareness about the rising cases within the state. Notably, the state has already recorded as many cases this year as it did throughout 2023, with several cases requiring hospitalization, often among individuals with HIV who were not vaccinated.

Efforts to curb Mpox transmission necessitate a targeted and compassionate approach, focusing on reaching vulnerable populations. Jeffrey Crowley, director of the Infectious Diseases Initiative at Georgetown’s O’Neill Institute for National and Global Health Law, stresses the importance of building trust and strategic partnerships with community groups to effectively reach those at highest risk.

A survey conducted in August 2022 revealed that the Mpox outbreak prompted behavioral changes among men who have sex with men, leading to a reduction in risky behaviors and a consequential impact on transmission rates. However, experts emphasize that vaccination remains the most sustainable preventive measure.

The Mpox vaccine offers long-term coverage without the need for annual boosters. Even individuals who have received only the first dose can improve their protection by getting the second shot outside the recommended four-week window. Additionally, the vaccine is expected to offer protection against the more severe subtype of the virus if it emerges in the US.

While the commercialization of Mpox vaccine distribution may enhance access, challenges such as limited visibility into vaccine distribution and ongoing treatment accessibility issues persist. These challenges underscore the importance of proactive preventive measures and continued efforts to address the evolving Mpox landscape effectively.


TABLE 1 – Mpox cases in the United States

Reporting AreaMpox §
Current weekPrevious 52 weeks Max †Cum YTD 2024 †Cum YTD 2023 †
U.S. Residents, excluding U.S. Territories2374658306
New England15258
Connecticut121
Maine12
Massachusetts4166
New Hampshire0
Rhode Island1141
Vermont11
Middle Atlantic62622041
New Jersey38523
New York (excluding New York City)25166
New York City11512631
Pennsylvania4261
East North Central9159322
Illinois8146410
Indiana542
Michigan13114
Ohio7145
Wisconsin21
West North Central798
Iowa01
Kansas02
Minnesota57
Missouri225
Nebraska1
North Dakota0
South Dakota0
South Atlantic41713563
Delaware111
District of Columbia473
Florida175229
Georgia10149
Maryland395
North Carolina8365
South Carolina07
Virginia35164
West Virginia0
East South Central252211
Alabama222
Kentucky217
Mississippi111
Tennessee24181
West South Central1104667
Arkansas112
Louisiana416
Oklahoma211
Texas194358
Mountain113311
Arizona217
Colorado5281
Idaho5
Montana0
Nevada511
New Mexico12
Utah212
Wyoming0
Pacific347575
Alaska0
California296735
Hawaii1
Oregon339
Washington5531
U.S. Territories261
American Samoa0
Commonwealth of Northern Mariana Islands0
Guam0
Puerto Rico261
U.S. Virgin Islands0
Non-U.S. Residents0
Total2374664307
  • U: Unavailable — The reporting jurisdiction was unable to send the data to CDC or CDC was unable to process the data.
  • -: No reported cases — The reporting jurisdiction did not submit any cases to CDC.
  • N: Not reportable — The disease or condition was not reportable by law, statute, or regulation in the reporting jurisdiction.
  • NN: Not nationally notifiable — This condition was not designated as being nationally notifiable.
  • NP: Nationally notifiable but not published.
  • NC: Not calculated — There is insufficient data available to support the calculation of this statistic.
  • Cum: Cumulative year-to-date counts.
  • * Case counts for reporting years 2023 and 2024 are provisional and subject to change. Cases are assigned to the reporting jurisdiction submitting the case to NNDSS, if the case’s country of usual residence is the U.S., a U.S. territory, unknown, or null (i.e. country not reported); otherwise, the case is assigned to the ‘Non-U.S. Residents’ category. Country of usual residence is currently not reported by all jurisdictions or for all conditions. For further information on interpretation of these data, see https://www.cdc.gov/nndss/data-statistics/readers-guides/.
  • † Previous 52 week maximum and cumulative YTD are determined from periods of time when the condition was reportable in the jurisdiction (i.e., may be less than 52 weeks of data or incomplete YTD data).
  • § Case count includes both probable and confirmed cases.

Notes:

  • These are weekly cases of selected infectious national notifiable diseases, from the National Notifiable Diseases Surveillance System (NNDSS). NNDSS data reported by the 50 states, New York City, the District of Columbia, and the U.S. territories are collated and published weekly in alphabetical order by condition. Cases reported by state health departments to CDC for weekly publication are subject to ongoing revision of information and delayed reporting. Therefore, numbers listed in later weeks may reflect changes made to these counts as additional information becomes available. Case counts in the tables are presented as published each week. See also Guide to Interpreting Provisional and Finalized NNDSS Data.
  • Weekly tables since 1996 are available on CDC WONDER.
  • Weekly tables since 2014 are available on Data.CDC.gov.
  • Weekly tables for 1952–2017 published in the Morbidity and Mortality Weekly Reports (MMWR) are available at CDC Stacks MMWR, and weekly tables starting in 2018 are available at CDC Stacks NNDSS (once in CDC Stacks NNDSS select “Weekly Tables” in the “Genre” box at the left).
  • Notices, errata, and other notes are available in the Notice To Data Users page.
  • The list of national notifiable infectious diseases and conditions and their national surveillance case definitions are available at https://ndc.services.cdc.gov/. This list incorporates the Council of State and Territorial Epidemiologists (CSTE) position statements approved by CSTE for national surveillance.


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