Mpox in the New York Metropolitan area, Summer 2022
Rachel Gnanaprakasam1, Marina Keller2, Rebecca Glassman3, Marc El-Khoury4, Donald S Chen5, Nicholas Feola6, Jared Feldman7, Vishnu Chaturvedi8
1 Infectious Diseases Fellow, Infectious Diseases, Westchester Medical Center, Rachel.Gnanaprakasam@wmchealth.org
2Infectious Diseases/Associate Hospital Epidemiologist, Infectious Diseases, Westchester Medical Center, marina.keller@wmchealth.org
3Internist, Department of Medicine, Westchester Medical Center, Rebecca.Glassman@wmchealth.org
4Chair Infectious Diseases, Program Director, Infectious Diseases, Westchester Medical Center,
Marc.ElKhoury@wmchealth.org
5Hospital Epidemiologist, Infection Prevention, Westchester Medical Center
Donald.Chen@wmchealth.org
6Pharmacists, Department of Pharmacy, Westchester Medical Center,
Nick.Feola@wmchealth.org
7Resident in Internal Medicine, Department of Medicine, Westchester Medical Center, Jared.Feldman@wmchealth.org
8Chief of Microbiology/Professor of Pathology, Microbiology, and Immunology, Department of Pathology, Westchester Medical Center, Vishnu.Chaturvedi@wmchealth.org
Corresponding author : Marina Keller, 100 Woods Road, Valhalla, NY 10595, (845)741-8895, marina.keller@wmchealth.org, ORCID ID 0000-0002-9796-3190
Running title: Mpox in New York
Abstract: Early in the 2022 Mpox (MPX) global outbreak, caseloads in the New York Metropolitan area climbed rapidly before other US urban areas. This case series summarizes the authors’ clinical experience detecting and treating MPX, during a quickly evolving outbreak. Clinical outcomes were recorded with a focus on varied clinical presentation and outcomes such as complications and response to experimental tecovirimat therapy. A focal or multifocal rash was the most common presenting symptom in 91% of patients. Almost two thirds (62%) of patients had anogenital involvement. Proctitis was one of the most painful presentations with 75% requiring antiviral treatment and 3 patients needing hospitalization for pain management. Most patients responded promptly to antiviral treatment with tecovirimat. Five out of 10 patients treated with tecovirimat reported symptom resolution within 48 – 72 hours of therapy and another 3 saw resolution within first 96 hours. Two patients had poor response to tecovirimat. This series includes the only reported case of an HIV positive, immunocompetent patient who experienced recurrent anal ulcers due to Mpox and required a second course of tecovirimat. Other unique presentations included urethritis, abscess formation and MPX infection post-vaccination. Control of this current Mpox outbreak was possible due to timely diagnosis and the availability of both a licensed vaccine and an investigational drug.
Keywords: Mpox, Monkeypox, Orthopox, outbreak, tecovirimat, Jynneos