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Mpox
Where Are We Now With Mpox?

Released: July 24, 2024

Expiration: July 23, 2025

Carlos del Rio
Carlos del Rio, MD
Activity Information

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Key Takeaways
  • The ongoing Mpox outbreak disproportionately affected men who have sex with men, including people living with HIV and racial and ethnic minority groups.
  • Implementation of the Mpox vaccine should bring vaccination services to key communities and work with HIV or sexual health clinics to target vulnerable populations.

Until recently, Mpox was considered an animal-driven infection that occurred primarily in endemic countries in Africa, with transmission to humans occurring after contact with small animals, particularly rodents. However, since May 2022, cases of Mpox have been occurring in regions where the disease was not previously endemic, such as Europe, the Americas, and Australia.

In addition to arising in new areas of the world where the Mpox virus had not previously been reported, the virus has also been behaving in new ways since 2022: it is spreading more easily through close contact, including sexual contact, and infecting large groups at once.

What’s more, there is now a new outbreak in the Democratic Republic of Congo (DRC) of Mpox clade I, a clade that is thought to cause even more severe illness and higher mortality.

I think this new outbreak, and ongoing transmission of the 2022 outbreak strain, highlight the need for more widespread implementation of the Mpox vaccine, the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN). Although Mpox vaccination is not yet recommended as part of routine vaccinations for the public, healthcare professionals need to identify patients who are part of key populations and counsel them on the potential benefits of receiving the Mpox vaccine.

Key Populations
The ongoing 2022 Mpox outbreak disproportionately affected men who have sex with men, including people living with HIV and racial and ethnic minority groups. The great majority of Mpox cases (96.4%) have occurred among men, most of whom are men who have sex with men (94%), with a disproportionate impact on Black and Hispanic/Latino persons. In addition, more than 40% of Mpox cases have been in people living with HIV. A study of Mpox deaths in the United States found a disproportionate number of deaths occurred among Black people living in the South, many of whom had undiagnosed and/or uncontrolled HIV infection with low CD4 counts.

Unfortunately, emerging diseases such as Mpox and COVID-19 often exacerbate existing healthcare disparities. Widespread implementation of the Mpox vaccine is an opportunity to work towards healthcare equity by providing immunologic equity. Equity is the epicenter of addressing the inordinate impact of epidemics and pandemics. If every US citizen had access to appropriate and equitable care, the level of mortality associated with these diseases would have been much lower. Now is our chance to try to correct this.

Widespread Vaccine Implementation
The CDC estimates that only 23% of people in key populations have been fully vaccinated. With many people still vulnerable, there is still a persistent need to continue offering vaccination to those at risk. The ACIP recommends vaccination with 2 doses of the MVA-BN Mpox vaccine, 28 days apart, for persons aged 18 years or older who are at risk of Mpox, defined as:

  • Gay, bisexual, and other men who have sex with men, transgender or binary people who in the past 6 months have had 1 of the following:
    • A new diagnosis of more than 1 sexually transmitted disease
    • More than 1 sex partner 
    • Sex at a commercial sex venue
    • Sex in association with a large public event in a geographic area where Mpox transmission is occurring
  • Sexual partners of persons with the risk described above
  • Persons who anticipate experiencing any of the above

To advance uptake of the Mpox vaccine, healthcare professionals should work closely with community-based organizations. Building trust within the community and focusing on equity are important strategies to continue vaccinating at risk populations against Mpox.

Some of the most successful vaccination strategies used in 2022 involved bringing the Mpox vaccine to vulnerable communities through mobile or pop-up vaccination units. In particular, many sexual health and HIV clinics reached out to the community and worked with public health groups to provide the vaccine to as many vulnerable individuals as possible.

Given the success of this strategy and that Mpox has a higher morbidity and mortality among persons with undiagnosed and/or uncontrolled HIV, more widespread implementation of the Mpox vaccine should also include reaching out to minority populations with HIV testing and improving linkage and retention in care and antiretroviral therapy administration. 

Your Thoughts?
What are some strategies you use to promote vaccine uptake and immunologic equity? Leave a comment to join the discussion!