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Mpox Vaccination for Vulnerable Populations

CE / CME

Protection Beyond Outbreaks: Routine Mpox Vaccination for Vulnerable Populations

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: July 17, 2024

Expiration: July 16, 2025

Carlos del Rio
Carlos del Rio, MD
Aniruddha (Anu) Hazra
Aniruddha (Anu) Hazra, MD
CME/CE Information

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What Is Mpox?

Carlos del Rio, MD, FIDSA:
As we discuss the burden of disease during the current (2022-2024) mpox outbreak and implications for clinical practice and vaccination, it is helpful to begin by considering our classical understanding of mpox and its clinical presentation as a reference point for the differences we observed in the current outbreak.

Mpox and Clinical Manifestations

Carlos del Rio, MD, FIDSA:
Mpox is the disease caused by infection with the enveloped double-stranded DNA virus, MPXV. MPXV is classified in the Poxviridae family within the Orthopoxvirus genus, which includes variola (the cause of smallpox), vaccinia virus, and cowpox virus. In fact, as we will discuss later in the module, smallpox and mpox vaccines are both based on modified forms of the vaccinia virus.

The typical clinical presentation of mpox is similar to smallpox, beginning with a prodrome before the appearance of a rash. The symptoms of the prodrome include fever, malaise, headache, weakness, and lymphadenopathy. When the rash begins, lesions usually develop and evolve simultaneously over time. The lesions are painful and undergo 4 stages of development before scabbing: macular, papular, vesicular, and pustular.

Aniruddha Hazra, MD:
The current global outbreak has really challenged these notions of the clinical presentation of mpox. For example, in many cases in the current outbreak, the rash appeared either before or at about the same time as the prodrome, and in some cases the prodrome persisted after the rash developed.

There are also important differences related to the rash itself, the most notable being the location. In previous mpox outbreaks, the lesions evolved somewhat uniformly in a centrifugal pattern affecting the limbs and the torso as well as potentially the palms of the hands and soles of the feet. However, in the current outbreak, the rash has primarily affected the anogenital area and the lesions have not evolved uniformly.

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Mpox Symptoms in 2022-2024 Outbreak: Men

Aniruddha Hazra, MD:
This slide depicts the frequency of symptoms among men in the current outbreak, showing that one half experienced genital rash.

Another difference in the current outbreak is that fever and lymphadenopathy have been less prominent, occurring in approximately 60% and 30% of men, respectively.

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Mpox Symptoms in 2022-2024 Outbreak: Women

Carlos del Rio, MD, FIDSA:
Another surprising finding, particularly given the fact that there was sexual transmission as we will discuss, is how few cases have been in women: fewer than 4% of global cases in the current outbreak have occurred in women. The distribution of symptoms in women was generally similar to that in men, with nearly 30% experiencing genital rash.

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Mpox Complications: 2022-2024 Outbreak

Carlos del Rio, MD, FIDSA:
In addition to considering the symptoms of mpox, it is important to understand the severity of the disease in terms of both clinical outcomes and experiences of the patients.

Regarding clinical outcomes, severe disease is generally that which requires hospitalization, intensive care unit admission, and/or causes death. From March 2022 to March 2024 of the current mpox outbreak, approximately 11% of patients required hospitalization, 0.3% required intensive care unit admission, and 0.3% died. Severe outcomes have primarily occurred among people with uncontrolled, advanced HIV.

However, many people experienced severe disease in terms of their degree of pain and discomfort, without necessarily requiring hospitalization. The significant pain associated with mpox should not be discounted. As a healthcare professional (HCP), I was struck by the level of suffering I witnessed, with patients stating that it was one of the most painful experiences they had ever had.

Click for audio from Aniruddha Hazra, MD.

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