Demographics and disease associations of patients with mpox and recipients of mpox vaccine from safety net hospitals in New York City: A cross-sectional study

To the Editor: Mpox (Monkeypox) is a new public health threat in the United States for which there is limited epidemiologic data.1, 2, 3 Over a quarter of all cases in America have been diagnosed in New York City (NYC).^{1 , 4} Here we investigate demographics and risk factors of patients with mpox and mpox vaccine recipients from safety net hospitals in NYC.

All patients treated between February 18th 2022 to August 18th 2022 with a confirmed diagnosis of mpox, and recipients of the Mpox/Smallpox vaccine were identified from the electronic medical records of the NYC Health and Hospitals System. The demographic distribution and the presence of sexually transmitted diseases associated with these cases were evaluated. De-identified, aggregated data were obtained (Slicer/Dicer, EPIC Systems).

Nine hundred seventy-three patients presented with suspected cases of mpox. Of those, 250 had laboratory evidence of Orthopox virus DNA infection and were considered confirmed cases. The racial and ethnic breakdown of confirmed patients was 54% Hispanic/Latino, 34% Black, 14% White, and 2% Asian; 97% were male as described by their legal sex. While the majority of patients had not disclosed their sexual orientation (63%), 18% identified as gay and 13% as straight (Table I ). The chief complaint of “rash” was noted in 61%; 18% of patients received the antiviral Tecovirimat, approved for treatment of mpox under a non-research expanded access Investigational New Drug protocol (sometimes called “compassionate use”).³

Table I.

Demographics of patients diagnosed with mpox and vaccine recipients

Demographics	Confirmed cases N = 250 (%)∗	Vaccinated patients N = 7105 (%)†	P value
Race
Black/African American	85 (34.0)	1329 (18.7)	<.001
White/Caucasian	32 (13.2)	3338 (47.0)	<.001
Asian	6 (2.4)	513 (7.2)	.004
Native American	3 (1.2)	28 (0.4)	.057
Other	124 (49.6)	1948 (27.4)	<.001
Ethnicity
Hispanic/Latino	135 (54)	1612 (22.7)	<.001
Not Hispanic/Latino	115 (46)	5493 (77.3)	<.001
Legal sex
Male	242 (96.8)	6501 (91.5)	.003
Female	7 (2.8)	561 (7.9)	.003
Other	1 (0.4)	43 (0.6)	.686
Age
30 y or younger	58 (23.2)	2061 (29)	.047
31 to 60 y old	188 (75.2)	4564 (64.2)	<.001
61 y or older	4 (1.6)	466 (6.6)	.002
No value		14 (0.2)	-
Sexual orientation
Gay	45 (18)	1901 (26.8)	.002
Straight	32 (12.8)	212 (3.0)	<.001
Bisexual	11 (4.4)	249 (3.5)	.447
Lesbian	8 (3.2)	160 (2.3)	.354
Other/unknown/choose not to disclose	157 (62.8)	4583 (64.5)	.581
Treatment with tecovirimat	44 (17.6)	2 (0.03)	<.001

Bold indicates statistical significance (P < .05) as calculated by Chi-squared test.

^∗Inclusion criteria: All patients presenting in the NYC Health and Hospitals system between February 17, 2022 and August 16, 2022 with either lab component: ORTHOPOXVIRUSPCR: Abnormal and Final, ORTHOPOXVIRUS DNA: Abnormal and Final and Any of the following diagnostic designations: Diagnosis: Human Monkeypox, New Infections: Monkeypox (rule out), Active Infections: Monkeypox (rule out), New Infections: Monkeypox (exposure), Active Infections: Monkeypox (exposure), Medical History: Monkeypox(ICD-10-CM: B04), New Infections: Monkeypox (confirmed), Active Infections: Monkeypox (confirmed).

^†Inclusion Criteria: All patients presenting in the NYC Health and Hospitals system between February 17, 2022 and August 16, 2022 with the immunization designation SMALLPOX/MONKEYPOX VACCINE.

The association of sexually transmitted disease with the diagnosis of mpox was striking; 41% carried a confirmed diagnosis of HIV; 26% had Hepatitis C antibody positivity, 16% had detectable Hepatitis B antigen, and 30% had a history of an abnormal rapid plasma reagin titer (Fig 1 ). Despite the marked association of HIV with mpox (41% of cases), only 3% of male patients with HIV received the vaccine and only 68% of patients with mpox were screened for concurrent HIV infection (Supplementary Table I, available via Mendeley at https://doi.org/10.17632/6dbwp3kxyr.1). Although treatment of mpox is primarily supportive, vaccination may ameliorate symptoms and prevent the development of significant disease.⁵ Of 250 confirmed mpox cases, 20 (8%) patients had received the mpox vaccine. As shown, demographics of vaccinated patients significantly diverged from that of the confirmed cases (Table I). Although patients with skin of color had the highest rates of mpox infection in our population, Whites had higher rates of vaccination.

Fig 1.

Sexually transmitted diseases associated with mpox cases. Inclusion criteria included all patients presenting to the New York City Health and Hospitals system between February 17, 2022 and August 16, 2022 with either lab component: ORTHOPOXVIRUSPCR: Abnormal and Final, ORTHOPOXVIRUS DNA: Abnormal and Final and one of the following: Confirmed Diagnosis of HIV, Hepatitis C antibody, Hepatitis B antigen, rapid plasma reagin (abnormal). Fractions: # of patients with sexually transmitted disease/# of patients with laboratory confirmed mpox infection.

This study investigates cases from the public hospital system during the earliest stages of the mpox outbreak in NYC. Limitations include the possibility of coding omissions and/or errors and the probability that not all diagnoses and therapeutics rendered at outside facilities were incorporated into our medical record. Mpox is a rapidly evolving outbreak with vaccines and therapeutics in limited supply. As dermatologists are at the forefront of diagnosing this disease, a thorough understanding of patients at greatest risk is crucial to target critical resources and improve clinical care.

Conflicts of interest

None disclosed.