Summary of CDC COCA Call - Mpox Update: Clinical Mgmt and Outbreaks (June 27, 2024)

The CDC COCA call on June 27, 2024, provided an update on the clinical management and outbreaks of Mpox (formerly known as monkeypox). The discussion focused on the epidemiology of the Mpox Virus, vaccination strategies, and treatment options available for affected populations.

Scientific Concepts and Discoveries:

• Mpox Virus (MPXV): The disease is caused by the monkeypox virus, with two main clades: Clade 1 and Clade 2.
• Epidemiology:
  • Clade 2 has been endemic in several African countries for decades and saw an outbreak in Nigeria starting in 2017, with subsequent cases in non-endemic countries.
  • A significant outbreak in 2022 was associated with men who have sex with men (MSM), leading to human-to-human transmission.
  • Case counts in the U.S. peaked in mid-2022 but have stabilized since October 2023, averaging around 58 cases per week.
• Vaccine Effectiveness:
  • Current data suggests that vaccine effectiveness is stable, and breakthrough infections are rare.
  • No booster doses are recommended for those who completed the two-dose series, as the immunity from vaccination remains sufficient.
• Vaccination Recommendations:
  • Vaccination is recommended for individuals at risk, particularly MSM and those with multiple sexual partners.
  • The vaccine is now included in the routine immunization schedule for at-risk populations.
• Treatment Options:
  • Tecovirimat (TPOXX) is an antiviral developed for smallpox but is used investigationally for Mpox under an expanded access protocol.
  • Eligibility criteria for treatment with Tecovirimat were revised to include individuals with severe immunocompromise and certain severe manifestations of Mpox.

Methodology and Recommendations:

• Vaccination Strategy:
  • Individuals who received only one dose of the vaccine should complete the two-dose series as soon as possible.
  • Vaccination is recommended for those with specific risk factors, including MSM and individuals anticipating high-risk sexual behavior.
• Treatment Protocols:
  • For patients with Mpox, treatment with Tecovirimat is primarily available through the NIH's clinical trial (STOMP) or CDC's expanded access protocol.
  • The eligibility for Tecovirimat treatment includes patients with severe immunocompromise or life-threatening manifestations.

Researchers and Sources Featured:

• Dr. Agam Morral, Chief Medical Officer for the Pox Virus and Rabies Branch at CDC.
• Dr. Megan Panini, Chief Science Officer for HHS Coordination Operations and Response.
• Dr. Yan Yu, Lead for the Medical Countermeasures Regulatory Support Team at CDC.
• Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS).

This summary captures the key points discussed during the call, focusing on the epidemiology, vaccination, and treatment strategies related to the Mpox outbreak.

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