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Ongoing Transmission of Mpox in Texas and Recommendations for Preparedness

Health Advisory
Health Advisory
July 19, 2024

Summary

Texas continues to report ongoing transmission of mpox caused by clade II monkeypox virus (MPXV). This is consistent with mpox cases reported nationally. Preliminary surveillance data indicate potential recent periods of increase in mpox cases in 2024. Additionally, there is an ongoing outbreak of mpox in the Democratic Republic of Congo (DRC) caused by clade I MPXV, potentially raising the risk of transmission and severe disease in the United States. DSHS recommends that healthcare professionals, public health and the public should take measures to detect and prevent the spread of mpox. Healthcare providers should monitor for signs and symptoms of mpox, consider it as a possible diagnosis, conduct testing when necessary, and provide recommended vaccinations as appropriate. DSHS also recommends that public health organizations continue surveillance and community outreach efforts for mpox and that Texans take precautions to protect themselves from the disease, such as getting the recommended vaccine and limiting contact with sick individuals.

Background

Following the large global outbreak experienced in 2022, mpox case counts in the U.S. decreased significantly but never reached zero. Since October 2023, U.S. cases increased slightly, with steady case reporting during October 1, 2023-June 1, 2024. Through the first 24 weeks of 2024, Texas has reported 152 mpox cases, compared with 86 cases during the same period in 2023, representing a 76.7% increase (based on preliminary data as of 6/17/2024).

Thus far, all the mpox cases in the United States, including Texas, are due to clade II monkeypox virus (MPXV). Currently, there is an ongoing outbreak caused by clade I MPXV in the Democratic Republic of the Congo (DRC). Clade I MPXV is suspected to cause more severe disease and be more transmissible than clade II MPXV. Both clades have demonstrated the ability to spread through intimate or sexual contact. However, there have been no detected cases of mpox caused by clade I MPXV in the United States to date.

Recommendations for Clinicians

Clinicians are key to identifying and treating mpox cases. Because of this, DSHS recommends that clinicians familiarize themselves with mpox symptoms, specimen collection, laboratory testing procedures, and treatment options. Clinicians should consider mpox in the differential diagnosis for patients with diffuse or localized rash, or those with a higher risk for mpox, and confirm with laboratory testing. Of note, patients with undiagnosed or uncontrolled HIV or other immunocompromising conditions are at higher risk of severe disease.

Laboratory testing is readily available at many commercial and hospital laboratories and can also be accessed through local health departments. Consideration of clade I mpox should be heightened in patients who have certain epidemiologic characteristics, particularly travel from mpox-endemic regions such as the DRC within 21 days of illness onset. Clinicians are required to report any suspected, probable, or confirmed case of clade I or clade II mpox as quickly as possible.

The CDC recently conducted a Clinical Outreach and Communication Activity (COCA) webinar on this topic. The recording and the slides from this webinar can be accessed here: Webinar Thursday, June 27, 2024 - Mpox Update: Clinical Management and Outbreaks (cdc.gov)

Tecovirimat (TPOXX) is an antiviral medication approved by the United States Food and Drug Administration for treatment against smallpox and is available under CDC’s Expanded Access Investigational New Drug protocol for treatment against mpox. Tecovirimat is primarily available through enrollment in the Study of Tecovirimat for Mpox (STOMP). Clinicians with patients who are ineligible for the STOMP trial but meet the EA-IND eligibility should contact their local health department. Additional information on tecovirimat can be found here.

The Advisory Committee on Immunization Practices recommends that people ≥18 years of age with risk factors for mpox be vaccinated, before an exposure, with two doses of the JYNNEOS vaccine 28 days apart unless they were previously infected with mpox or already received two doses. Eligible patients who have only received one dose of the JYNNEOS vaccine should receive the second dose as soon as possible, regardless of the amount of time that has elapsed since the first dose. People who have been exposed to someone with mpox (if exposed less than 14 days ago, ideally with 4 days of exposure) should get vaccinated as soon as possible to prevent or lessen the severity of the disease.

Healthcare providers may order vaccine commercially or through their local health department.

Additional information on these and other topics can be found at the resources below:

Recommendations for Public Health

Mpox is a reportable condition and should be investigated promptly. Regional and local health departments should:

  • Report and enter case investigations as soon as practical
  • Notify DSHS whenever a suspect case presents with a recent travel history to the DRC
  • Conduct education and outreach with healthcare providers and facilities and community organizations to help ensure they are aware of the situation

Regional and local health departments are also encouraged to submit specimens to the DSHS Laboratory in Austin for genetic sequencing to aid in the identification and detection of clade I MPXV.

Recommendations for the Public

Mpox spreads most commonly from direct skin-to-skin contact with the mpox rash or lesions of a person infected with MPXV. This contact often, although not always, occurs during intimate or sexual contact. Mpox lesions are often painful and symptoms generally last from 2 to 4 weeks.

  • People who are sick or have any of the signs or symptoms of mpox should refrain from intimate or sexual contact to prevent the spread of mpox.
  • People diagnosed with mpox should notify those that they may have exposed to the disease as soon as possible so those individuals can be on the lookout for signs and symptoms and get vaccinated as soon as possible.

Individuals can help protect themselves by getting vaccinated against mpox and should consult with their healthcare provider to determine if vaccination against mpox is appropriate.

  • People who previously received only one JYNNEOS vaccine dose should receive a second dose as soon as possible as two doses provide greater protection. There is no need to restart the vaccine series if there was a delay in receiving the second dose.
  • Get vaccinated as soon as possible after being exposed to someone with mpox (if exposed less than 14 days ago, ideally within 4 days of exposure), regardless of your sexual or gender identify.
  • People who are vaccinated should continue to avoid close, skin-to-skin contact with someone who has mpox.
  • The Mpox Vaccine Locator can be used to identify providers that can administer the vaccine.

For More Information

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