Many of the problems in the mpox response were due to a deflated and exhausted public health workforce across the country.
The test the US Centers for Disease Control and Prevention uses to identify clade I mpox cases is 'most likely not reliable' for detection of the substrain identified in the study, the authors say.
Another mpox study today showed that dose-sparing vaccine administration of the Jynneos vaccine appeared to have worked.
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By the end of November 2022, Florida had recorded 2,845 confirmed or probable mpox cases.
For women, the estimated sample case hospitalization risk was 18%, compared with 5% for men, but the authors noted 'considerable' uncertainty because of the small number of cases in women.
The epi investigation revealed that many of the patients were young women involved in sex work.
The authors found strong evidence of viral circulation before initial case detection in each affected world region.
The most common symptom throughout the study period was rash, followed by enlarged lymph nodes.
Sensitivity was 99% for all patients and 100% in the people affected by HIV.
As small clusters continue, the CDC notes that only 1 in 4 eligible people have received both mpox vaccine doses.
Early tecovirimat was associated with shorter time to symptom improvement (by 5.5 days) among participants with severe illness.
Wastewater tests had a sensitivity of 32% for detecting 1 or more people shedding mpox virus, but it was 77% for detecting 15 or more people shedding virus.
Countries reporting the most cases were Spain, Portugal, the UK, and Germany.