Explore the vast range of titles available.

Monkeypox (mpox) cases in the 2022 outbreak have primarily occurred among adult gay, bisexual, and other men who have sex with men (MSM); however, other populations have also been affected (1). To date, data on mpox in cisgender women and pregnant persons have been limited. Understanding transmission in these populations is critical for mpox prevention. In addition, among pregnant persons, Monkeypox virus can be transmitted to the fetus during pregnancy or to the neonate through close contact during or after birth (2-5). Adverse pregnancy outcomes, including spontaneous abortion and stillbirth, have been reported in previous mpox outbreaks (3). During May 11-November 7, 2022, CDC and U.S. jurisdictional health departments identified mpox in 769 cisgender women aged ≥15 years, representing 2.7% of all reported mpox cases. Among cases with available data, 44% occurred in cisgender women who were non-Hispanic Black or African American (Black), 25% who were non-Hispanic White (White), and 23% who were Hispanic or Latino (Hispanic). Among cisgender women with available data, 73% reported sexual activity or close intimate contact as the likely route of exposure, with mpox lesions most frequently reported on the legs, arms, and genitals. Twenty-three mpox cases were reported in persons who were pregnant or recently pregnant ; all identified as cisgender women based on the mpox case report form. Four pregnant persons required hospitalization for mpox. Eleven pregnant persons received tecovirimat, and no adverse reactions were reported. Continued studies on mpox transmission risks in populations less commonly affected during the outbreak, including cisgender women and pregnant persons, are important to assess and understand the impact of mpox on sexual, reproductive, and overall health.

Morbidity and Mortality Weekly Report (MMWR)

Currently, no Food and Drug Administration (FDA)-approved treatments for human monkeypox are available. Tecovirimat (Tpoxx), however, is an antiviral drug that has demonstrated efficacy in animal studies and is FDA-approved for treating smallpox. Use of tecovirimat for treatment of monkeypox in the United States is permitted only through an FDA-regulated Expanded Access Investigational New Drug (EA-IND) mechanism. CDC holds a nonresearch EA-IND protocol that facilitates access to and use of tecovirimat for treatment of monkeypox. The protocol includes patient treatment and adverse event reporting forms to monitor safety and ensure intended clinical use in accordance with FDA EA-IND requirements. The current multinational monkeypox outbreak, first detected in a country where Monkeypox virus infection is not endemic in May 2022, has predominantly affected gay, bisexual, and other men who have sex with men (MSM) (1,2). To describe characteristics of persons treated with tecovirimat for Monkeypox virus infection, demographic and clinical data abstracted from available tecovirimat EA-IND treatment forms were analyzed. As of August 20, 2022, intake and outcome forms were available for 549 and 369 patients, respectively; 97.7% of patients were men, with a median age of 36.5 years. Among patients with available data, 38.8% were reported to be non-Hispanic White (White) persons, 99.8% were prescribed oral tecovirimat, and 93.1% were not hospitalized. Approximately one half of patients with Monkeypox virus infection who received tecovirimat were living with HIV infection. The median interval from initiation of tecovirimat to subjective improvement was 3 days and did not differ by HIV infection status. Adverse events were reported in 3.5% of patients; all but one adverse event were nonserious. These data support the continued access to and treatment with tecovirimat for patients with or at risk for severe disease in the ongoing monkeypox outbreak.

Background Research on the role of preclinical AD pathology (brain Aβ deposition) and postoperative cognitive dysfunction is limited. We aimed to explore the association between brain Aβ deposition measured via Pittsburgh Compound B (PiB) PET imaging and POCD. We hypothesized that brain Aβ deposition would be associated with POCD in older women at 2 weeks and 3 months after surgery. Method This is a prospective cohort study of women aged ≥60 years who underwent urogynecologic surgery. Exclusion criteria included cognitive impairment diagnosis, abnormal cognition screen (Modified Mini‐mental State Exam (3MS) score < 84), and history of stroke. Baseline clinical and sociodemographic data were ascertained by interview and chart review. Brain Aβ deposition (global PiB standardized uptake value ratio (SUVR)) was measured through PiB‐PET using a combined MR/PET scanner. Eight neuropsychological tests, assessing memory, executive function, attention, and language were administered preoperatively, 2 weeks post‐surgery and 3 months post‐surgery. POCD was defined as ≥1 standard deviation (SD) decline on ≥2 neuropsychological tests or ≥ 2 SD decline on ≥1 tests. The association between Aβ PiB SUVR and cognitive performance was tested with Spearman correlation coefficient. Linear regression models, adjusted for clinically relevant variables, were generated. Result There were 20 patients enrolled with mean±SD age of 71.3±5.4 years, 14.7±2.23 years of education, baseline 3MS score of 97.3±2.63, and 1.12±0.20 global PiB SUVR. There was 45% (n = 9) POCD incidence at 2 weeks postoperatively and at 24% (n = 4/17) POCD prevalence at 3 months postoperatively. Table 1 summarizes demographics and cognitive performance at each time point. There were no significant correlations between PiB and cognitive domain at each time point although there appears to be a trend towards association of Aβ deposition on Spearman correlations (Table 2; Figure 1). On exploratory linear mixed models, there were no significant associations between Aβ deposition and cognitive performance by domain, nor with POCD. Conclusion In this cohort of older women, 45% had POCD 2 weeks post‐surgery and 24% had POCD 3 months post‐surgery. Brain Aβ deposition was not associated with cognitive performance nor POCD. Studies with larger cohorts are needed to fully investigate this potential predisposing risk factor.

As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States. Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox. Engaging all persons with HIV in sustained care remains a critical public health priority.