Background:
In the 2022 outbreak of mpox, reported hospitalization rates have ranged from 2%-13%. Severe clinical manifestations have been reported in persons coinfected with mpox and HIV. However, data describing sociodemographic characteristics and comorbidities among hospitalized persons with mpox are limited. We compared demographic characteristics, highlighting socioeconomic disparities and clinical characteristics, including HIV infection, among persons with mpox who were and were not hospitalized in California.
Methods:
We included mpox cases reported in California from May 17 through September 8, 2022. All analyses were stratified by HIV status. Census tracts of residence of mpox cases were matched to the California Healthy Places Index (HPI), which categorizes neighborhoods based on characteristics that influence health of residents, with lower scores relating to fewer opportunities for residents of these communities to lead healthy lives. Fisher’s exact tests and Wilcoxon rank sum tests were used to compare groups.
Results:
Of 3241 persons with mpox, 1317(41%) had HIV and 119(4%) were hospitalized. Among those with HIV 68(5%) were hospitalized and 51(3%) without HIV were hospitalized. Hospitalization was commonly for oropharyngeal (25(21%)) or rectal symptoms (19(16%)), and bacterial infections (19(16%)). Among those with HIV, more hospitalized than non-hospitalized persons lived in the lowest HPI quartile (26(42%) versus 279(23%), p=0.01); no difference was seen among those without HIV. In those with HIV, having CD4 < 200 cells/uL (9(14%) versus 46(4%)) or a non-suppressed (≥200 copies/mL) viral load (27(42%) versus 121(9%)) was associated with hospitalization (p-values< 0.01). For those with HIV who were hospitalized, 13(36.1%) with non-suppressed viral loads and 4(44%) with CD4< 200 cells/uL lived in the lowest HPI quartile. Among those without HIV, having diabetes (3(6%) versus 31(2%), p< 0.001) or exfoliative skin conditions (5(10%) versus 59(3%), p< 0.001) was associated with hospitalization.
Conclusions:
Among persons with mpox and HIV, more hospitalized cases had uncontrolled HIV and lived in communities with fewer opportunities to lead healthy lives. Among persons with mpox and without HIV, more that were hospitalized had diabetes or exfoliative skin disorders. Vaccination and rapid access to testing and treatment should be prioritized in these groups.
Table 1: Characteristics of persons with mpox in California from May 17th 2022- September 8th 2022 (Nf3241).