Background:
During the 2022 mpox outbreak, most patients were managed as outpatients, however many required hospitalization. We describe demographics, indications for hospitalization, therapeutic interventions and risk factors associated with hospitalization among patients with mpox in an urban health system.
Methods:
Patients in the Johns Hopkins Health System (JHHS) with an mpox diagnosis from July 1 through December 15, 2022 were included. Demographic and clinical data were abstracted. Patients were stratified by location of care (outpatient (OP) vs inpatient (IP)). Characteristics were analyzed using Wilcoxon Rank Sum and chi-square tests. Logistic regression was performed to assess for factors associated with hospitalization, as well as a subset analysis among PLWH to assess the impact of CD4 and HIV-1 RNA.
Results:
There were 85 patients identified with mpox during the study. Median age was 36 years, 61% were Black, 11% Latino, 97% assigned male sex at birth, 4% transgender women, 43% Medicaid or uninsured, 54% PLWH. Seventy (82%) were treated OP and 15 were IP (18%). There were no statistically significant differences between OP and IP in age, race, ethnicity, insurance status, HIV risk group, HIV status or obesity (Table 1). Among PLWH, CD4 < 350 was associated with IP (aOR 10.8 95% CI 1.1-108.3). There was a trend for increased IP among those with HIV-1 RNA >200 (aOR 10.0 [0.6-161.4], P=0.1).The most common indication for hospitalization was pain control (66.7%). Fewer OP received tecovirimat than IP (19% vs. 93%), opiate pain control (5% vs 80%), and antibiotics (21% vs. 80%). Two IPs received vaccinia immune globulin (13%), two received cidofovir (13%) and two received trifluridine eye drops (13%). Among IP, the median LOS was 5 days (1-48). Forty percent of IP received surgical consultation. Two IP (13%) required ICU level care and ultimately died. Both deaths were in PLWH with CD4 < 50.
Conclusions:
In this multi-hospital system, a significant proportion of mpox patients required hospitalization. Immunosuppression and HIV-1 viremia was associated with hospitalization for mpox. Achieving viral suppression and mpox immunization should be prioritized among those at risk.
Table 1