Infectious Disease

Texas reports first US death in person with monkeypox

August 31, 2022

3 min read

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Disclosures:
Hellerstedt and Hotez report no relevant financial disclosures.

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Texas officials announced the first death of someone in the United States with monkeypox, although officials have not determined whether the disease was the person’s cause of death.

The adult, who died on Aug. 28 at a hospital in Harris County, had “various severe illnesses [and] was also presumptive positive for monkeypox,” according to Harris County Public Health.

Source: CDC.gov.

Texas reported the first US death in a person with monkeypox. Source: Adobe Stock

The state health department said the patient was “severely immunocompromised” and that the case is being investigated for the role monkeypox played in the death. Autopsy results are expected within the next few weeks, according to Harris County Public Health.

“Monkeypox is a serious disease, particularly for those with weakened immune systems,” John Hellerstedt, MD, commissioner of the Texas Department of State Health Services, said in a statement.

The CDC reports more than 18,000 cases of monkeypox in the United States as of Aug. 30, a higher proportion of the 50,000 global cases than any other nation.

Texas has reported roughly 1,600 cases of monkeypox.

Although monkeypox can be a painful infection, it is treatable and not life threatening for most people, according to the CDC.

Peter HotezMD, PhD, Healio told that the United States’ inexperience with monkeypox is only part of the challenge the country faces as the number of cases rises.

“Extrapolating from smallpox, we know that the consequences could be severe,” Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital for Vaccine Development, said in an email.

Peter Hotez

Although there is little information about the patient who died and their underlying conditions, he said that “given the high rate of HIV/AIDS in the highest risk group, such individuals should be prioritized for both vaccination and treatment with tecovirimat for any breakthrough cases. ”

The CDC and other agencies are working to speed distribution of the Jynneos vaccine, as well as tecovirimat, otherwise known as TPOXX.

To combat a shortage, the FDA has approved splitting JYNNEOS doses using one-fifth the amount of vaccine that is typically used. Hotez suggested looking toward TPOXX as a method of filling the gap amid the shortage.

“Given that the current vaccine shortage won’t end any time soon, we should also look to the potential of TPOXX for post-exposure prophylaxis and possibly even pre-exposure prophylaxis if the data support such use.”

TPOXX has to date only been clinically trialed in healthy volunteers but is being used for treatment of monkeypox under an expanded access protocol, which requires providers to request the drug.

While it has been approved for treatment of smallpox since 2018, the drug’s manufacturer, Siga Technologies, started trials for its use as post-exposure prophylaxis (PEP) in March. The company said in a press release at the time that it previously considered using the drug for PEP for smallpox as well.

Texas health officials, as well as those at the CDC, recommend that people exposed to monkeypox and those at high risk for the disease seek vaccination.

“We continue to urge people to seek treatment if they have been exposed to monkeypox or have symptoms consistent with the disease,” Hellerstedt said.

References:

CDC. Monkeypox – 2022 monkeypox outbreak global map. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html. Accessed Aug 31, 2022.

CDC. Monkeypox – 2022 US map & case count. https://www.cdc.gov/poxvirus/monkeypox/response/2022/us-map.html. Accessed Aug 31, 2022.

Harris County resident with severe illnesses in addition to being presumptive positive for monkeypox passes away. https://publichealth.harriscountytx.gov/Portals/27/Documents/HC%20Resident%20with%20Underlying%20Health%20Conditions%20and%20Presumptive%20Positive%20for%20Monkeypox%20Passes%20Away_8.29.pdf?ver=9dxCTNCpj3NOzBp4_4- aRA%3d%3d. Published Aug. 29, 2022. Accessed Aug. 31, 2022.

Texas Health and Human Services. Texas confirms first death of a person with monkeypox. https://dshs.texas.gov/news-alerts/texas-confirms-first-death-of-a-person-with-monkeypox/. Published August 30, 2022. Accessed August 31, 2022.

Texas Health and Human Services. New updates. https://dshs.texas.gov/news/updates.shtm#monkeypox. Accessed Aug 31, 2022.

Siga announces start of TPOXX post-exposure prophylactic (“PEP”) clinical trials. https://investor.siga.com/news-releases/news-release-details/siga-announces-start-tpoxxr-post-exposure-prophylactic-pep. Published March 2, 2022. Accessed Aug. 31, 2022.

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