After the 2022 global mpox outbreak, which primarily affected gay and
bisexual men who have sex with men (GBMSM), US cases declined but **low-level
transmission continued.** Local outbreaks raised a specific worry: that cases
were appearing among people nobody was testing, because they did not fit the
risk profile.
This study tested that directly.
The design
During June–December 2023, 196 patients aged 3 months and over were
evaluated at 13 US emergency departments for **an mpox-compatible rash,
irrespective of epidemiologic risk factors.**
That last clause is the whole method. Testing only people with known risk
factors can only ever confirm what is already believed. Testing every
compatible rash is how you find out whether the belief is wrong.
The result
Three mpox cases (1.5%) were identified — and **all three were among
unvaccinated GBMSM who had engaged in sex with one or more partners met
through smartphone dating applications.**
The concern was not borne out. Looking without a filter found no unsuspected
population; it found the pattern already described.
That is a useful negative result, and it only exists because somebody
deliberately looked where they did not expect to find anything.
What clinicians are asked to do
**Remain vigilant for monkeypox virus infections, particularly among GBMSM,
and educate patients about the importance of risk reduction and JYNNEOS
vaccination.**
Unvaccinated is doing work in the findings above: all three cases were in
people eligible for a vaccine they had not had.
*Source: Berdahl CT, Krishnadasan A, Pathmarajah K, et al. Mpox Surveillance
Based on Rash Characteristics — 13 Emergency Departments, United States,
June–December 2023. MMWR, Centers for Disease Control and Prevention.*
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