Two clades of monkeypox virus make people ill. Clade I is endemic in Central Africa and rising in the Democratic Republic of the Congo. Clade II caused the global outbreak that began in 2022; its illness is milder and usually clears on its own, though people with weakened immune systems — especially advanced HIV, with a CD4 count under 200 cells/mm³ — have had more severe infections. Clade II still circulates at low levels in the United States; no clade I case had been reported in the country.
From outbreak to low, steady spread
U.S. cases peaked at about 3,000 a week in late July and August 2022 — 3,274 in the week beginning July 31 — then fell sharply. From October 1, 2023, to April 30, 2024, the national count held steady at an average of 59 a week, a fifty-five-fold drop from the peak, even as local counts rose and fell.
Probable and confirmed clade II mpox cases by week, May 2022–April 2024. CDC.
Who got it, October 2023–April 2024
1,802 probable and confirmed cases were reported from 42 states, the District of Columbia and Puerto Rico.
- Gender and orientation. 94% of patients who reported gender identity were cisgender men (1,054 of 1,121); 90% of those who reported sexual orientation identified as gay or bisexual (326 of 361).
- Age. 62% were 25 to 40 years old; the median age was 34 (range 0–76). Six cases were in people under 18.
- Race and ethnicity. 32% were White, 25% Black, 3% Asian, 2% multiracial and 4% another race; compared with May 2022–September 2023, the Black share fell 7 points (from 32%) and the Hispanic share rose 3 points (from 31% to 34%). The report's other figures here do not agree with each other: it says race and ethnicity were reported for 1,651 cases, "98%" of the 1,802, and gives 526 Hispanic patients as 34% — numbers that fit neither that total nor the other groups.
- HIV. 48% of those who reported HIV status were HIV-positive (282 of 593).
How sick
- Hospitalized: 10% of patients with data (145 of 1,429), slightly more than the 8% of May 2022–September 2023; 68% of hospitalized patients who reported HIV status were HIV-positive (49 of 72).
- Deaths: five since October 2023 — 0.3% of cases.
- Vaccination: of the 684 patients who reported their status, 67% (458) had never been vaccinated against mpox; 33% (226) had had at least one dose of an mpox or smallpox vaccine, and only two of those (1%) were hospitalized.
What CDC is doing and recommends
CDC continues genomic sequencing and clade-specific testing, to watch for mutations that weaken medical countermeasures — such as resistance to the antiviral tecovirimat — and to catch any clade I case.
Since the outbreak began, only 39% of people at risk of mpox have had at least one vaccine dose, and 25% both doses, so most remain unvaccinated. CDC recommends that everyone at risk of exposure who has not already had mpox — including some gay, bisexual and other men who have sex with men — complete the two-dose JYNNEOS series, however long ago the first dose was given and whichever way it was given.
Sources
- Alexandra Tuttle, Christine M. Hughes, Mitchell Dvorak and colleagues, "Notes from the Field: Clade II Mpox Surveillance Update — United States, October 2023–April 2024," MMWR 73(20), 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7320a4.htm
- CDC, JYNNEOS vaccine recommendations: https://www.cdc.gov/poxvirus/mpox/vaccines/vaccine-recommendations.html
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