MMWR News Synopsis

Articles

HIV and Sexually Transmitted Infections Among Persons with Monkeypox — Eight U.S. Jurisdictions, May 17–July 22, 2022  

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A new report shows people with monkeypox have higher than expected rates of HIV and sexually transmitted infections (STIs). Additionally, among people with monkeypox, hospitalization was more common among people with HIV than people without HIV. HIV and STI testing should be routinely offered to people evaluated for monkeypox, with linkage to HIV care or HIV pre-exposure prophylaxis (PrEP) as appropriate. CDC and eight health departments collaborated to link monkeypox surveillance data with HIV and STI surveillance data to assess the number of people in the United States with monkeypox who also had an HIV infection or were diagnosed with another STI in the preceding year. They found 755 people (38%) had HIV infection and 816 (41%) were diagnosed with an STI (other than HIV) in the preceding year. To date, most U.S. monkeypox cases have occurred among gay, bisexual, and other men who have sex with men (MSM), who have higher rates of HIV and other STIs than the general population. However, these analyses found that the HIV prevalence among people with monkeypox was higher than national HIV prevalence estimates for U.S. MSM (23%). Among people with monkeypox, the weekly percentage with concurrent HIV infection increased over time. This suggests that monkeypox might be increasingly transmitted among networks of people with HIV infection and underscores the importance of leveraging HIV and STI care and prevention delivery systems for monkeypox vaccination and prevention efforts.

Detection of a Highly Divergent Type 3 Vaccine-Derived Poliovirus in a Child with a Severe Primary Immunodeficiency Disorder — Chongqing, China, 2022 

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Surveillance among patients with primary immunodeficiency disorder (PID; a variety of inherited disorders resulting from developmental defects or dysfunction of immune system components) can increase the detection of vaccine-derived polioviruses (VDPVs). Early identification of VDPVs is important because VDPVs can jeopardize global polio eradication efforts. Oral poliovirus vaccine, used in some parts of the world outside of the United States, is highly effective in the global effort to eradicate poliomyelitis but can lead to VDPVs in undervaccinated communities and in people with weakened immune systems. Early identification of VDPVs is important because VDPVs can jeopardize polio eradication efforts through long-term excretion by patients with PID. In 2022, a pilot surveillance program in China to identify VDPVs in children with PID detected vaccine-derived poliovirus in stool specimens from a child with newly diagnosed PID. Integrated surveillance to detect acute flaccid paralysis, polioviruses in wastewater, and VDPVs in children with weakened immune systems is critical to detecting and containing all polioviruses and achieving the goal of global polio eradication.

Detection of Higher Cycle Threshold Values in Culturable SARS-CoV-2 Omicron BA.1 Sublineage Compared with Pre-Omicron Variant Specimens — San Francisco Bay Area, California, July 2021—March 2022 

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A new study explored the relationship between cycle threshold (Ct) values and the detection of infectious virus for people infected with Omicron BA.1 and pre-Omicron variants. Ct values are obtained from polymerase chain reaction (PCR) tests and are inversely related to the amount of viral RNA present in a specimen; higher Ct values mean less viral genetic material was detected. Among samples in which infectious COVID-19 virus was detected, Ct values were higher, suggesting lower viral RNA levels, in individuals with the Omicron BA.1 variant compared to individuals with pre-Omicron variants. These data highlight that Ct values likely do not provide a reliable or consistent substitute for infectiousness across SARS-CoV-2 variants. People and their household members living in the San Francisco Bay Area, CA, who tested positive for COVID-19, were asked to collect nasal swab samples once daily for 2 weeks. Ct values for the Omicron BA.1 variant were compared to values for variants that emerged prior to Omicron (pre-Omicron variants). Among study participants, 17 were infected with the Omicron BA.1 variant and 124 had pre-Omicron variants. Consistent with other published findings, Ct values were higher (suggesting lower RNA levels) in people with the Omicron BA.1 variant compared to those with prior variants. The study also found that potentially infectious samples (with culturable virus detected) from people with the BA.1 variant had higher Ct values than samples found in people with pre-Omicron variants. This highlights that Ct values likely do not reliably or consistently identify infectiousness across variants of the virus that causes COVID-19. The presence of culturable Omicron BA.1 in nasal specimens, despite high Ct values, might also contribute to the high levels of Omicron transmission observed in other studies.

Previously Released: Orthopoxvirus Testing Challenges for Persons in Populations at Low Risk or Without Known Epidemiologic Link to Monkeypox — United States, 2022

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• Age-Adjusted Suicide Rates, by Urbanization Level and Sex — National Vital Statistics System, 2020

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