Monkeypox deaths reported while CDC releases new study on brain inflammation

The August 30 Press Briefing by White House Monkeypox Response Team and Public Health Officials. (Youtube screenshot.)

The U.S. has recorded its first deaths from monkeypox, while also reporting cases are slowing among certain groups, notably white men. Communities of color remain disproportionately impacted as vaccine distribution continues to be more haphazard in reaching Black and brown communities.

“Back in July, CDC estimated that it took eight days for cases to double nationwide. By mid-August, the doubling rate was 25 days, showing encouraging signs of progress,” said Dr. Demetre Daskalakis, deputy coordinator for the White House Monkeypox Response. 

David Harvey, executive director of the National Coalition of STD Directors, said in a press briefing Sept. 13, “We still have to ramp up our efforts to respond to this outbreak. And there are many, many data questions, clinical care questions, research questions that remain to be answered about this very unusual outbreak of a known virus over the decades that is presenting itself very differently in the United States.” 

According to an announcement on Sept. 12 from the Los Angeles County Public Health Department, a resident who was “severely immunocompromised and had been hospitalized,” has died of monkeypox. The department said others “who are severely immunocompromised and suspect they have monkeypox should seek medical treatment.” 

The announcement comes after officials in Texas confirmed August 29 that they were investigating a potential death from the virus. The person in Texas who died was “severely immunocompromised,” according to health officials.

“We are sharing this information to err on the side of transparency and to avoid potential misinformation about this case,” Harris County Judge Lina Hidalgo said in a statement announcing the death. Harris County, which includes Houston, is the third-most populous county in the U.S. and is 44% Latinx and 20% Black.

The Los Angeles health department said, while offering condolences to the family of the deceased, “to protect confidentiality and privacy, additional information on this case will not be made public.” 

The Centers for Disease Control and Prevention (CDC) reports that “At this time, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current monkeypox outbreak.”

California has the highest number of reported cases at over 4,300. Texas has the fourth highest number of cases at 2,017. 

“This is not a benign infection. This death is very concerning to all of us,” David Harvey, executive director of the National Coalition of STD Directors, said at a Tuesday briefing with public and sexual health experts about the need for more federal funding for the outbreak. “We have to stay the course. We have to monitor this.” 

Deaths in non-endemic countries are rare. Nature reported Sept. 13 that “out of more than 57,000 people confirmed to have had monkeypox infections, at least 22 have died, representing a death rate of about 0.04%.” Access to therapeutics and overall health care make deaths from the disease less likely in non-endemic countries. There have been six other new reported monkeypox deaths in non-endemic countries, including in Brazil, India and Spain. 

Another concerning development which made no national headlines was a CDC study published Sept. 13 detailing how two previously healthy young men experienced inflammation of the brain and spinal cord as a result of the virus. CDC wrote: “Two U.S. cases of encephalomyelitis associated with acute MPXV infection were identified during summer 2022.” 

CDC explained, “The current monkeypox outbreak differs clinically and epidemiologically from previous outbreaks, and little is known about potential associated neurologic complications.”

The public health ramifications are limited, according to CDC, but the agency recommends that “suspected cases of neurologic complications of monkeypox should be reported to state, tribal, local, or territorial health departments to improve understanding of the range of clinical manifestations of MPXV infections during the current outbreak and treatment options.”

These reports come concomitant with the hopeful news that the rate of new monkeypox infections is slowing. 

But concerns that Black and Latinx people are not being treated at the same rates as their white peers abound. NBC News reports, “Although [Black people] make up roughly 12% of the population, they make up 38% of the most recent monkeypox cases, according to the CDC. In Atlanta, 71% of people with the infection, which can cause painful and irritating skin lesions, are Black men who have sex with men and about two-thirds of those men have HIV, according to the Georgia Health Department.”

Georgia GOP Rep. Marjorie Taylor Greene, an anti-science, anti-vaxxer who is virulently anti-LGBTQ, said in a video posted to her Twitter account on Sept. 13 that “no one is concerned” about monkeypox. Yet Georgia has the fifth highest case rate after California, New York, Florida and Texas. Georgia’s population is less than half of Florida and New York, a third of Texas and a quarter of California. Also, Georgia has the third highest overall percentage of Black people at 34%.

NBC News also noted about Black people and monkeypox treatment that, “In North Carolina, 70% of those infected are Black men, with nearly all of the cases affecting men who have sex with men. However, only 24% of the vaccines in the state have gone to Black North Carolinians.”  

On Sept. 12 it was reported that Black Mississippians now account for 93% of monkeypox infections in the state. Mississippi has the largest Black demographic in the U.S. at 40% and health crises are prevalent in the Black community in Mississippi which also has the highest rate of Black maternal deaths in the U.S. Public-health data show that, among Mississippians infected with monkeypox, 93% are male, 93% are Black, 67% are people living with HIV and the median age is only 31. 

But in an interview Sept. 12 with NPR with Daskalakis, the former Director of the CDC Division of HIV Prevention was optimistic that men had altered their sexual behaviors to such a degree, while also getting vaccinated, that monkeypox could “get to a point where we’ll see occasional cases because of introductions [of the virus] from other places. We’ll also potentially see small clusters. But in terms of this big ol’ curve that we’ve been seeing, I think that’s going to dissipate so it’s no longer an outbreak, but more episodic.”

A CDC survey, “Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex with Men to Prevent Monkeypox virus Transmission,” reported that almost half of men who have sex with men who responded to the survey had limited the number of sex partners and especially altered their behavior regarding one-time sexual encounters, or sex with partners met through dating apps or sex venues. 

Daskalakis quoted from a paper he co-authored, saying, “It is important that systems for delivering HIV and STI care and prevention be leveraged for monkeypox evaluation, vaccination and other prevention interventions, and treatment.”

Daskalakis said, “We’re in this phase where getting the supply and maintaining the demand [for vaccines] is so important. It’s reasonable to think people will change behavior for a while, but not reasonable to think that they’re going to change it forever. And we’re not asking for forever, we’re asking for now.”

For more information on vaccines and testing, visit the Philadelphia Health Department or Mazzoni Center web sites.