Surveillance of Complicated Mpox Cases Unresponsive to Oral Tecovirimat in Los Angeles County, 2022
Abraar Karan, Naman K. Shah, Jacob M. Garrigues, Jemma Alarcón, Peera Hemarajata, Lauren E Finn, Kathleen Poortinga, Phoebe Danza, Sonali Kulkarni, Moon Kim, Dawn Terashita, Nicole M. Green, Sharon Balter
Abstract
The Los Angeles County Department of Public Health established a surveillance system to identify complicated (advanced human immunodeficiency virus [HIV] or hospitalized) mpox cases. From 1 August to 30 November 2022, we identified 1581 mpox cases, of which 134 (8.5%) were complicated. A subset of 8 cases did not recover after either initiating or completing a course of oral tecovirimat. All 8 patients were HIV positive and had advanced HIV (CD4 count <200 cells/μL). We identified 8 distinct mutations previously associated with tecovirimat resistance in specimens collected from 6 patients. Ongoing surveillance of viral evolution requires close coordination between health departments and frontline providers.