On May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity, † 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact, § 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity, ¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex * https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html † Persons whose reported sex differed from their gender or who reported being transgender were classified as transgender. Among cases with reported information on sex but not gender, sex was used to categorize persons as cisgender women or men. Among cases with reported information on gender but not sex, gender was used to categorize persons as cisgender women or men. Among 25,001 adults with information on sex or gender, 3,589 (14%) only had information on sex, and 6,142 (25%) only had information on gender. § Sexual or close intimate contact is defined as engaging in any sex (e.g., vaginal, oral, or anal) or close intimate contact (e.g., cuddling, kissing, touching partner's genitals or anus, or sharing sex toys) during the 21 days before symptom onset. ¶ Persons who indicated Hispanic ethnicity, regardless of race, were categorized as Hispanic or Latino. Persons missing data on ethnicity were assumed to be non-Hispanic.

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As of November 9, 2022, a total of 28,730 cases of monkeypox (mpox) had been reported in the United States,* primarily among adult cisgender men reporting recent male-to-male sexual contact (1). Transgender and gender-diverse persons, who constitute an estimated 0.5% of the U.S. adult population, † face unique health disparities and barriers to care (2-4). However, data on the epidemiologic and clinical features of Monkeypox virus infections in this population are limited (5). CDC analyzed U.S. case surveillance data on mpox cases in transgender and gender-diverse adults reported during May 17-November 4, 2022. During this period, 466 mpox cases in transgender and gender-diverse adults were reported, accounting for 1.7% of reported cases among adults. Most were in transgender women (43.1%) or gender-diverse persons (42.1%); 14.8% were in transgender men. Among 374 (80.3%) mpox cases in transgender and gender-diverse adults with information available on sexual or close intimate contact, 276 (73.8%) reported sexual or close intimate contact with a cisgender male partner during the 3 weeks preceding symptom onset. During the ongoing outbreak, transgender and genderdiverse persons have been disproportionately affected by mpox. Members of this population frequently reported recent sexual or close intimate contact with cisgender men, who might be in sexual networks experiencing the highest incidence of mpox. These findings highlight the importance of tailoring public health prevention * https://www.cdc.gov/poxvirus/monkeypox/response/2022/index.html (Accessed November 9, 2022). † Transgender and gender-diverse persons are those whose gender identity might differ from their assigned sex at birth. This description includes transgender women, transgender men, and gender-diverse persons identifying as another gender (i.e., not transgender or cisgender), such as nonbinary, genderqueer, and gender nonconforming. Using data from CDC's 2017-2020 Behavior Risk Factor Surveillance System and 2017 and 2019 Youth Risk Behavior Survey, which rely on self-reporting of gender identity, the Williams Institute estimates that 1.3 million transgender and gender-diverse adults live in the United States; however, this percentage might be an underestimate because some persons might have been reluctant to disclose their gender identity because of fear of stigma or other reasons. and outreach efforts to transgender and gender-diverse communities and could guide strategies to reduce mpox transmission. Data on confirmed and probable cases of mpox are electronically reported by jurisdictional health departments to CDC using a standardized case report form § or the National Notifiable Diseases Surveillance System. ¶ CDC analyzed case report form § https://www.cdc.gov/poxvirus/monkeypox/pdf/sCRF-Short-Form.pdf ¶ https://www.cdc.gov/nndss/index.html INSIDE