Epidemiologic and Clinical Features of Mpox in Transgender and Gender-Diverse Adults — United States, May–November 2022

Abstract

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

Mpox Cases Among Cisgender Women and Pregnant Persons — United States, May 11–November 7, 2022

“…Monkeypox (mpox) cases in the 2022 outbreak have primarily occurred among adult gay, bisexual, and other men who have sex with men (MSM); however, other populations have also been affected ( 1 ). To date, data on mpox in cisgender women and pregnant persons have been limited.…”

Modifications to Sexual Behaviors Associated With Mpox (Monkeypox) Virus Transmission Among Persons Presenting for mpox Vaccination, Washington, DC, August–October, 2022

“…Similarly, a participant who marked no change to a behavior is not necessarily an indication that the behavior occurred or occurred within a time frame that would be relevant for potential mpox exposure risk. In addition, the small numbers of transgender persons in this analysis do not allow us to examine their reports of sexual behavior change separately, despite evidence that transgender persons nationally have accounted for a disproportionate share of mpox virus infections 13 . Despite these limitations, our findings could be extended to understand how individuals who engage in behaviors associated with mpox transmission use prevention messages, whether in lieu of or in addition to vaccination; this information is pivotal to the development of interventions to increase vaccine uptake and vaccine coverage.…”

“…While disaggregated reporting of sexual orientation and gender identity are among the best practices for data collection, we combined gender identity, sexual orientation (for men), and gender identity of sex partners to reflect categories that were inclusive of gender identity and to distinguish groups at higher risk for mpox virus infection, including MSM. Transgender persons have experienced a disproportionate prevalence of mpox virus infections, 13 but the number of transgender women (n = 5) and transgender men (n = 3) in this analysis were too small to analyze their reports of behavior change separately. Men, including transgender men, were categorized as MSM if they reported sex with men or transgender men in the past 14 days or they reported their sexual orientation as gay or bisexual.…”

Simulating the impact of optimized prevention and control measures on the transmission of monkeypox in the United States: A model‐based study

“…Furthermore, among the more than 90 000 cumulative monkeypox cases globally, approximately 98% occurred in areas where no previous epidemics had been documented 1,4,5 . As one of the nonendemic countries most severely affected by the monkeypox epidemic, the United States has reported over 30 000 confirmed cases, with a majority of them reported in adult males who have sex with other males 6 . These findings indicated that the monkeypox outbreak had spread extensively worldwide, particularly in nonendemic countries that may lack adequate experience in prevention and control.…”