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Vaccinia Virus Infection & Temporal Analysis of Virus Gene Expression: Part 2
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Prolonged Monkeypox Virus Infections, California, USA, May 2022-August 2024.

Samuel Schildhauer, Kayla Saadeh, Robert E Snyder

    Emerging Infectious Diseases
    |September 12, 2025
    PubMed
    Summary
    This summary is machine-generated.

    Prolonged mpox virus (MPXV) infection, lasting over 28 days, disproportionately affects Black individuals and those with HIV. Vaccination with two JYNNEOS doses prevented prolonged MPXV infections.

    Keywords:
    CaliforniaHIVMPXVUnited Statesepidemiologymonkeypoxmpoxprolonged infectionsexually transmitted infectionsviruseszoonoses

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    Area of Science:

    • Public Health
    • Infectious Diseases
    • Epidemiology

    Background:

    • Monkeypox virus (MPXV) infection typically resolves within 14–28 days.
    • Prolonged MPXV infection (>28 days) is documented but not well understood.
    • Understanding risk factors for prolonged mpox is crucial for targeted interventions.

    Purpose of the Study:

    • To characterize prolonged mpox cases compared to non-prolonged cases.
    • To identify demographic, clinical, and vaccination factors associated with prolonged MPXV infection.

    Main Methods:

    • Analysis of mpox cases from the California Department of Public Health mpox registry.
    • Comparison of prolonged (>28 days) versus non-prolonged (<28 days) mpox cases.
    • Evaluation of demographics, HIV status, and JYNNEOS vaccination status.

    Main Results:

    • 1.3% (82 of 6,469) of mpox cases were prolonged.
    • Prolonged infections were more common in Black or African American individuals (20.7% vs. 11.6%) and those with HIV (61.0% vs. 39.9%).
    • Among persons with HIV, prolonged infection was linked to lower CD4 counts (<200) and lack of HIV care engagement.
    • No prolonged infections were observed in individuals who received two JYNNEOS vaccine doses.

    Conclusions:

    • Black individuals and persons with HIV are disproportionately affected by prolonged mpox.
    • HIV status, particularly low CD4 count and disengagement from care, increases risk.
    • Two-dose JYNNEOS vaccination appears protective against prolonged mpox.
    • Prioritize mpox vaccine education and outreach for disproportionately affected groups.