Mpox: Special Considerations in the Immunocompromised Host

Opinion statementHerein, we review the clinical course of mpox, treatment options, and prevention strategies in immunocompromised hosts. As there are limited publications on mpox in the immunocompromised, we also explore other human-infecting poxviruses. Poxviruses share genomic, structural, and forOrthopoxviruses, antigenic similarities, suggesting that study of one species can inform our expectations for host and pathogen interactions and treatment response in another. We attempt to make inferences from this review but also identify ongoing research needs for mpox in immunocompromised individuals. The yearly number of mpox cases has been increasing since the cessation of mass smallpox vaccination campaigns. A global mpox outbreak started in May 2022 placing immunocompromised individuals at heightened risk and necessitating a better understanding of how the disease course is modified by compromised immunity. Review of poxviridae case reports, including mpox, shows that many of the most severe cases have been in immunocompromised individuals. In vitro, animal studies, and limited case reports suggest that the therapeutics tecovirimat, cidofovir, brincidofovir, and vaccinia immune globulin IV may attenuate disease severity, but large-scale clinical trial data is needed to better evaluate efficacy. Vaccination is also an important countermeasure for protecting vulnerable populations.
Source: Current Treatment Options in Infectious Diseases - Category: Infectious Diseases Source Type: research