{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:32:04Z","timestamp":1787632324235,"version":"build-2736575974"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","funder":[{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In May 2022, mpox cases were reported in nonendemic countries, including the United States. We examined mpox infections in the Veterans Health Administration (VHA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Mpox diagnostic and whole genome sequencing (WGS) results, demographics, risk factors, hospitalizations, exposures, deaths, and pharmacy and immunization data were obtained from VHA data sources (23 May 2022\u201331 May 2023).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1144 Veterans tested, 251 (21.9%) were presumptive positive for nonvariola orthopoxvirus (NVO) or confirmed positive for NVO and Monkeypox virus (MPXV). Incidence rate was 7.5 per 100 000 Veterans in care, with the highest rate observed in Veterans aged 25\u201334 years (13.83 cases per 100 000). Higher odds of NVO or NVO\/MPXV positivity was associated with male sex; non-Hispanic Black race\/ethnicity; syphilis or human immunodeficiency virus (HIV) positivity; or genital\/rectal sample site, whereas older age and vaccination with JYNNEOS or vaccinia (smallpox) had lower odds. Among 209 with confirmatory testing, 90.4% reported intimate contact and\/or an epidemiological link, 84.5% were men who have sex with men (MSM), 24.2% received tecovirimat, and 8.1% were hospitalized with 1 death. Eighty-six sequenced samples had evaluable WGS results. All were clade IIb, representing 10 different lineages from 20 states and the District of Columbia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mpox affected younger, MSM, non-Hispanic Black, and HIV\/syphilis-positive men among US Veterans. Viral diversity was noted across geographic regions. At-risk Veterans would benefit from vaccination and risk reduction strategies for mpox and other sexually transmitted infections.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiad600","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T19:12:43Z","timestamp":1703272363000},"page":"S172-S180","source":"Crossref","is-referenced-by-count":9,"title":["Epidemiology of the 2022 Mpox Outbreak in the US Veterans Health Administration"],"prefix":"10.1093","volume":"229","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4378-5293","authenticated-orcid":false,"given":"Cynthia","family":"Lucero-Obusan","sequence":"first","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7623-3500","authenticated-orcid":false,"given":"Gina","family":"Oda","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6457-3113","authenticated-orcid":false,"given":"Patricia","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Edson","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Trevino","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5983-0867","authenticated-orcid":false,"given":"Tarek","family":"Elbeik","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6655-7982","authenticated-orcid":false,"given":"Mark","family":"Holodniy","sequence":"additional","affiliation":[{"name":"Public Health National Program Office, US Department of Veterans Affairs , Washington, District of Columbia"},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs , Palo Alto, California"},{"name":"Division of Infectious Diseases and Geographic Medicine, Stanford University , Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"key":"2024032619385920500_jiad600-B1","author":"World Health Organization."},{"key":"2024032619385920500_jiad600-B2","author":"Administration for Strategic Preparedness and Response"},{"key":"2024032619385920500_jiad600-B3","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1186\/s12879-022-07900-7","article-title":"Human monkeypox: a comparison of the characteristics of the new epidemic to the endemic disease","volume":"22","author":"Sukhdeo","year":"2022","journal-title":"BMC Infect Dis"},{"key":"2024032619385920500_jiad600-B4","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1056\/NEJMra2208860","article-title":"Monkeypox","volume":"387","author":"Gessain","year":"2022","journal-title":"N Engl J 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Med"},{"key":"2024032619385920500_jiad600-B8","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1177\/09564624231185812","article-title":"A retrospective study on 198 mpox cases in South Florida: clinical characteristics and outcomes with focus on human immunodeficiency virus status","volume":"34","author":"Kim","year":"2023","journal-title":"Int J STD AIDS"},{"key":"2024032619385920500_jiad600-B9","doi-asserted-by":"crossref","first-page":"e072410","DOI":"10.1136\/bmj-2022-072410","article-title":"Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series","volume":"378","author":"Patel","year":"2022","journal-title":"BMJ"},{"key":"2024032619385920500_jiad600-B10","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort 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of VA and non-VA ambulatory patients: the Veterans\u2019 health and medical outcomes studies","volume":"27","author":"Rogers","year":"2004","journal-title":"J Ambul Care Manage"},{"key":"2024032619385920500_jiad600-B17","first-page":"13","article-title":"Current and projected characteristics and unique health care needs of the patient population served by the Department of Veterans Affairs","volume":"5","author":"Eibner","year":"2016","journal-title":"Rand Health Q"},{"key":"2024032619385920500_jiad600-B18","author":"US Department of Veterans Affairs"},{"key":"2024032619385920500_jiad600-B19","author":"National Center for Veterans Analysis and Statistics"},{"key":"2024032619385920500_jiad600-B20","author":"US Department of Veterans Affairs"},{"key":"2024032619385920500_jiad600-B21","author":"US Department of Agriculture"},{"key":"2024032619385920500_jiad600-B22","author":"Centers for Disease Control and Prevention"},{"key":"2024032619385920500_jiad600-B23","author":"Centers for Disease 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