Clinical features and outcomes of mpox in people with and without HIV: a national comparative study.

BACKGROUND: People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. SETTING: Country-wide study in Mexico. METHODS: We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. RESULTS: Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. CONCLUSION: People with HIV have a higher risk of severe mpox and death due to mpox.

Epidemiological and clinical characteristics of patients with human monkeypox infection in Mexico: a nationwide observational study.

Background: Human monkeypox, a zoonosis historically endemic to West and South Africa, has led to a worldwide outbreak driven by human-to-human transmission resulting in an international public health emergency. Endemic and outbreak monkeypox cases may differ in their affected populations, clinical features, and outcomes. Thus, profiling cases of the current monkeypox outbreak worldwide is crucial. Methods: We performed a nationwide observational surveillance-based study from May 24 to September 5, 2022. Patients that met the operational clinical definition of monkeypox or symptomatic close contacts of confirmed cases were tested by real-time polymerase chain reaction. Clinical data were collected with a standardized case-report form. We report epidemiologic, sociodemographic, and clinical characteristics of confirmed cases. Findings: Five-hundred and sixty-five human monkeypox confirmed cases were analysed; 97.2% were men, of whom 59.5% identified as men who have sex with men, and 54.5% had human immunodeficiency virus infection. The median age was 34 years. All patients but one had rash (99.8%), 78.9% had fever, and 47.8% reported myalgia. The anogenital area was the most commonly affected one by rash (49.6%), and proctitis occurred in 6.2% of patients. Six patients required hospitalization, of which one died due to causes unrelated to monkeypox. Interpretation: The 2022 monkeypox outbreak in Mexico is mainly driven by middle-aged men who have sex with men, of which a large proportion are persons who live with human immunodeficiency virus infection. Clinical features such as the high proportion of anogenital lesions suggest sexual contact is a pivotal transmission mechanism in this outbreak. Funding: This research was supported by grant A1-S-18342 from Consejo Nacional de Ciencia y Tecnología (CONACyT), Mexico (to S.I.V.-F.).

Disponibilidad de antisépticos obsoletos e infecciones nosocomiales en unidades de cuidados intensivos de hospitales de México / Availability of antiseptics obsolete and nosocomial infections in intensive care units of hospitals in Mexico

Objetivo: Analizar la relación entre la existencia de políticas para el manejo de antisépticos, la presencia de antisépticos obsoletos y la prevalencia de infecciones nosocomiales (IN) en unidades de cuidados intensivos de hospitales públicos. Material y métodos: Análisis ecológico en 41 hospitales de 3 instituciones públicas de salud en México. Mediante regresión lineal se estimó la asociación entre la prevalencia de IN con la existencia de políticas y la presencia de antisépticos obsoletos. Resultados: Se observó una alta prevalencia de antisépticos inadecuados, particularmente peróxido de hidrógeno (46.7%). Los hospitales con antisépticos obsoletos tuvieron una prevalencia de IN 7 puntos porcentuales más elevada (p=0.001) en comparación con aquellos que carecían de éstos. Aquellos que contaban con evidencia de políticas para el manejo de antisépticos tuvieron una prevalencia 2 puntos porcentuales menor. Conclusiones: Nuestros hallazgos sugieren que la selección adecuada de antisépticos puede redundar en mejorar la seguridad del paciente.

Objective: To analyze the relationship between explicit policies for antiseptics handling, the presence of obsolete antiseptics and nosocomial infections prevalence in intensive care units public hospitals. Methods: An ecological analysis was conducted involving 41 general hospitals of three public health institutions. We use linear regression to estimate the association between hospital-level nosocomial infection prevalence and existence of antiseptics policy and obsolete antiseptics presence. Results: Adjusting by potential confounders, hospitals where had obsolete antiseptics had seven points higher prevalence of nosocomial infection (p=0.001). Those who had evidence of handling policies antiseptics had two points prevalence lower. There was high prevalence of inadequate antiseptics, particularly hydrogen peroxide (46.7%). Conclusions: Our findings confirm that proper selection of antiseptics can lead to improved patient safety. Antiseptics obsolete, even in suitable compounds presence, correlated with higher nosocomial infection prevalence.