(P48) CHARACTERIZING CLADE II MPOX RASH PRESENTATION USING NATIONAL SURVEILLANCE DATA IN THE UNITED STATES, MAY 2022 TO MARCH 2024

Background:
The mpox outbreak that began in 2022 (Clade II) has caused >90,000 infections and >150 deaths in non-endemic countries. While many cases experienced localized lesions, often in the anogenital area, others presented with more severe disease. Understanding factors associated with current Clade II mpox presentation is necessary to differentiate the current outbreak from future Clade I or Clade II monkeypox virus (MPXV) outbreaks.  This analysis explores the correlation between reported sexual contact and anogenital lesions and describes differences in clinical and demographic characteristics captured in national surveillance data among cases with localized vs diffuse mpox lesions for Clade II MPXV in the United States from May 2022 to March 2024.

Methods:
Mpox cases were reported to the Centers for Disease Control and Prevention (CDC) by local and state health departments since May 2022. Case reports included case age, sex assigned at birth, race/ethnicity, HIV status, suspected exposure type, mpox vaccination status, lesion sites, and whether a case was hospitalized. Cases were classified as having diffuse lesions if >1 body site was indicated in the case report.

Results:
Of 32,222 infections that occurred between May 2022 and March 2024, 18,653 cases (57.9%) had reported lesion locations and were included for analysis. Of those, 5,789 cases (31.0%) reported localized lesions, often in the anogenital area. Reported sexual contact was associated with anogenital rash. Age, sex assigned at birth, race/ethnicity, HIV status, mpox vaccination status, and hospitalization were significant predictors of diffuse rash. Cases with reported vaccination more commonly reported localized lesions.

Conclusion:
Localized anogenital lesions are common among cases in the current Clade II mpox outbreak. Surveillance data remains a key tool in understanding mpox epidemiology, but challenges remain, including data completeness and difficulty capturing disease progression. CDC continues to monitor changes in mpox epidemiology to prepare for future outbreaks.