Doctors Investigating First Monkeypox-Related Death in Texas

The monkeypox pandemic shows no signs of slowing as the number of cases continues to rise, currently at just over 18,000. The virus has mainly affected men who have sex with men, but anyone can get infected through close personal contact, particularly sex. Three months into the crisis, officials in Texas have reported the nation’s first death related to the disease. Doctors described the patient as “severely immunocompromised,” but it’s too soon to say whether monkeypox played a role in his death.

Monkeypox is rarely known to be fatal. Symptoms include chills, fever, and a severe rash that will eventually scab before healing. The illness typically lasts two to four weeks from infection to recovery, but this patient was facing extreme circumstances.

“This is the first death in an presumed positive for monkeypox that we are aware of. However, the individual had various severe illnesses and until the investigation is complete, it is premature to assign a specific cause of death,” CDC spokesperson Scott Pauley said in a statement.

While this is the first patient with monkeypox to have died in the U.S., the CDC reports that there have been 15 patient deaths worldwide, with the most occurring in Africa and several in Spain. So far, the deaths have only occurred in individuals with compromised immune systems.

The patient died in a Texas hospital from “various severe illnesses.” Officials said the autopsy results are expected “in the next few weeks.”

“We are sharing this information to err on the side of transparency and to avoid potential misinformation about this case,” Lina Hidalgo, Harris County’s top official, said in a statement.

Officials are encouraging the public to take the outbreak seriously.

“Monkeypox is a serious disease, particularly for those with weakened immune systems,” said Dr. John Hellerstedt, head of the Texas health department, in a statement.

Pauley added that the CDC is working with local officials to investigate the circumstances of the death.

“Most people who get this form of the disease are likely to survive. However, people with weakened immune systems may be more likely to get seriously ill or die,” said Pauley.

It’s not clear if the patient had HIV, but officials say patients that are HIV positive face a higher risk.

With limited vaccines to go around, jurisdictions have been prioritizing people with compromised immune systems. However, those currently taking their medications for HIV face substantially less risk than those with infections that are not in control.

“In my experience, I’ve not seen differences in the clinical manifestation of this particular atypical outbreak between those that are taking medicine to prevent HIV and those that are taking medicine to treat their HIV,” the CDC’s Bruce Furness said at a recent webinar.

“That being said, we have seen one or two pretty bad outbreaks among HIV infected individuals that didn’t have good control. And when I say this, I’m talking, the pictures of these patients are similar to what you see about those with those really bad outbreaks in the Congo, and in the parts of Africa where this virus is endemic,” Furness added.

Monkeypox and Children

The CDC is reminding the public that while monkeypox is mainly transmitted through sexual contact, it is not a sexually transmitted disease. Individuals do not need to be sexually active to get infected. Children can be susceptible to the virus as well.

At least 18 children in 10 states have been diagnosed with monkeypox so far and little is known about the cases due to patient privacy.

One occurred in Kingston County, Washington where officials are treating an infant under the age of one that was recently diagnosed. Officials say they didn’t contract the virus through public settings. Instead, they got it from a family member that had been infected.

Dr. Danielle Zerr, medical director of infection prevention at Seattle Children’s Hospital, told reporters the patient is doing better but they still need to be hospitalized for several more days.

“The main thing that the patient was experiencing was the rash and complications of the rash, so, concern of super infection of the rash. Those were really the reasons that the patient came into the hospital,” Zerr said.

“The rash can be quite pronounced in many patients, especially as it evolves over time. And I think that sort of a rash on a child is going to raise people’s antennae, and lead a parent to seek care,” she added.

The infant required supportive care and was severely dehydrated, according to Zerr. They were also treated with TPOXX, an FDA-approved treatment for smallpox, that has been made available for children under special expanded access protocols.

“Once we had the confirmed test result, we started that antiviral for the patient and it did really seem like there was some improvement in the days following starting the antiviral,” Zerr said. “The rash has shown some improvement with treatment. So that’s a great sign, and [the] patient seems to maybe be feeling a little bit better.”