Clinical, Epidemiological, Virological Characteristics and Outcomes of 286 Patients Infected With Monkeypox Virus in China

Background: Monkeypox virus (mpox) outbreak since 2022 has already constituted a public health emergency of international concern. A comprehensive study on epidemiological features, symptoms and signs, complications, sequelae, and clinical outcomes has been lacking. Accordingly, we performed a large-scale multicenter study to comprehensively summarize the clinical, epidemiological, behavioral, laboratory, virological characteristics, and treatment-related outcomes of mpox in China. Method: In this multicenter hospital-based retrospective study, demographic information, clinical characteristics, laboratory results, hospitalization records, prescribed medications, and clinical outcomes were extracted from the electronic medical records of 286 confirmed mpox cases from five regions of China. Result: An approximately 1:1 ratio of HIV-positive (52.1%) and HIV-negative was found, with an overall median age of 32 years (IQR 27-37). Most patients were male (99.3%), lived in urban areas (86.0%), single (72.6%), and had a college degree or higher (62.0%). Men having sex with men (MSM) was the predominant sexual orientation (83.0%), and sexual contact was the most likely mode of exposure (85.4%). 17 (9.6%) patients reported a history of smallpox vaccination. Hundered and seven patients had at least one co-morbid other sexually transmitted infection. Fourteen patients had a self-reported history of allergy. Significant differences were found between HIV-negative and HIV-positive mpox in the proportion of MSM, anal and perianal pain, levels of AST, CRP, CD4+ T-cell, CD8+ T-cell, NK-cell levels, and clinical outcomes. Conclusion: MSM individuals with an interquartile age range of 27-37 years, particularly from coastal or developed regions of China, were identified as "main affected population" for mpox prevention and control. HIV infection may contribute to more severe mpox manifestations, characterized by elevated AST and CRP levels, reduced CD4 + T-cell and NK-cell counts, and unfavorable clinical outcomes with increased mortality.