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Public Health Alerts: Public health response to clade Ib mpox with multiple exposures in congregate living settings—New Hampshire, February 2025
Jim Wappes
Today at 10:05 a.m.
Mpox
Public Health Alerts
The authors of a Public Health Alerts report today describe how public health officials were able to prevent additional cases of clade 1b mpox after a person who contracted the disease exposed others at two congregate living facilities in New Hampshire, a healthcare facility, and the patient’s home.
The authors, from the New Hampshire Department of Health and Human Services (NHDHHS), the US Centers for Disease Control and Prevention (CDC), and the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, say further mpox transmission may have been prevented through rapid testing and administration of postexposure prophylaxis (PEP) with the Jynneos vaccine to 90% of people at risk, most within six days of exposure.
Public Health Alerts, a collaboration between NEJM Evidence and CIDRAP, fills a gap in reliable data, offering expert-reviewed reports that translate frontline observations into actionable public health evidence. An NEJM Evidence editorial explains the initiative further.
Of 20 contacts, 18 were vaccinated
In February 2025, the NHDHHS was notified of a resident who developed fever, nausea, vomiting, and genital lesions during a trip to East Africa. Within 24 hours of returning home from the trip, the person sought care in an emergency department (ED) at a New Hampshire hospital; signs and symptoms had developed four days before this first ED visit.
The patient was initially discharged without testing for the mpox virus (MPXV) but returned four days later with widespread lesions on the hands, face, and inside the mouth and throat. The patient was then placed in airborne isolation.
Specimens from the patient tested positive via polymerase chain reaction (PCR) for MPXV. In less than three days, PCR testing confirmed clade 1b, an mpox strain that has so far been confirmed in just 23 patients in the United States.
Investigators confirmed exposures at two small group homes for adults with disabilities where the patient worked multiple shifts and had close contact with five other staff and 12 residents. Healthcare workers exposures to the patient were limited to two clinicians who directly examined the lesions without MPXV-appropriate personal protective equipment during the patient’s first ED visit.
Jynneos vaccination was recommended for 20 adult contacts, which included the contacts listed above plus a household member. Eleven of these were initially considered intermediate risk, while the rest were deemed high risk of contracting mpox. Two intermediate- risk co-workers, however, were later reclassified as low or uncertain risk.
PEP is thought to be most effective when administered within 4 days of exposure, but this standard is often difficult to achieve.
The local hospital administered PEP to the two healthcare workers and the patient’s household contact. The NHDHHS administered PEP to 15 (88%) of the identified at-risk group home contacts, while two declined vaccination. All vaccine was administered within eight days of first exposure, with a median time of six days.
The authors write, “PEP is thought to be most effective when administered within 4 days of exposure, but this standard is often difficult to achieve.” None of the contacts were vaccinated within this time frame.
They conclude, “With ongoing outbreaks in Central and East Africa, additional travel- associated cases are possible and will require rapid public health response to prevent further transmission of clade I MPXV in the United States.”
Public Health Alerts: Public health response to clade Ib mpox with multiple exposures in congregate living settings—New Hampshire, February 2025
Jim Wappes
Today at 10:05 a.m.
Mpox
Public Health Alerts
The authors of a Public Health Alerts report today describe how public health officials were able to prevent additional cases of clade 1b mpox after a person who contracted the disease exposed others at two congregate living facilities in New Hampshire, a healthcare facility, and the patient’s home.
The authors, from the New Hampshire Department of Health and Human Services (NHDHHS), the US Centers for Disease Control and Prevention (CDC), and the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, say further mpox transmission may have been prevented through rapid testing and administration of postexposure prophylaxis (PEP) with the Jynneos vaccine to 90% of people at risk, most within six days of exposure.
Public Health Alerts, a collaboration between NEJM Evidence and CIDRAP, fills a gap in reliable data, offering expert-reviewed reports that translate frontline observations into actionable public health evidence. An NEJM Evidence editorial explains the initiative further.
Of 20 contacts, 18 were vaccinated
In February 2025, the NHDHHS was notified of a resident who developed fever, nausea, vomiting, and genital lesions during a trip to East Africa. Within 24 hours of returning home from the trip, the person sought care in an emergency department (ED) at a New Hampshire hospital; signs and symptoms had developed four days before this first ED visit.
The patient was initially discharged without testing for the mpox virus (MPXV) but returned four days later with widespread lesions on the hands, face, and inside the mouth and throat. The patient was then placed in airborne isolation.
Specimens from the patient tested positive via polymerase chain reaction (PCR) for MPXV. In less than three days, PCR testing confirmed clade 1b, an mpox strain that has so far been confirmed in just 23 patients in the United States.
Investigators confirmed exposures at two small group homes for adults with disabilities where the patient worked multiple shifts and had close contact with five other staff and 12 residents. Healthcare workers exposures to the patient were limited to two clinicians who directly examined the lesions without MPXV-appropriate personal protective equipment during the patient’s first ED visit.
Jynneos vaccination was recommended for 20 adult contacts, which included the contacts listed above plus a household member. Eleven of these were initially considered intermediate risk, while the rest were deemed high risk of contracting mpox. Two intermediate- risk co-workers, however, were later reclassified as low or uncertain risk.
PEP is thought to be most effective when administered within 4 days of exposure, but this standard is often difficult to achieve.
The local hospital administered PEP to the two healthcare workers and the patient’s household contact. The NHDHHS administered PEP to 15 (88%) of the identified at-risk group home contacts, while two declined vaccination. All vaccine was administered within eight days of first exposure, with a median time of six days.
The authors write, “PEP is thought to be most effective when administered within 4 days of exposure, but this standard is often difficult to achieve.” None of the contacts were vaccinated within this time frame.
They conclude, “With ongoing outbreaks in Central and East Africa, additional travel- associated cases are possible and will require rapid public health response to prevent further transmission of clade I MPXV in the United States.”