How concerned should we be about the first confirmed monkeypox death in the U.S.?

·Writer and Reporter
·5-min read

Los Angeles health officials and the Centers for Disease Control and Prevention confirmed the first death due to monkeypox in the U.S. in a news release on Sept. 12 — a new milestone in the outbreak that first took hold in the U.S. this spring.

The patient was a resident of Los Angeles County, was “severely immunocompromised” and had been hospitalized. No other details about the case have been given.

Dr. Jessica Justman, an associate professor of epidemiology at Columbia University, told Yahoo News she wasn’t surprised by the announcement — or that the victim was an immunocompromised patient in California.

“I see it as something that was ultimately inevitable, given the large number of cases that have occurred in the U.S., that [monkeypox] was going to be the cause of death or associated with the death of somebody with other medical problems,” Justman said.

“California has reported more cases of monkeypox than any other state, so from that perspective it makes sense that the first death would happen in the state that has the highest number of cases thus far that have been reported as confirmed cases,” she added.

More than 24,200 confirmed cases had been reported in the U.S. as of Wednesday, according to the CDC. Worldwide, there have been over 63,100 cases and 20 confirmed deaths, including 10 deaths in countries that haven’t historically reported monkeypox.

The death of another “severely immunocompromised” patient with monkeypox was reported in Harris County, Texas, on Aug. 30, but officials investigating the death have yet to update on what role, if any, monkeypox played in the person’s demise.

“Monkeypox is a serious disease, particularly for those with weakened immune systems,” Dr. John Hellerstedt, the Texas Department of State Health Services commissioner, said in a news release last month. “We continue to urge people to seek treatment if they have been exposed to monkeypox or have symptoms consistent with the disease.”

Those with weakened immune systems are particularly susceptible to complications from monkeypox. A CDC report released this month found that in a group of nearly 2,000 people diagnosed with monkeypox between May and July, nearly 38% were also living with HIV; and those who were HIV-positive were more likely to be hospitalized with monkeypox than those who were not HIV-positive.

Skin lesions resembling pimples or blisters are a common symptom of monkeypox. They can become infected and cause complications in severely immunocompromised people.
Skin lesions resembling pimples or blisters are a common symptom of monkeypox. They can become infected and cause complications in severely immunocompromised people. (Ernesto Benavides/AFP via Getty Images)

Justman also explained that skin lesions — a common monkeypox symptom — can become infected. The infection can spread throughout a person’s system, which can be difficult to fight off for immunocompromised patients.

“I think people who are severely immunocompromised generally always need to be careful about getting exposed to illnesses, whether it’s COVID or monkeypox or even influenza,” Justman said. “These are individuals who are just more likely to have a hard time clearing an infection than others.”

She urged people with immunodeficiencies to get vaccinated for monkeypox, especially if they are in or have frequent interactions with people in groups most affected by monkeypox, which currently includes gay or bisexual men or men who have sex with other men.

Complications from monkeypox have been reported in immunocompetent patients as well. A report released earlier this month identified two cases of encephalomyelitis, which involves inflammation of the brain and spinal cord, in otherwise healthy individuals who had been diagnosed with monkeypox in the U.S. This same condition was responsible for the death of a monkeypox patient in Spain during the summer.

The CDC also notes that children under 8 years of age, people with a history of eczema and those who are pregnant or breastfeeding may also “be more likely to get seriously ill or die” if they contract monkeypox, though very few monkeypox cases in children or pregnant or breastfeeding individuals have been reported.

Still, complications and deaths from monkeypox remain extremely rare. Justman stressed that news of the death in Los Angeles does not change her view of the U.S. monkeypox outbreak, and that it shouldn’t change our understanding of the status of the outbreak, either.

“For people with normal immune systems, I don’t think that this news changes anything,” Justman said.

“I don’t think we need to panic. I remember at the beginning of COVID people were worried about opening their mail; they were washing their groceries. We didn’t need to do that then, and we certainly don’t need to do that now for monkeypox.”

During a White House monkeypox response team press briefing on Sept. 15, CDC Director Rochelle Walensky said they're keeping
During a White House monkeypox response team press briefing on Sept. 15, CDC Director Rochelle Walensky said they're keeping "the pedal to the metal." (Drew Angerer/Getty Images)

During a White House monkeypox response team press briefing last week, officials made no reference to the deaths in Los Angeles or Texas, but expressed “cautious optimism” about the outbreak as new cases in the U.S. and abroad continue to decline. Overall, cases are down by nearly 50% since peaking in early August, though cases in some parts of the U.S. continue to rise. Officials at the briefing attributed the decrease to a “multilayered approach” including scaled-up testing efforts, education and outreach and vaccine distribution.

"We're encouraged by the case rate of rise declining, and yet we are keeping the gas pedal heavily, heavily downward, pedal to the metal, and we continue the vigilance here," CDC Director Rochelle Walensky said.

"[The declining case count] is a result of education efforts, the work being done to vaccinate at-risk individuals, and people who have made informed decisions to make temporary changes to their behavior to protect themselves and their community.”