L.A. County investigating death of resident diagnosed with MPX

·5 min read
Luis Garcia, a registered nurse, prepares Monkeypox virus vaccine at St.John's Well Child & Family Center
Luis Garcia, a registered nurse, prepares a vaccine for the MPX virus at St. John's Well Child & Family Center on Aug. 10 in Los Angeles. (Irfan Khan / Los Angeles Times)

Los Angeles County health officials are investigating the death of a person diagnosed with MPX to see whether the viral illness was a primary cause of mortality.

An autopsy still needs to be conducted, and "it does take time for those results to come back. So it may be as soon as a few days, or it may take a few weeks," according to Dr. Rita Singhal, chief medical officer for the county's Department of Public Health.

"It's not a confirmed death due to monkeypox," she said at a briefing Thursday. "We do have a death of a person who did have a diagnosis of monkeypox. And so this is something that we will investigate further."

Singhal didn't respond to a question about whether the individual had underlying health conditions.

Health officials in California recently started to use the name MPX — pronounced mpox — instead of monkeypox because of widespread concerns the older name is stigmatizing and racist. The World Health Organization is in the process of formally renaming the disease, which will take several months.

L.A. County officials will work with the U.S. Centers for Disease Control and Prevention and state health officials to determine whether they need to change guidelines about how to treat MPX patients, especially those who are severely ill, Singhal said.

Deaths and severe illness are still rare in the global outbreak. This is the second death in the U.S. in which officials are probing whether MPX was a contributing cause.

Health officials in Texas said last week they were investigating the death of an adult who was severely immunocompromised. It wasn't immediately clear what role MPX played in that person's death.

There have been more than 56,000 cases worldwide, including more than 21,000 in the U.S. Globally, there have been seven confirmed deaths among MPX-infected people in countries where the virus was not circulating prior to this year's outbreak.

More than 4,100 probable and confirmed MPX cases have been reported in California. L.A. County, the most populous in the nation, has reported 1,805 cumulative cases. San Francisco has the second-highest tally, with more than 750. However, on a per capita basis, San Francisco has a much higher case rate — 87 cases for every 100,000 residents, compared with L.A. County's 18.

San Diego, Riverside, Alameda, Orange, Santa Clara and Sacramento counties have each reported at least 125 MPX cases as well.

Of the roughly 3,100 MPX cases in California for which data are available, 140 patients were hospitalized at some point — a rate of about 4.5%.

The rate of newly reported MPX cases continues to slow. For the seven-day period that ended Thursday, L.A. County reported 187 new MPX cases, a 30% decline from the prior week's tally of 269.

L.A. County's apparent weekly peak was Aug. 19 to Aug. 25, when 313 MPX cases were reported.

San Francisco is also observing a slowdown in newly reported MPX cases.

Last week, Singhal credited the slowdown in part to vaccination efforts and nationwide survey data suggesting that gay and bisexual men have decreased their number of sexual partners and one-time sexual encounters in light of the outbreak.

And because MPX is much harder to transmit — it typically requires close skin-to-skin contact for an infection to occur, and is nowhere near as transmissible through air as the coronavirus — "there is going to be a natural burning out that you'll see after some time," Singhal said.

MPX disease is characterized by virus-filled rashes and lesions that can look like pimples, bumps or blisters. It can appear first in the genital area and rectum before spreading to other parts of the body, and because the rashes can be mistaken for other skin issues, the virus can easily spread during intimate encounters. Risk is higher for people with multiple sexual partners.

"We likely will continue to see cases for a long time to come. But at least the current high number that we're seeing, we are hoping to see that that will go down," Singhal said.

The median age of MPX cases in L.A. County remains 35. Of the county's reported cases, 98% have been males. Among cases for whom sexual orientation is known, 95% identify as LGBTQ+.

About 45% of MPX cases in L.A. County are among residents in the health-service planning area covering the central portion of the county, which includes West Hollywood, Hollywood, downtown Los Angeles, Eagle Rock, Highland Park, Echo Park, Silver Lake, Los Feliz and Boyle Heights. About 12% of the county's residents live in this area.

The shortage of the MPX vaccine is also easing. Two weeks ago, L.A. County began allowing people to walk up to some MPX vaccination sites to get immunized without requiring an appointment.

L.A. County on Thursday expanded eligibility for the Jynneos vaccine to include people who may be at risk for future exposures. Eligibility had been limited to higher-risk people and those who may have had a recent exposure.

"At this time, only about one-third of individuals in L.A. County who are due for a second dose of monkeypox vaccine have received it. We are strongly encouraging that anyone who is due should receive their second dose to optimize their immune response," Singhal said.

This story originally appeared in Los Angeles Times.