Abstract
BACKGROUND: Inoculation of the eye with monkeypox virus can cause vision-threatening disease necessitating hospitalization and urgent treatment. Ocular mpox is poorly understood, including who is most affected. METHODS: We performed a cross-sectional study comparing ocular and non-ocular mpox cases reported to the California Department of Public Health from May 1, 2022, to September 30, 2023. χ2 and t tests were used to compare between-group sociodemographic characteristics, HIV status, and vaccine status. Bivariate and multivariate logistic regressions adjusting for HIV and race/ethnicity were used to calculate odds ratios and 95% confidence intervals for the association between JYNNEOS vaccination and ocular mpox. RESULTS: Of 5878 mpox infections, 2403 (40.9%) had complete ocular symptom reporting and were included in this analysis. Of these, 260 (10.8%) were ocular cases. Among the 2403 included cases, most were cisgender men (94.6%) and reported male-to-male sexual contact (72.0%). The proportion of non-ocular versus ocular mpox cases differed significantly by race/ethnicity and HIV status ( P < 0.05), with more ocular cases being Hispanic/Latinx (50.8% vs. 41.8%), Black (14.2% vs. 8.9%), and with HIV (50.8% vs. 40.4%). After adjusting for race/ethnicity and HIV status, people with ≥1 dose of JYNNEOS had approximately half the odds of having ocular symptoms compared with people who were unvaccinated (adjusted odds ratio, 0.52; 95% confidence interval, 0.24-0.97). CONCLUSIONS: A higher proportion of Black, Latinx, or people living with HIV had ocular mpox symptoms, suggesting that these groups may benefit from focused interventions to prevent infection and this complication. JYNNEOS before mpox exposure may protect against ocular complications, stressing the importance of vaccination to prevent severe sequelae, especially for vulnerable populations.