Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021-2022

Abstract

In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March--June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

Keywords: Florida; MSM; United States; bacteria; hepatitis A; meningitis/encephalitis; meningococcal disease; monkeypox; mpox; outbreaks; sexually transmitted infections; viruses.

Figure 1

Epidemiologic curve of concurrent outbreaks of hepatitis A, invasive meningococcal disease, and mpox, by week of symptom onset, Florida, USA, November 1, 2021—November 30, 2022. A) Invasive meningococcal disease; B) hepatitis A; C) mpox. The case definition for invasive meningococcal disease cases had 2 categories: confirmed and probable. The case definition for hepatitis A cases had 3 categories: confirmed, probable, and suspect. The graph for mpox includes all confirmed and probable cases.

Figure 2

Spatial distribution of outbreak-associated cases of hepatitis A and invasive meningococcal disease in an investigation of concurrent outbreaks of hepatitis A, invasive meningococcal disease, and mpox, Florida, USA, 2021–2022. A) Locations of cases by postal (ZIP) code of patient residence; B) detail of box from central Florida in panel A, in which >1 case of each disease were reported in the same postal code. Outside the area represented in that panel, no cases of both diseases were identified in the same postal code. Invasive meningococcal disease cases were georeferenced by postal code centroid. Small polygons are outlines of postal code areas. Light gray lines indicat county borders; dark gray lines indicate postal areas where instances were identified.

Figure 3

Distribution of mpox cases by county of residence in an investigation of concurrent outbreaks of hepatitis A, invasive meningococcal disease, and mpox, Florida, USA, 2021–2022. Numbers on map indicate numbers of persons with mpox reported to Florida Department of Health, by the person’s county of residence.

Figure 4

Persons vaccinated by month and antigen during concurrent outbreaks of hepatitis A, invasive meningococcal disease, and mpox, Florida, USA, 2021–2022. The figure shows the number of adult persons (>18 years of age) vaccinated with their first dose, by month the first dose was administered. For hepatitis A, the number includes persons vaccinated with any Food and Drug Administration (FDA)–approved vaccine against hepatitis A virus. For meningococcal disease, the number includes persons vaccinated with any FDA-approved serogroup ACWY vaccine (Menveo [GlaxoSmithKline], Menactra [Sanofi Pasteur, Inc.], MenQuadfi [Sanofi Pasteur, Inc.]). For mpox, the number includes persons vaccinated with JYNNEOS (Bavarian Nordic). FDA, Food and Drug Administration.