The 2022 global outbreak of clade II mpox virus marked a significant moment in infectious disease surveillance in the United States. With over 34,000 confirmed cases between January 2022 and October 2024, the outbreak primarily affected urban areas, including New York City and Houston. While acute mpox manifestations varied from mild rashes to severe, life-threatening illness, long-term sequelae remained largely uncharacterized. A recent cohort study published in the Annals of Internal Medicine provides critical insight into persistent physical, psychosocial, and behavioral consequences of mpox 11 to 18 months after acute infection.
This study, known as the Life After Mpox or LAMP study, enrolled 154 adults with confirmed mpox infection and 201 adults at risk but not diagnosed with mpox. Researchers evaluated long-term effects through clinical assessment, electronic medical records, and participant self-reports. The study aimed to characterize post-mpox sequelae, examine associations with risk factors, and compare psychosocial and behavioral changes among post-mpox and no-mpox participants.
Participants were recruited from HIV, pre-exposure prophylaxis, and sexually transmitted infection clinics in two urban medical systems: Columbia University Irving Medical Center in New York City and UTHealth Houston in Texas. Eligible participants were adults aged 18 or older, able to read or speak English or Spanish, and willing to provide informed consent. Post-mpox participants had laboratory-confirmed mpox diagnoses between May 2022 and January 2023. No-mpox participants were at risk for mpox exposure but had no history of infection.
The cohort was predominantly male, accounting for 90 percent of participants. Most participants self-identified as Black or Hispanic, reflecting populations disproportionately affected by the outbreak. Men who reported male-to-male sexual contact made up 67 percent of the total study group. Many participants relied on public health insurance, highlighting socioeconomic factors relevant to disease impact and access to care.
Clinical characteristics revealed that 63 percent of post-mpox participants were living with HIV, and 23 percent of those had uncontrolled HIV, defined as a viral load of 200 copies per milliliter or higher. Notably, 51 percent of post-mpox participants received the antiviral tecovirimat during acute illness, and 19 percent had at least one dose of the Modified Vaccinia Ankara-Bavarian Nordic vaccine (MVA-BN) prior to infection.
The LAMP study found that 58 percent of post-mpox participants had at least one persistent sequela 11 to 18 months after infection. These sequelae affected mucosal and nonmucosal regions, with the most common locations including the genital area, groin, upper extremities, trunk, and face. Appearance-related sequelae were common, with 56 percent of post-mpox participants reporting changes such as scarring or persistent skin discoloration. Most participants had sequelae at one or two sites, and the number of scars or pigmented areas was generally low.
Functional sequelae were less frequent, affecting 13 percent of post-mpox participants. The most common issues included ongoing anorectal symptoms, urinary dysfunction, and reduced range of motion. Less commonly reported problems included neurological impairment, chronic pain, vision loss, and challenges performing activities of daily living. Only a small number of participants required interventional procedures or assistive devices to manage persistent symptoms.
Importantly, clinicians rated 97 percent of post-mpox participants’ overall health as good or better. The majority of participants rated their own health similarly, indicating that while physical sequelae persisted, overall well-being was largely maintained.
The study highlighted significant psychosocial sequelae among post-mpox participants. Nearly half reported increased depressive symptoms, and over one third experienced heightened anhedonia, which refers to reduced ability to experience pleasure. Social and sexual impacts were also substantial. Approximately 49 percent reported ongoing social challenges, 19 percent reported sexual performance difficulties, and six percent faced employment-related obstacles due to mpox.
Appearance-related sequelae correlated with adverse social effects, while functional sequelae were associated with negative impacts on sexual performance. Participants who experienced any persistent physical sequelae were more likely to report stigma, including being hurt by others’ reactions or facing hesitation from others to engage socially. Additionally, some participants experienced employment discrimination due to mpox, with 18 percent losing their job or needing to change roles because of persistent symptoms.
The study explored associations between demographic, clinical, and socioeconomic factors and the likelihood of long-term sequelae. Interestingly, poorly controlled HIV, race or ethnicity, unstable housing, lack of insurance, and receipt of MVA-BN vaccine or tecovirimat were not independently associated with persistent sequelae.
Severity of acute mpox infection emerged as the strongest predictor of long-term physical sequelae. Specifically, participants with confluent lesions measuring two centimeters or larger were more likely to experience appearance-related sequelae. Other severity indicators, such as having ten or more lesions or bacterial superinfection during acute illness, were associated with sequelae in bivariate analyses but not consistently in multivariable models. These findings suggest that lesion size may be a critical factor in determining long-term outcomes and may warrant closer monitoring or early dermatology intervention.
The findings from the LAMP study have several important implications for clinical practice. First, healthcare providers should be aware that while the majority of post-mpox patients recover without severe long-term complications, a significant proportion experience persistent appearance-related or functional sequelae. Clinicians should consider screening for depressive symptoms and disruptions in social, sexual, or occupational functioning. Early referral to mental health services, physical therapy, or dermatology may improve long-term outcomes.
Second, the study underscores that antiviral therapy with tecovirimat and prior MVA-BN vaccination did not significantly alter the risk of post-mpox sequelae. While these interventions are important for acute management and prevention, additional research is needed to determine strategies for minimizing long-term sequelae.
Third, socioeconomic factors such as housing instability, unemployment, and food insecurity were linked to ongoing mpox-related impacts, particularly in employment. This highlights the importance of addressing social determinants of health when supporting recovery after infectious disease outbreaks.
Previous studies on post-mpox sequelae were limited in scope and follow-up duration. Research from Spain found nearly half of participants developed cutaneous scarring 12 to 15 months after infection, consistent with the LAMP study findings. A Belgian study reported outcomes through 24 months, providing further evidence that mild appearance-related sequelae persist for extended periods.
The LAMP study adds to this literature by providing detailed characterization of functional, psychosocial, and behavioral sequelae, alongside clinical assessment and self-reported outcomes. Its focus on urban U.S. populations affected during the 2022 outbreak makes it particularly relevant for understanding long-term impacts in similar settings.
The study had several limitations. Participants were recruited from only two urban medical systems, which may limit generalizability. The cohort may underrepresent individuals with milder mpox who did not seek care. CD4 counts during acute infection were not consistently available, preventing analysis of immunocompromise as a factor. Additionally, timing of MVA-BN vaccination relative to mpox exposure was unknown, limiting interpretation of its protective effect. Finally, the sample size may have been insufficient to detect associations with less common sequelae or outcomes.
Despite these limitations, the LAMP study underscores the ongoing public health relevance of mpox. The World Health Organization recently declared a public health emergency due to a resurgence of clade I and clade II mpox in Central Africa. Understanding the long-term sequelae of clade II mpox provides a foundation for anticipating outcomes of future outbreaks, particularly regarding physical, psychosocial, and functional impacts.
Healthcare systems should prioritize long-term follow-up, access to mental health and supportive services, and addressing social determinants of health to improve outcomes for individuals affected by mpox. Public education campaigns and stigma reduction initiatives may also mitigate psychosocial burdens associated with infection.
The LAMP study provides valuable insights into long-term outcomes following the 2022 clade II mpox outbreak in the United States. Most participants did not experience severe sequelae, but persistent appearance-related and functional changes were observed in a notable proportion. Psychosocial and behavioral impacts, including stigma, depression, and social disruption, were significant. Severity of acute lesions, particularly confluent lesions of two centimeters or more, was the strongest predictor of long-term sequelae.
These findings highlight the importance of continued monitoring and supportive care for individuals recovering from mpox, as well as targeted interventions to mitigate long-term physical and psychosocial consequences. Awareness of the potential for sequelae can inform clinical management, public health strategies, and patient education to promote recovery and quality of life.
This blog is intended for informational purposes only and does not constitute medical advice. For diagnosis, treatment, or management of mpox or any other medical condition, consult a qualified healthcare professional.
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