Texas confirms first U.S. death in monkeypox outbreak, says patient was "severely immunocompromised"

Health officials in Texas announced Monday they are investigating what role monkeypox played in the death of a patient who was diagnosed with the virus. State officials said in a statement that the adult patient was "severely immunocompromised."

The patient's death is the first publicly reported by health authorities in the U.S. during the current monkeypox outbreak. However, health officials cautioned that it was too early to say for sure exactly what role monkeypox actually played in the death.

"This is the first death in an presumed positive for monkeypox that we are aware of. However, the individual had various severe illnesses and until the investigation is complete, it is premature to assign a specific cause of death," CDC spokesperson Scott Pauley said in a statement.

As of Monday, the Centers for Disease Control and Prevention had tallied 15 deaths around the world in monkeypox patients. 

Local officials said the patient died Sunday in a hospital with "various severe illnesses" in Texas' Harris County, and that autopsy results are expected "in the next few weeks." 

"We are sharing this information to err on the side of transparency and to avoid potential misinformation about this case," Lina Hidalgo, Harris County's top official, said in a statement.

More than 18,000 monkeypox cases have been reported nationwide since the outbreak began in the spring. Texas has 1,604 total infections, the fourth-most of any state.

"Monkeypox is a serious disease, particularly for those with weakened immune systems," said Dr. John Hellerstedt, head of the state's health department, in a statement.

While many monkeypox patients endure weeks of excruciating rashes and lesions from the virus, officials say deaths remain rare.

Early in the outbreak, federal health officials had said that deaths had been seen only in "very immunocompromised" patients — a risk authorities hoped to blunt with the rollout of vaccines and treatments for the disease. 

The currently circulating strain of the virus is believed to be the less deadly of the two known "clades" of monkeypox, and far less dangerous than its cousin smallpox. 

"Most people who get this form of the disease are likely to survive. However, people with weakened immune systems may be more likely to get seriously ill or die," said Pauley.

Pauley added that the CDC is "actively working with Texas officials" to investigate the death.

The CDC says that that those who are at "increased risk for severe monkeypox disease" include children under the age of 8, people who are pregnant or immunocompromised, and people who have previously had eczema. 

Among the immunocompromised Americans that health officials have been most concerned with are those living with HIV, who have made up a large share of diagnosed monkeypox infections to date. 

In developing its vaccination strategy, federal health authorities have been allocating vials based in part based on the estimated size of the population in each state or jurisdiction of people living with HIV. 

A spokesperson for the Texas Department of Health and Human Services declined to confirm whether the patient's compromised immune system was the result of HIV or another cause. 

County officials also said they would not release further information about the death "at this time to respect the family's privacy." 

While the CDC says people who are taking treatments for their HIV infections appear not to be experiencing more complications during the current outbreak than other patients, those with uncontrolled HIV may be at higher risk. 

"In my experience, I've not seen differences in the clinical manifestation of this particular atypical outbreak between those that are taking medicine to prevent HIV and those that are taking medicine to treat their HIV," the CDC's Bruce Furness said at a recent webinar hosted by the group UnidosUS.

"That being said, we have seen one or two pretty bad outbreaks among HIV infected individuals that didn't have good control. And when I say this, I'm talking, the pictures of these patients are similar to what you see about those with those really bad outbreaks in the Congo, and in the parts of Africa where this virus is endemic," Furness added.