Preliminary medical record review indicates that vaccinated patients experienced self-limited illness, managed in outpatient settings. Patients were vaccinated at multiple locations, and CDPH is investigating potential temperature excursions in transportation, storage, and handling at vaccination sites. ¶¶ In discussions with Bavarian Nordic (the vaccine manufacturer) and the Strategic National Stockpile (SNS),*** CDC and CDPH identified no concerning temperature excursions that could result in reduced vaccine effectiveness among involved vaccine lots at SNS, during transit from SNS to CDPH, or in CDPH custody. Among the 22 patients who received 2 doses of JYNNEOS vaccine or 1 dose of ACAM2000, eight (36%) received 2 subcutaneous doses of JYNNEOS, seven (32%) received 1 subcutaneous and 1 intradermal dose, one (5%) received 2 intradermal doses, and one received 1 dose of ACAM2000 §§ abroad. In the Chicago cluster, the median interval from receipt of the second JYNNEOS vaccine dose to mpox diagnosis was 8.4 months (IQR = 7.9–8.8 months). Eleven (28%) patients were living with HIV, 10 of whom had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine and whose HIV was well-controlled (CD4 count >200 cells/mm 3 and viral load 6 months after vaccination †† ( 3). Median age was 33 years (IQR = 23–49 years), and non-Hispanic White men accounted for the largest percentage of patients (19 48%), followed by Hispanic or Latino (eight 20%) and non-Hispanic Black or African American men (seven 18%). All cases occurred among persons who were assigned male sex at birth 37 (93%) identified as male and 28 (70%) as gay. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.**ĭuring March 18–June 12, 2023, 40 laboratory-confirmed mpox cases were identified in Chicago, including 22 (55%), five (13%), and 13 (33%), respectively, among patients who had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine, those who had received 1 vaccine dose of JYNNEOS vaccine, and those who had not received any vaccines for mpox ( Table). § CDPH and CDC launched an investigation to 1) determine the cluster’s scope and etiology by evaluating patients’ commonalities, JYNNEOS ¶ vaccine cold-chain management, whole genome sequencing of clinical samples, and serologic immune response after infections, and to 2) identify important risk factors for mpox exposure to guide prevention efforts. On May 9, 2023, CDPH issued a health alert, † urging clinicians to remain vigilant for mpox cases and encouraging vaccination for persons at risk for mpox. This increase in cases before large summer events scheduled nationwide and in Chicago raised concerns about possible future case increases. The cluster was remarkable because it comprised more than 10 cases at a time when sporadic cases or small clusters (i.e., involving fewer than three cases) were being reported in the United States, and >69% of the persons in this cluster had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine.* Some cases among persons who received doses of JYNNEOS vaccine are expected to occur based on vaccine effectiveness data ( 1, 2) however, the observed proportion of cases among persons who had received 2 doses of JYNNEOS or 1 dose of ACAM2000 in this cluster was unusual. This is a system made up of sp 2 electrons - hardly the definition of a strongly correlated material - and yet it displays the hallmarks of topological order, which include dissipationless transport and emergent particles with fractional charge and statistics.During April 17–May 5, 2023, 13 monkeypox (mpox) cases were reported to the Chicago Department of Public Health (CDPH) after 2 months during which only a single case had been reported. Moreover, as if to make the point even stronger, these discoveries came almost simultaneously with a flurry of spectacular observations in graphene, including the observation of the fractional quantum Hall effect 5, 6. Although part of a wider surge in interest in topologically protected states of matter, the excitement surrounding topological insulators was principally due to the robust nature of the metallic surface states that characterized them, and the relatively loose requirements for their realization: neither strong electron–electron interactions nor low-dimensionality are required. This taste for emergent properties coincided with the experimental discovery of topological insulators, which was made on the back of large strides forward in the understanding of electronic states in terms of topological invariants - essentially a geometric property of the electron wavefunction 4.
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