# COVID-19 and MPXV: Twindemic Response and Dual Infections in Individuals in a US Metro

## TL;DR

This study examines individuals in Houston who had both SARS-CoV-2 and MPXV infections, finding differences in testing timing and risk factors.

## Contribution

The study identifies dual infections and differences in testing intervals during overlapping outbreaks of SARS-CoV-2 and MPXV.

## Key findings

- 88 individuals were found to have both SARS-CoV-2 and MPXV infections.
- Dual-infected individuals had a longer time between tests (99 days) compared to those with only one infection.
- Demographics were similar across groups, but risk factors and testing timing differed significantly.

## Abstract

Background/Objectives: The purpose of this study was to identify shared and differing characteristics of individuals testing for both SARS-CoV-2 and MPXV in 2022 in the greater Houston metro area. Methods: Data from the Houston Electronic Disease Surveillance System (HEDSS) identified 7,754,198 SARS-CoV-2 PCR lab results and 1246 MPXVV PCR lab results in 2022. Three cohorts for analysis were created where tests were performed, as follows: those positive for both viruses, those negative for COVID-19 but positive for MPXV, and those positive for COVID-19 but negative for MPXV. Results: We identified 88 individuals positive for both viral infections, those negative for COVID-19 but positive for MPXV (n = 38), and those positive for COVID-19 but negative for MPXV (n = 96). While groups were generally similar in regard to demographics (age, sex, and race) and risk factors reported, key differences in timing of testing and risk factors were reported. Notably, there was statistically significant difference in the time between t-tests for dual-infected individuals (99 days) compared to MPXV-positive only (58 days, p < 0.01) or COVID-19 positive only (63 days, p < 0.01). Conclusions: In the setting of multiple disease outbreaks, the characteristics of infected patients may be largely similar. Some people with dual infection may show unusual test results or symptom patterns compared with those with only one infection. Large public health studies with robust reporting systems and laboratory screening are vital for early detection of dual infections. Public health strategies to educate providers and outreach teams enhance response during concurrent outbreaks. Further research is needed on behavior and risk factors in communities with simultaneous outbreaks.