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Volume 29, Number 12—December 2023
Research

Tecovirimat Resistance in Mpox Patients, United States, 2022–2023

Todd G. SmithComments to Author , Crystal M. Gigante, Nhien T. Wynn, Audrey Matheny, Whitni Davidson, Yong Yang, Rene Edgar Condori, Kyle O’Connell, Lynsey Kovar, Tracie L. Williams, Yon C. Yu, Brett W. Petersen, Nicolle Baird, David Lowe, Yu Li, Panayampalli S. Satheshkumar, and Christina L. Hutson
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T.G. Smith, C.M. Gigante, N.T. Wynn, A. Matheny, W. Davidson, Y. Yang, R.E. Condori, K. O’Connell, L. Kovar, T.L. Williams, Y.C. Yu, B.W. Petersen, N. Baird, D. Lowe, Y. Li, P.S. Satheshkumar, C.L. Hutson); Deloitte Consulting LLC, Arlington, Virginia, USA (K. O’Connell); Leidos Inc., Reston, Virginia, USA (L. Kovar)

Main Article

Table 2

MPXV F13 mutations identified from 76 patients with mpox, United States, 2023*

Amino acid substitution Isolates Patients EC50, µmol/L Fold change†
A288P (25,26) 6 4 0.5 to >500 29 to >29,000
A288P, A290V, D294V (26) 3 1 0.66 to >500 38 to >29,000
A288P, A290V, L297ins (26) 1 1 >500 >29,000
A288P, A290V, I372N 1 1 15 880
A288P, D294V, A295E 1 1 1.4 83
A288P, D294V, D301del (26) 1 1 >500 >29,000
A288P, I372N 1 1 >150 >8,600
A290V (25,26) 9 9 0.17–43 10–2,500
A290V, I372N (25) 5 5 30–32 1,700–1,800
A295E 3 3 2.0–3.3 110–190
D100N 2 2 0.008 −2
D217N 11 11 0.007–0.012 −2.4 to −1.3
D248N 1 1 0.007 −2.4
D256N 3 3 0.009 −1.8
D283G 2 1 7.1–7.3 404–420
D294V (25) 8 7 0.23–1.4 13–78
D294V, A295E 1 1 1 59
H238Q (25) 4 4 0.54–0.6 28–34
H238Q, A288P, D294V, I372N (25) 1 1 ≈5.2 ≈290
H238Q, N267D, A295E 1 1 24 1,400
I372N (25) 12 9 0.04–>150 2.3 to >8600
K174N, N267D 1 1 12 720
N267D (25) 3 3 10–11 570–630
N267D, A288P (25,26) 4 3 1.2–16 71–900
N267D, A290V 1 1 2.0 110
N267D, D294V 1 1 12 680
N267D, A288P, A290V, D294V (26) 1 1 >500 >29,000
N267D, A288P, A290V, A295E, L297ins (26) 1 1 >500 >29,000
N267D, A288P, A290V, A295E, I372N 1 1 >500 >29,000
N267del (27) 8 7 1.5–4.0 85–230
N267del, N267D 1 1 Not tested
N267del, N267D, A295E 2 2 2.9–18 160–1,000
N267del, N267D, A288P, A295E 1 1 Not tested
N267del, N267D, D294V, A295E 1 1 2.5 140
N267del, A288P, A295E 1 1 >500 >29,000
N267del, T289A, A295E 1 1 0.26 15
N267del, A290V 1 1 0.13 7.5
N267del, A290V, I372N 1 1 3.1 180
P243S, A288P, A290V (26) 1 1 0.56 32
S215F, T289A, A290V, I372N 1 1 Not tested
S369L 3 3 0.006 −2.9
T245I, A290V 1 1 0.17 10
T289A 3 3 0.078–0.14 3.7–7.8
T289A, I372N 1 1 Not tested
T289A, R291K 1 1 1.7 98
Y258C 1 1 18 1,000
Y285H, I372N 1 1 0.045 2.6

*All specimens belong to MPXV clade IIb lineage B.1 and contain E353K substitution in addition to the listed substitutions. All substitutions detected from a specimen are listed regardless of their proportion in the viral population. Insertions (ins) and deletions (del) were detected in addition to substitutions. EC50, 50% effective concentration; MPXV, monkeypox virus. †Fold change was calculated based on the EC50 of the reference strain MPXV clade IIa (U.S., 2003), which was 0.0175 µmol/L.

Main Article

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Page created: October 18, 2023
Page updated: November 18, 2023
Page reviewed: November 18, 2023
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