Health authorities are now investigating what role monkeypox may have played in the death of a person diagnosed with the virus, officials in California said Thursday. This is the second known person to die in the U.S. after contracting the virus during the current outbreak. 

The announcement comes less than a month after officials in Texas confirmed they were investigating a potential death from the virus. 

California has tallied 4,140 monkeypox cases, more than any other state in the country.

“We will be doing an autopsy. So it does take time for those results to come back. So it may be as soon as a few days, or it may take a few weeks,” Los Angeles County’s Dr. Rita Singhal told reporters on Thursday.

The autopsy is scheduled to begin on Friday, a county spokesperson later confirmed to CBS News. 

Singhal said the county was working with state and federal health officials to investigate the death, which might lead to changes in guidelines for doctors treating Americans facing severe illness from the virus.

Aside from weeks of excruciating rashes and lesions, authorities have said most cases in the outbreak have gotten better with only minimal treatment. Only a handful of reported cases have faced more dangerous symptoms. 

The CDC says young children under eight years old, people who are pregnant or immunocompromised and people with a history of eczema “may be at especially increased risk for severe outcomes” from the virus.

The Centers for Disease Control and Prevention reported early data on Thursday suggesting that some people with HIV – who make up a large portion of cases in the outbreak so far – may be at higher risk of being hospitalized with the disease, especially if their HIV was untreated. 

In the Houston death reported last month, officials confirmed the patient was “severely immunocompromised.” Singhal declined to confirm additional details about their case, saying they were “early in the investigation” of the death. 

The CDC count 18 confirmed monkeypox deaths outside the U.S. in connection with the current outbreak. The CDC says eight of the deaths around the world are in “locations that have not historically reported monkeypox.” 

There have been no confirmed monkeypox deaths in the U.S. in connection with this outbreak.

The monkeypox response

The death in Los Angeles comes at a turning point for the Biden administration’s response to the virus, which recently passed 20,000 reported infections nationwide.

Once in scarce supply, officials say doses of the monkeypox vaccine are now widely available in many states thanks to the administration’s dose-sparing “intradermal” strategy. More than 70% of doses are now being given intradermally, officials said. 

“So now that supply is less of an issue, we need to make sure we focus on maintaining demand by making sure that people know that effective and safe vaccine is available for those that could benefit,” Bob Fenton, the White House’s top monkeypox official, said Wednesday.

CDC officials have said since August that the agency might soon expand its recommendations to health departments now rationing out the vaccine, which currently urge jurisdictions to prioritize shots for “post-exposure prophylaxis” for people “after known or presumed exposure to someone with monkeypox.” 

Of the more than a million vials of vaccine allocated nationwide, jurisdictions have requested 775,033 doses from the Biden administration. 

Officials have credited the vaccination campaign for helping drive a slowdown in the pace of newly reported monkeypox cases. In a technical report last week, the CDC said it predicted the U.S. outbreak was on track to “grow very slowly” over the coming month “likely with a declining growth rate.” 

However, the agency also acknowledged it had “low confidence” in the assessment. Some states are now beginning to see “accelerating” outbreaks of the virus, the CDC noted.

The new phase of the outbreak has also heralded a leadership reshuffling at the CDC, which recently tapped the head of its National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) to take over management of the response. 

The agency also recently tweaked its monkeypox guidance, removing a line that emphasized that monkeypox did not meet the textbook definition of a sexually transmitted disease. 

“Monkeypox is often transmitted through close, sustained physical contact, almost exclusively associated with sexual contact in the current outbreak,” the CDC says in its new recommendations.  

“Monkeypox poses new concerns to health and safety. It requires that all of us step up with our expertise, tools, partnerships, programs, and talent,” NCHHSTP head Dr. Jono Mermin wrote in a letter announcing his new role heading the monkeypox response.

The agency’s ranks working on monkeypox have also swelled over the past few months, amid the growing complexity of the outbreak.

Among the new challenges soon to be on Mermin’s plate: the CDC recently spotted a “significant” mutation in the monkeypox virus that resulted in at least three infected Californians who were initially given “false negative” results. 

While scientists believe the mutation is still rare, the change prompted the agency to issue a warning to labs urging them to update their tests to guard against missed cases. 

That warning came just weeks after the agency had also urged some labs to double check some of their results because of “false positives” spotted in women and children incorrectly diagnosed with the virus.

“Many people within CDC and NCHHSTP are currently working on the monkeypox response, and many public health colleagues throughout the nation are being asked to take on additional responsibilities. I look forward to joining them in this effort,” wrote Mermin.