Monkeypox is a misnomer that results from the fact that it was discovered at the Statens Serum Institut in Copenhagen in 1958, when outbreaks of a pox-like disease occurred in monkeys kept for. Cumulative parametric estimates for the distribution of the serial interval for monkeypox, fit to data from 79 patients using a gamma distribution. If an individual was identified as a contact by a case and became a case or was already a case, we recorded these as a case-contact pair. The Atlantic. The rise in cases also comes ahead of the Platinum Jubilee, where thousands will attend street parties or watch the royal celebrations in groups. In 2020, less than 10% of the largest global health organizations were head-quartered in the African region, and very few of the global health organizations are led by African nationals . Growth rates of cases by reporting date, when monkeypox virus was confirmed and reported to UKHSA, were estimated using generalised additive models. A total of 220 case-contact pairs were reported in HPZone, 79 with a symptom onset date for both individuals in the case-contact pair, forming our serial interval cohort. Monkeypox virus, a zoonotic orthopox DNA virus related to the virus that causes smallpox, was first described in humans in 1970 in the Democratic Republic of Congo (formerly Zaire). Negative times from primary case onset to secondary contact exposure indicate pre-symptomatic transmission. Monkeypox is a re-emerging zoonotic infection caused by the monkeypox virus, which belongs to the Orthopoxvirus genus of the Poxviridae family 1 and was first identified in the Democratic Republic of the Congo in 1970. RC worked on data processing. The first case was reported in Vienna, Austria, on May 22, 2022. The UK Health Security Agency had classified the outbreak as "significant and concerning" but says the risk to people "remains low".. The subsamples therefore captured the two key personal characteristics of infected individuals in the outbreak. With the emergence of COVID-19 and the recent surge in monkeypox cases, scientists and doctors who specialize in infectious disease are issuing increasingly dire warnings, saying wealthy countries can no longer afford to ignore small outbreaks abroad. Multi-country monkeypox outbreak in non-endemic countries, 2022. Figure 6 shows the instantaneous growth rate of case numbers over time and log scale model fit to case counts. Stockholm, Sweden: European Centers for Disease Prevention and Control; 2022. Since monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. The time from exposure to onset of symptoms ranges from five to twenty-one days. Transmission was probably through contact with contaminated bedding. However, anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has mpox is at risk. We used a previously described method22 to estimate the growth rate of monkeypox cases since the start of the outbreak in England. The central estimate for the doubling time declined throughout the outbreak up to 9 July, when it reached a growth rate of about zero (infinite doubling time). [2], Mpox (also known as monkeypox[3]) is an infectious viral disease that can occur in humans and some other animals. We considered three parametric distributions: gamma, Weibull, and lognormal. Monkeypox is a rare viral infection which does not spread easily . If you are unable to import citations, please contact Design Contact tracing study, linking data on case-contact pairs and on probable exposure dates. Monkeypox - Democratic Republic of the Congo. From the dataset we removed records with missing data for symptom onset and pseudo identifier number, as well as duplicates. WHO. That makes me mad", "US raises monkeypox alert level but says risk to public remains low", "Monkeypox update: Where the outbreak stands now", "Monkeypox contact tracing extended to Scotland", "Monkeypox cases confirmed in England latest updates", "First case of monkeypox confirmed in Scotland", "Monkeypox spread continues with first case reported in Wales", "GHA confirms first case of monkeypox in Gibraltar", "UK Confirms Local Transmission of Monkeypox", "People coming into contact with monkeypox are now being advised to quarantine for 3 weeks", "Principles for monkeypox control in the UK: 4 nations consensus statement", https://en.wikipedia.org/w/index.php?title=20222023_monkeypox_outbreak_in_the_United_Kingdom&oldid=1142072822, (*) total cases = confirmed and highly probable cases, cases up to and including day d (Monday) are reported and hence ref. Our likelihood function therefore relies on three functions (equation 2, fig 1). Individuals report other individuals who they have been in contact with or who they think might have infected them, but this does not necessarily mean transmission occurred during that contact. This relies on the assumption that the primary case identified by the secondary contact in the questionnaire is the same primary case identified in case-contact pair. This sample size is small and relies on the completion of an optional case questionnaire and on the cases being linked by contact tracing. Throughout my . The mean incubation period was estimated to be 7.6 days (95% credible interval 6.5 to 9.9) using the ICC model and 7.8 days (6.6 to 9.2) using the ICRTC model. [36], Confirmed cases by countries in the United Kingdom during the 2022 outbreak (as of 12 July), The first three paragraphs an excerpt from, 20222023 monkeypox outbreak in the United Kingdom, Number of cases confirmed in constituent countries. This definition of symptom onset describes the date that an individual first noticed their symptoms; however, the true date of symptom onset could have been earlier but not detected. Data for both the serial interval and the incubation period are similarly distributed across the monkeypox outbreak in the UK, so temporal changes in reporting should affect both distributions comparably (see supplementary material C). Similarly, the secondary event time (symptom onset in secondary contact for serial interval or symptom onset for incubation period) sits within an interval [s1, s2]. [4][14] People can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. To obtain data on the incubation period we analysed completed case questionnaires and linked infected individuals to probable exposure dates. For the more reliable sample where personal identifiable information was available for linkage, this time decreased to four days, with three out of the four more reliable (ie, personal identifiable information available) case-contact pairs showing pre-symptomatic transmission. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The counts below combine both of these categories. [11] Of the two types in humans, cladeII (formerly West African clade)[12] causes a less severe disease than the Central African (Congo basin) type. A random effect on the day of week accounts for the average difference in reporting between days. The 2022 monkeypox outbreak in the United Kingdom is part of the larger outbreak of human mpox caused by the West African clade (type) of the monkeypox virus. As the global monkeypox outbreak lingers on, health officials are warning that the virus is mutating at a pace that may soon allow it to become resistant to an antiviral drug used to treat patients at risk of serious illness. it produces flu-like symptoms followed by a skin rash. The data sharing section includes a link to a repository containing the code for the model and the trace results from the MCMC sample. Of the 30 primary cases, 19 had a symptom onset date recorded in the line list. Goodrich B, Gabry J, Ali I, et al. Other approaches can be applied to handle right truncation bias.21 We opted for our approach because the epidemic phase related terms, P(E=e*), cancel each other out, so we do not need to explicitly describe the phase of the epidemic within the model. The growing number prompted the World Health Organization (WHO) to declare monkeypox a global health emergency, as it did for COVID-19 in 2020. 2 The ongoing outbreak was first reported from the United Kingdom by the UK Health Security Agency on May 7, 2022. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa. The current strain of monkeypox in the UK shows 48 single mutations in the genome compared with strain sequencing from 2018.27 The impact of these mutations is difficult to assess currently, although several have been associated with increased virulence and severity. As of 1 August 2022, 650 people had completed questionnaires, 54 of whom had provided information on symptom onset date and had reported the date of last contact with a primary case, forming our incubation period cohort. To fit the model to the data, we used a Markov chain Monte Carlo (MCMC) implemented in Stan through the Cmdstanr package, with full model formula (equation 3, fig 1). It is assumed both 1 and 2 follow a standard normal prior distribution. In other populations and with different disease severity, the incubation periods are likely to differ.29303132. If a substantial proportion of secondary transmission occurs before symptom onset, the implications will be that many infections cannot be prevented by isolating individuals with symptoms. Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. There has recently been an increase in cases in the UK, but the risk of catching it is low. The global transmission of the monkeypox virus has been on a scale not previously seen outside of Central Africa. Monkeypox rarely spreads outside of Central and West Africa The first known case of the current monkeypox outbreak was announced in the UK on May 7 in a person who had traveled to Nigeria. Monkeypox contact tracing guidance: classification of contacts and advice for vaccination and follow-up. In early August, the Biden administration declared monkeypox a public health emergency with several states such as California and Illinois, and cities like New York and San Francisco following suit. 4. Design Contact tracing study, linking data on case-contact pairs and on probable exposure dates. Incubation periods can vary with severity and personal characteristics of infected individuals,29303132 and serial intervals are highly dependent on viral transmission dynamics. 2022. Work was undertaken in line with national data regulations. Although case numbers are declining, increased international transmission would facilitate infection importation and might drive stochastic outbreaks even if vaccination in local networks limits transmission. Onset to exposure, serial interval, and incubation period for 13 primary cases with monkeypox who had matching personal identifiable information or were matched but without such information. The paper was, however, read by members of the public upon submission. 2022. This is combined with case information recorded by local Health Protection Teams in the UKHSA national case management system. These figures are used for official reporting of monkeypox confirmed case counts in the UK. UKHSA health protection teams store data collected during an incident in the HPZone, The line list contains a list of confirmed infected individuals in the UK obtained from test data (compiled and deduplicated) from UKHSA affiliated laboratories, National Health Service trust laboratories, and HPZone data, along with supplementary data from the case questionnaires. All requests to access data are reviewed by the Office for Data Release and are subject to strict confidentiality provisions in line with the requirements of: the common law duty of confidentiality, data protection legislation (including the General Data Protection Regulation), Caldicott principles, the Information Commissioners statutory data sharing code of practice, and the national data opt-out programme. The international outbreak of monkeypox since May 2022 has produced more contemporary estimates of the incubation period with this mutated clade. The estimated mean serial interval was 8.0 days (95% credible interval 6.5 to 9.8) using the ICC model and 9.5 days (7.4 to 12.3) using the ICRTC model. MPXV, causing the 2022 multi-country monkeypox outbreak, is equipped with a faster speed of microevolution and multi-patterns of transmission between humans and . 32 Total Deaths Global Cases 85,922 Total Cases At this time, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the current mpox outbreak. UK Health Security Agency. Short serial intervals were more common than short incubation periods suggesting considerable pre-symptomatic transmission, which was validated through linked patient level records. Later cases had no link to the first case, and those infected hadn't traveled to where monkeypox is endemic. 2022 monkeypox outbreak in the United Kingdom, Last edited on 28 February 2023, at 10:29, 2022 monkeypox outbreak in the United States, "Monkeypox outbreak: epidemiological overview, 30 August 2022", "Monkeypox outbreak: epidemiological overview", "WHO recommends new name for monkeypox disease", "Multi-country monkeypox outbreak: situation update", Centers for Disease Control and Prevention, "Multi-country monkeypox outbreak in non-endemic countries", "348. Therefore, backward contact tracing strategies should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases. Setting Case questionnaires from the UK Health Security Agency (UKHSA), United Kingdom. This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. Under an assumption of statistical independence between the serial interval and incubation period, the probability that the serial interval would be shorter than the incubation period (and therefore the proportion of patients with pre-symptomatic transmission) was 53% (95% credible interval 43% to 62%). In particular, symptom onset date is defined as the date patients noticed they had an infection. 2022. WHO. See: http://creativecommons.org/licenses/by-nc/4.0/. Monkeypox is a zoonotic infection, caused by the monkeypox virus, that occurs mostly in West and Central Africa. For the seven primary cases with available personal identifiable information, four matched and three did not match. Mpox Virus in Human Samples other than Skin Rash Lesions and Implications for Transmission. The outbreak could spread beyond U.K. borders, the agency said, particularly because there appears . To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. Right truncation leads to the observed distribution of time delays being biased towards shorter observations, since for a delay when the primary event occurs close to the final date of observation, only the secondary event will be observed if the delay is short. CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[26]. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. Of these, 94 were in Scotland, 34 were in Northern Ireland, 46 were in Wales and 3,480 were in England. Additionally, the conclusions around the presence of pre-symptomatic transmission are supported by analysis of the relative shapes of both the incubation period and the serial interval distributions as well as individual level patient data. Since the international epidemic began in May, the U.S. has recorded 201. UK health chiefs are already modelling how outbreak among humans could start. Dont worry we wont send you spam or share your email address with anyone. Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. The primary strength of this analysis is the large sample size, obtained from the UKHSA surveillance and contact tracing data, enabling the distributions to be estimated with reasonably narrow credible intervals. The probable case is epidemiologically linked to the two confirmed cases and has fully recovered. An isolation period of 16 to 23 days would be required to detect 95% of people with a potential infection. To expand the UKs capability to detect monkeypox cases, some NHS laboratories are now testing suspected monkeypox samples with an orthopox polymerase chain reaction (PCR) test (orthopox is the group of viruses which includes monkeypox). the next day, This page was last edited on 28 February 2023, at 10:29. UKHSA health protection teams identified pairs of linked individuals through contact tracing. For the ICC and ICRTC models, the corresponding estimates ranged from 1.8 days (95% credible interval 1.5 to 1.8) to 1.6 days (1.4 to 1.6) shorter at the 25th centile and 1.6 days (1.5 to 1.7) to 0.8 days (0.3 to 1.2) shorter at the median. A side effect of this is that, assuming the linked pair are a genuine transmission event, we cannot directly ascertain the direction of transmission. A major outbreak of human monkeypox occurred in Katako-Combe, Zaire in 1996, From February 1996 to February 1997, 89 persons in this outbreak were diagnosed with human monkeypox [19], [26]. As of July 26, 3,591 cases in 46 states, Puerto Rico, and Washington, D.C., have been diagnosed (see . Negative serial intervals are possible in the presence of pre-symptomatic transmission, although the nature of contact tracing data means that the direction of transmission can be difficult to infer from the data, and positive serial intervals are more likely than negative serial intervals. The story of monkeypox feels to experts frustratingly like a replay of the first months of the COVID-19 pandemic in 2020. . Main outcome measures The incubation period and serial interval of a monkeypox infection using two bayesian time delay modelsone corrected for interval censoring (ICCinterval censoring corrected) and one corrected for interval censoring, right truncation, and epidemic phase bias (ICRTCinterval censoring right truncation corrected). Such spread has resulted in divergence of the virus, with two distinct clades circulating in different regions of Africa. Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. Surveillance and laboratory studies have found the Congo Basin clade to the more severe of the two, with higher transmissibility.34 In May 2022, the World Health Organization reported a monkeypox outbreak in several originally non-endemic countries,5 since linked to the Western African clade.6 These cases were of considerable concern as they could not be clearly linked to recent travel from an endemic area. In the U.S., the first monkeypox case in the current outbreak was identified on May 18, 2022. As of 25 July 2022, both definitions were recognised in the UK as representing a case of monkeypox. Following the methods of Ward et al,22 this can be generalised to an epidemic that is not in an exponential phase, by replacing rt with a smooth function of time, s(t). The lead author (TW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. We did not directly involve patients and members of the public in the design and conception of the study, primarily because of the pace at which this study was conducted to inform the UK governments response to the monkeypox outbreak in the UK. 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Understand how you use GOV.UK, remember your settings and improve government services of it.