10 out of 13 linked patients had documented pre-symptomatic transmission. Our likelihood function therefore relies on three functions (equation 2, fig 1). Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. This study was conducted for the purpose of informing the outbreak response to the monkeypox pandemic. Of these, 94 were in Scotland, 34 were in Northern Ireland, 46 were in Wales and 3,480 were in England. We have assumed that transmission follows the direction of symptom onset dates. 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. 73% of cases reported contact with another human case while 27% had known contact with a wild animal. Accessed August 3, 2022. https://monkeypoxreport.ecdc.europa.eu. England counts may differ from those published in the Notifications of infectious diseases (NOIDs) causative agents weekly report. To investigate potential exposure dates that occurred before symptom onset in a primary case, which would suggest pre-symptomatic transmission, we linked data on the date of symptom onset in the primary case with exposure dates in their secondary contacts. 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. [29], On 30 May, the four main public health agencies published a consensus statement describing the principles they will put in use, with the aim of limiting community transmission. The identification of pre-symptomatic transmission might be indicative of changes to the primary route of transmission. From the remaining 16 records, seven primary cases had personal identifiable information in both the questionnaire and the line list, allowing us to verify whether the individual identified by the secondary contact was also the primary case from the case-contact pair. The other six include the H1N1 influenza pandemic of 2009; the Ebola outbreak in West Africa from 2013 to 2015; the Ebola outbreak in the Democratic Republic of the Congo from 2018 to 2020; the . Monkeypox, a zoonotic disease, was identified in 1958 in monkeys showing signs of a poxvirus.1 The disease is caused by a virus belonging to the orthopoxvirus genus and was first detected in humans in 1970 in the Democratic Republic of the Congo.2 The disease has since become endemic in that region and spread to other central and west African countries. Growth rates of cases by reporting date, when monkeypox virus was confirmed and reported to UKHSA, were estimated using generalised additive models. To understand the transmission dynamics of the monkeypox outbreak, accurate estimates are needed of the time between subsequent infections (generation time) and time from becoming infected to developing symptoms (incubation period). 2020 Election Business Tech . Vaccinating less than half of high-risk men may stop monkeypox spread,A modelling study suggests that between 5 and 47 per cent of high-risk men who have sex with men would need to be vaccinated to stop the ongoing monkeypox outbreak Proportion of patients who reported being gay, bisexual, and other men who have sex with men (GBMSM) and mean age of each study sample compared with the total set of patients. Read Breaking News on Health updated and published at health | Page 36 Check benefits and financial support you can get, Find out about the Energy Bills Support Scheme, Health surveillance and reporting programmes, Monkeypox outbreak: epidemiological overview, Current epidemiological situation as of 3 October 2022, nationalarchives.gov.uk/doc/open-government-licence/version/3, Notifications of infectious diseases (NOIDs) causative agents weekly report, Monkeypox contact tracing guidance: classification of contacts and advice for vaccination and follow-up. 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. A side effect of this is that, assuming the linked pair are a genuine transmission event, we cannot directly ascertain the direction of transmission. [15], An ongoing outbreak of mpox was confirmed on 6May2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with mpox on 29 April 2022. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. However, this would be computationally expensive. [10] The variola virus, the causative agent of smallpox, is also in this genus. Named contacts are therefore likely to correspond to genuine transmission events. Since then, the incidence of the disease has been sporadic. 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). Able to work productively in a fast-paced and challenging environment. 2022-2023 monkeypox outbreak 39 languages An ongoing outbreak of mpox, a viral disease, was confirmed in May 2022. The UK has seen 82 new monkeypox cases this week and a total of 190 cases so far. Tom Clarke Science and technology editor @aTomClarke Wednesday 1 June 2022 17:12, UK Why you can trust Sky News The main limitations of this analysis relate to the nature of the data, which often rely on patient reported variables. Shaded area denotes span of time series where the serial intervals and incubation period distributions were estimated (6 May to 1 August 2022). Monkeypox - Democratic Republic of the Congo. Mpox Virus in Human Samples other than Skin Rash Lesions and Implications for Transmission. This sample size is small and relies on the completion of an optional case questionnaire and on the cases being linked by contact tracing. How you get monkeypox Monkeypox can be passed on from person to person through: Incubation periods can vary with severity and personal characteristics of infected individuals,29303132 and serial intervals are highly dependent on viral transmission dynamics. Doubling and halving times and log scale model fit of case numbers of monkeypox by reporting date. Taha, M. J., Abuawwad, M. T., Alrubasy, W. A., Sameer, S. K., Alsafi, T., Al-Bustanji, Y., & Nashwan, A. J. Ocular manifestations of recent viral pandemics: A literature. Work was undertaken in line with national data regulations. Throughout my . WHO. 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. When we compared the subsamples obtained through this data processing with the total set of patients (table 1), the mean age and proportion of patients who reported being gay, bisexual, and other men who have sex with men was consistent across all samples. From the dataset we removed records with missing data for symptom onset and pseudo identifier number, as well as duplicates. The probable case is epidemiologically linked to the two confirmed cases and has fully recovered. Design Contact tracing study, linking data on case-contact pairs and on probable exposure dates. For confirmed and highly probable cases in the UK, where gender information was available, 3,580 (98.6%) were men and 50 were women. In other populations and with different disease severity, the incubation periods are likely to differ.29303132. [5][7] The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks. Using the cumulative distribution function of the serial interval distribution, the median number was 5.0 days (95% credible interval 3.8 to 6.2) for the ICC model and 5.8 days (4.3 to 7.6) for the ICRTC model (table 5). [2], Mpox (also known as monkeypox[3]) is an infectious viral disease that can occur in humans and some other animals. The subsamples therefore captured the two key personal characteristics of infected individuals in the outbreak. [35], Furthermore, to combat the continued spread of the outbreak, the UKHSA has offered doses of the Imvanex smallpox vaccine, also effective against monkeypox, to people having had close contact with people confirmed to having been infected. [5][6] The duration of symptoms is typically two to four weeks. The Food and Drug Administration (FDA) is urging that providers be "judicious" in prescribing the The shorter median estimate for the serial interval relative to the incubation period suggests that pre-symptomatic transmission might be more substantial than was previously thought, which is further supported by linked patient level data. The MCMC algorithm preferentially selects parameters that better describe the data. For example, the multi-country outbreak of monkeypox in 2022 has already "invaded" 6 continents and over 100 countries, with more than 53,000 people from different nations infected. Results The mean age of participants was 37.8 years and 95% reported being gay, bisexual, and other men who have sex with men (1160 out of 1213 reporting). 2. UK Health Security Agency. From early May 2022 to September 21, 2022, 61,753 confirmed . Two RPA methods (F-RPA and VF- RPA) have been developed for monkeypox virus rapid detection. The outbreak has mainly been in gay, bisexual, and men who have sex with men without documented history of travel to. On 6 May 2022, monkeypox was detected in England in a patient who had recently travelled to Nigeria. In the U.S., the first monkeypox case in the current outbreak was identified on May 18, 2022. Monkeypox is a disease caused by monkeypox virus, a member of the Poxviridae family. To compare the model fits we calculated the leave-one-out cross validation (LOO) through Pareto smoothed importance sampling, using the LOO package in R.19 We applied MCMC to each model and evaluated its convergence using potential scale reduction factor, or (calculated using Cmdstanr20), where it is desirable to have a value <1.05. health, 13, 14. TW, CO, RP, and RC wrote the manuscript revisions. [13] It may spread from infected animals by handling infected meat or via bites or scratches. 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. The World Health Organization has said another 50 suspected cases are being investigated - without naming any. The data were found to be best described by a gamma distribution for both models. In the analysis, we assume that the direction of transmission is based on the date order of symptom onset, because the direction of transmission cannot be otherwise ascertained. However, anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has mpox is at risk. The posterior estimate for the mean incubation period of monkeypox from the UK sampling was 7.6 days (95% credible interval 6.5 to 9.9) for the ICC model and 7.8 days (6.6 to 9.2) (fig 2 and table 2) for the ICRTC model. Joint ECDC-WHO Reginal Office for Europe monkeypox surveillance bulletin. Although uncertain, some have expressed concerns that this outbreak of monkeypox could become the next global pandemic. As of 1 August 2022, 92 records (from 650 questionnaires) showed complete data for exposure date from the questionnaire and the pseudo identifier number needed for linking the datasets. When negative incubation periods were identified, we assumed that the patient was not infected by the named contact, as this is not possible. 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. Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. Firstly, we linked case-contact pairs to questionnaire records for each secondary contact, which enabled the primary case and the exposure date to be identified for the secondary contact. We do not capture any email address. Contributors: TW conceived and led the study. No cross-reaction was found in 14 rash and fever-associated viruses. [33], On 30 August 2022, 3413 cumulative cases (3,279 confirmed and 134 highly probable cases) of human monkeypox up to (and including) 29 August were reported for the UK. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. Data on monkeypox in children and adolescents aged <18 years are limited (1,2). Conclusions Analysis of the instantaneous growth rate of monkeypox incidence indicates that the epidemic peaked in the UK as of 9 July and then started to decline. Monkeypox is a rare viral illness that is seldom detected outside of Africa. 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. EXCLUSIVE: Top scientist calls for Britain to stockpile bird flu antivirals and PPE. Assuming all individuals behaved similarly, this is unlikely to have materially affected the serial interval distribution. Copyright 2023 BMJ Publishing Group Ltd, A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy, Comparison of West African and Congo Basin monkeypox viruses in BALB/c and C57BL/6 mice, Virulence differences between monkeypox virus isolates from West Africa and the Congo basin, On the relationship between serial interval, infectiousness profile and generation time, Presymptomatic transmission of SARS-CoV-2 infection: a secondary analysis using published data, Serial interval of novel coronavirus (COVID-19) infections, Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire, Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo, Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022, Understanding an evolving pandemic: An analysis of the clinical time delay distributions of COVID-19 in the United Kingdom, Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning, Inference from Iterative Simulation Using Multiple Sequences, Estimating a time-to-event distribution from right-truncated data in an epidemic: A review of methods, Growth, reproduction numbers and factors affecting the spread of SARS-CoV-2 novel variants of concern in the UK from October 2020 to July 2021: a modelling analysis, Estimating incubation period distributions with coarse data, Shorter incubation period is associated with severe disease progression in patients with COVID-19, Brief Report: Incubation Period Duration and Severity of Clinical Disease Following Severe Acute Respiratory Syndrome Coronavirus Infection, Association between Severity of MERS-CoV Infection and Incubation Period, Incubation period, severity of disease, and infecting dose: evidence from a Salmonella outbreak, Surveillance, case investigation and contact tracing for monkeypox: interim guidance, 25 August 2022, Transmission dynamics of monkeypox in the United Kingdom: contact tracing study, https://www.gov.uk/government/publications/accessing-ukhsa-protected-data/accessing-ukhsa-protected-data, https://github.com/OvertonC/Transmission-Dynamics-of-Monkeypox-in-the-United-Kingdom, http://creativecommons.org/licenses/by-nc/4.0/, https://www.who.int/news-room/fact-sheets/detail/monkeypox, https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385, https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview/monkeypox-outbreak-epidemiological-overview-13-september-2022, https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern, https://www.gov.uk/government/publications/principles-for-monkeypox-control-in-the-uk-4-nations-consensus-statement/principles-for-monkeypox-control-in-the-uk-4-nations-consensus-statement#:~:text=In%20the%20UK%2C%20all%20reported,about%20the%20West%20Afr, https://mc-stan.org/rstanarm/reference/loo.stanreg.html, https://www.ecdc.europa.eu/sites/default/files/documents/Considerations-for-Contact-Tracing-MPX_June%202022.pdf, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1#part-2-epidemiology-update, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-3, https://web.archive.org/web/20220605103903/https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1#part-3-genomics, https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.3, Birmingham and Solihull Mental Health NHS Foundation Trust: Consultant Psychiatrist General Adult - Northcroft CMHT, Brent Area Medical Centre: Salaried GP - Brent Area Medical Centre, Onebright Ltd: Consultant Psychiatrist (Neurodiversity) - Remote / London, The Royal Hospital for Neurodisability: Clinical Fellow, Womens, childrens & adolescents health. 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. Our finding does, however, provide evidence that there are patients who showed pre-symptomatic transmission in the monkeypox outbreak data. In particular, symptom onset date is defined as the date patients noticed they had an infection. 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. [4] The time from exposure to onset of symptoms ranges from five to twenty-one days. Participants 2746 people with polymerase chain reaction confirmed monkeypox virus in the UK between 6 May and 1 August 2022. 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 limit of detection was 15.32 copies/L for F-RPA and 8.53 copies/L for VF-RPA, 3. The median incubation period for the ICC model was 6.6 days (95% credible interval 5.5 to 7.7) and for the ICRTC model was 6.6 days (5.5 to 7.9). Mpox (previously called monkeypox) is a viral zoonosis, and in humans, it shares several clinical characteristics with smallpox [1,2].Although smallpox has been eradicated worldwide since 1980, mpox is still endemic in parts of Central and Western Africa [3,4,5].However, it should be noted that most of the mpox cases recorded in the 2022 outbreak occurred in Western and European countries . Funding: The authors were employed by the UK Health Security Agency but received no specific funding for this study. Table 3 shows the results of the cumulative distribution function of the incubation period distribution. Principles for monkeypox control in the UK: 4 nations consensus statement. Previous cases in the UK had been either imported from countries where monkeypox is endemic or contacts with documented epidemiological links to imported cases. Cases had the option of answering On what date did your illness begin?, In the 21 days (3 weeks) before first symptom onset did you have contact with anyone with suspected or confirmed monkeypox infection?, and Date of last contact with case. An exposure date was therefore defined as the last date an individual reported contact with a known case in the 21 days before symptoms manifested, and symptom onset was defined as the date symptoms manifested. 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. This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. 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