We are writing to provide an update of the GeoSentinel alert on monkeypox cases that was circulated yesterday. In addition to the UK cases, other suspected and confirmed monkeypox cases have emerged in several European countries and Canada.
Countries currently reporting monkeypox cases are:
UK (first report on May 7, 2022) n=7 confirmed
Portugal n=5 confirmed, 15 more suspected
Spain n=8 suspected
Sweden n=1 confirmed, additional cases suspected
Canada up to 15 cases under investigation (and more suspected)
Monkeypox is a zoonotic disease caused by an orthopoxvirus, a DNA virus that is antigenically related to the variola and vaccinia viruses. Monkeypox was initially diagnosed in 1970 in the Democratic Republic of the Congo, from where it spread to other regions of Africa (primarily West and Central Africa). Sporadic cases outside Africa have emerged in recent years. There are two distinct genetic clades of monkeypox, the Central African (or Congo Basin) clade and the West African clade. The UK cases reported earlier this month are likely West African clade (to be confirmed).
Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes, and chills. A rash that can look like chickenpox or syphilis can also develop and spread from the face to other parts of the body, including the genitals. Most people recover within a few weeks. The table below, taken from ref (1) lists the case definitions for monkeypox.
Monkeypox is transmitted from infected animals through a bite or through direct contact with the infected animal’s blood, body fluids, or lesions. It can be transmitted via abrasions in the mouth to persons eating infected animals. It can also be transferred from human-to-human via the respiratory tract, by direct contact with body fluids of an infected person, or with virus-contaminated objects. The incubation period is approximately 7 to 17 days.
Recommended isolation precautions therefore include contact AND droplet precautions until lesions are dried and crusted (2).
Monkeypox is not known to be a sexually transmitted disease. However, the UK patients identified as gay, bisexual or men who have sex with men. Sexual or intimate contact cannot be excluded as a mode of transmission. The rate of person-to person transmission may be increasing, with a secondary attack rate of approximately 10% (2). Secondary attack rates cited by Bunge et al. varied from zero to 50% (1). Estimated pooled case fatality rates in the review by Bunge were 8.7%, but lower CFR were reported for the West African clade, i.e., 3.6-4.6% (1).
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141
Weber, D. J., & Rutala, W. A. (2001). Risks and prevention of nosocomial transmission of rare zoonotic diseases. Clinical Infectious Diseases, 32 (3), 446-456.
Here is a link to US CDC guidance on monitoring people who have been exposed to monkeypox: https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html
We urge you to contact the OPI at geosentinel@geosentinel.org if you see any patients who you suspect might have monkeypox. Sequencing of all positive samples and sharing sequences in a common database will be critically important as this new outbreak progresses to understand the inter-relatedness of recent cases. If your site does not have local or national sequencing capacity and you see a suspect or confirmed case, please let us know so that we can facilitate sequencing. Monkeypox is a BSL 3 level pathogen so it needs to be handled in appropriate facilities although extracted DNA can be handled in BLS level 2 laboratories.
Details are available in a ProMed posting: https://promedmail.org/promed-post/?id=8706102
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We are writing to provide an update of the GeoSentinel alert on monkeypox cases that was circulated yesterday. In addition to the UK cases, other suspected and confirmed monkeypox cases have emerged in several European countries and Canada.
Countries currently reporting monkeypox cases are:
UK (first report on May 7, 2022) n=7 confirmed
Portugal n=5 confirmed, 15 more suspected
Spain n=8 suspected
Sweden n=1 confirmed, additional cases suspected
Canada up to 15 cases under investigation (and more suspected)
Monkeypox is a zoonotic disease caused by an orthopoxvirus, a DNA virus that is antigenically related to the variola and vaccinia viruses. Monkeypox was initially diagnosed in 1970 in the Democratic Republic of the Congo, from where it spread to other regions of Africa (primarily West and Central Africa). Sporadic cases outside Africa have emerged in recent years. There are two distinct genetic clades of monkeypox, the Central African (or Congo Basin) clade and the West African clade. The UK cases reported earlier this month are likely West African clade (to be confirmed).
Symptoms of monkeypox include fever, headache, muscle aches, swollen lymph nodes, and chills. A rash that can look like chickenpox or syphilis can also develop and spread from the face to other parts of the body, including the genitals. Most people recover within a few weeks. The table below, taken from ref (1) lists the case definitions for monkeypox.
Monkeypox is transmitted from infected animals through a bite or through direct contact with the infected animal’s blood, body fluids, or lesions. It can be transmitted via abrasions in the mouth to persons eating infected animals. It can also be transferred from human-to-human via the respiratory tract, by direct contact with body fluids of an infected person, or with virus-contaminated objects. The incubation period is approximately 7 to 17 days.
Recommended isolation precautions therefore include contact AND droplet precautions until lesions are dried and crusted (2).
Monkeypox is not known to be a sexually transmitted disease. However, the UK patients identified as gay, bisexual or men who have sex with men. Sexual or intimate contact cannot be excluded as a mode of transmission. The rate of person-to person transmission may be increasing, with a secondary attack rate of approximately 10% (2). Secondary attack rates cited by Bunge et al. varied from zero to 50% (1). Estimated pooled case fatality rates in the review by Bunge were 8.7%, but lower CFR were reported for the West African clade, i.e., 3.6-4.6% (1).
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141
Weber, D. J., & Rutala, W. A. (2001). Risks and prevention of nosocomial transmission of rare zoonotic diseases. Clinical Infectious Diseases, 32 (3), 446-456.
Here is a link to US CDC guidance on monitoring people who have been exposed to monkeypox: https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html
We urge you to contact the OPI at geosentinel@geosentinel.org if you see any patients who you suspect might have monkeypox. Sequencing of all positive samples and sharing sequences in a common database will be critically important as this new outbreak progresses to understand the inter-relatedness of recent cases. If your site does not have local or national sequencing capacity and you see a suspect or confirmed case, please let us know so that we can facilitate sequencing. Monkeypox is a BSL 3 level pathogen so it needs to be handled in appropriate facilities although extracted DNA can be handled in BLS level 2 laboratories.
Details are available in a ProMed posting: https://promedmail.org/promed-post/?id=8706102