2022–2023 mpox outbreak

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2022 monkeypox outbreak
Spread of disease as of 26 May 2022
  Endemic West African clade
  Endemic Congo Basin (Central African) clade
  Both clades recorded
  West African clade outbreak in 2022
DiseaseHuman monkeypox
Virus strainMonkeypox virus (MPV), West African clade, 2017–2019 outbreak subclade[1]
SourceTravel from Nigeria (presumed/hypothesis)[2][3]
Location29 countries (see § Cases per country)
First outbreakLondon, England (first outside West Africa)
Date4 May 2022 – ongoing (2 years, 1 month, and 2 days)
Confirmed cases399
Suspected cases‡50
Severe casesAt least 31 hospitalised
Deaths
0
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

An ongoing outbreak of monkeypox was confirmed on 6 May 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with monkeypox on 29 April 2022. The resident returned to the United Kingdom on 4 May, creating the country's index case of the outbreak.[4]

From 18 May onwards, cases were reported from an increasing number of countries and regions, predominantly in Europe, but also in North and South America, Western Asia, and Australia.[5][6][7][8] 334 cases have been confirmed as of 26 May, with around a third of those - 112 - reported over two days.[9]

The origin of several of the cases of monkeypox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May.[10] Further cases of the virus were reported in North East and South East England,[11] Scotland, Wales and Northern Ireland.[12][13][14]

Monkeypox is a viral infection that manifests a week or two after exposure with fever and other non-specific symptoms, and then produces a rash that can last for a couple of weeks before usually clearing up.[4] In infections before the current outbreak, between one and three people out of a hundred known infections have died. Cases in children are more likely to be severe.[15]

Background

These paragraphs are an excerpt from Monkeypox.

Outbreak characteristics

See also: Monkeypox § Epidemiology

This outbreak is of the West African clade, which has a reported case fatality rate of 1% according to the World Health Organization.[16]

On 23 May 2022, David Heymann, an advisor for the World Health Organization, said that the likely theory of how the outbreak started is transmission during sexual intercourse of gay and bisexual men at two raves in Belgium and Spain.[17] On 25 May, The Guardian stated that many scientists suspect the disease was circulating in the UK and Europe before reaching the MSM community, possibly misdiagnosed or detected only in isolated cases in 2018 and 2019.[18]

Monkeypox is endemic to West and Central Africa.[19][20] Prior to the 2022 outbreak, the United Kingdom had recorded only seven previous cases of monkeypox,[21] all of which were imported cases from Africa or healthcare workers involved in their treatment. The first three such cases were in 2018,[21] followed by a further case in 2019[22] and three more in 2021.[23] The only major monkeypox outbreak to be recorded in a Western country prior to 2022 was the 2003 Midwest monkeypox outbreak in the United States. That one did not feature community transmission.[24][25]

In an article published by The Conversation, Oyewale Tomori pointed out that the number of Monkeypox infections in Nigeria through 2021 is likely to be under-represented, because much of the Nigerian population has been avoiding healthcare facilities due to fear of contracting COVID-19.[26] As British health authorities reported the first case of Monkeypox in the UK in May 2022, the Nigerian government has released to the public information and statistics on reported cases and deaths in the country.

In the report released on May 9, 2022, the NCDC states that 230 cases were confirmed across 20 states and the Federal Capital Territory between 2017 and 2022. In 2022, NCDC has implemented National Technical Working Group, abbreviated as NTWG, for the purpose of reporting and monitoring infections, in addition to strengthening response capacity. In the NCDC report, Rivers State was the most affected by Monkeypox followed by Bayelsa and Lagos. In the span from 2017 to 2022, the NCDC reported 6 deaths in 6 different states, making for a 3.3% Case Fatality Ratio.[27] Nigeria's surveillance of various diseases, including monkeypox, had to focus on the global COVID-19 pandemic in 2020 and 2021, missing many cases and resulting in a drop in official statistics.[28]

Initially reported cases in United Kingdom

Guy's Hospital, where the April case was hospitalised
Stages of monkeypox lesion development

Beginning of May 2022, a case of monkeypox in a British resident was reported who had travelled to Lagos and Delta State in Nigeria,[29] in areas where monkeypox is considered to be an endemic disease. The person developed a rash, on 29 April while in Nigeria and flew back to the United Kingdom, arriving on 4 May.[21]and presented to hospital later the same day. Monkeypox infection was immediately suspected, and the patient was hospitalised at Guy's Hospital[21] and isolated, then tested positive for the virus on 6 May.[29] Testing of patient swab samples by polymerase chain reaction revealed the outbreak to be of the West African clade of monkeypox, which is the less deadly of the two known monkeypox variants with a case fatality rate of around 1%.[29]

Extensive contact tracing of people who had been in contact with the index case both on the international flight from Nigeria to the United Kingdom and within the country following their arrival was carried out, with potential contacts advised to remain aware of the symptoms of monkeypox and immediately isolate if any were to develop within 21 days of the contact event.[29] Following this contact tracing effort, the World Health Organization (WHO) considered further transmission of the virus within the United Kingdom to be of "minimal" risk.[29] Contact tracing was extended to Scotland on 14 May according to Public Health Scotland. A "small number" of people in Scotland were ordered to self-isolate following close contact with the person initially reported to have been infected, although overall risk to the general public remained "very low".[21]

On 12 May two new cases of monkeypox were confirmed by the UK Health Security Agency (UKHSA), both in London,[30] living together in the same household, with no known link between either of them and either the index case or travel to endemic regions. One of the new cases was hospitalised at St Mary's Hospital, while the other case with milder symptoms was said to be self-isolating at home.[30] On 17 May, another four cases of monkeypox were confirmed by the UKHSA in three Londoners and a person in North East England who had previously travelled to London.[31]

Unusually, none of these new cases had any known contact history with the previous three confirmed cases, which suggested a kind of transmission that had not been seen before[32] a wider community transmission of the virus in the London area. The UKHSA stated that the risk to the general public remained "very low".[31][10] Patients with active monkeypox infection were confirmed to be hospitalised at the Royal Victoria Infirmary in Newcastle upon Tyne and at the Royal Free Hospital and Guy's Hospital in London.[31]

Multi-country outbreak

On 18 May in Portugal, 14 cases of monkeypox were reported by health authorities out of total of 20 suspected cases. Two samples' test results were pending.[33] In Spain, there are seven confirmed cases as of 18 May.[34] On the same day, the United States confirmed its first 2022 case of monkeypox and Canada reported 13 suspected cases.[35][36]

On 19 May, Sweden and Belgium reported their first cases of monkeypox,[37][38] while Italy confirmed its first case in a traveller who had arrived from the Canary Islands.[39] A suspected case was reported in France.[40] A genomic analysis conducted on a case in Portugal places the virus infecting that patient in the West African clade, finding it most closely related to viruses associated with cases exported from Nigeria in 2018 and 2019.[41] Current sequencing error prevents exact placement of the virus within the group of these Nigerian viruses.[1]

Following the detection of a case in Massachusetts the previous day, the United States on 19 May placed a $119 million order with Bavarian Nordic, with an option to buy $180 million more, for up to 13 million vaccines against smallpox.[42] On 20 May, the US Department of Health and Human Services said the order was part of a standard preparedness effort and not a response to recent events. A spokesperson said, "BARDA has worked with industry to develop and purchase vaccines and treatments for a potential smallpox emergency, some of which may also be used to respond to monkeypox."[43] Separately, Bavarian Nordic stated an unidentified European country had placed an order for "Imvanex" vaccines in response to the monkeypox outbreak.[43]

On 20 May, Australia reported its first suspected case, in a man who fell ill after returning from travel in the UK.[44] A second case was also confirmed on the same day. The cases were identified as being in Melbourne and Sydney. Both recently returned from travel in Europe and the UK.[45] Germany, France and the Netherlands confirmed their first cases on the same day.[46][47][48] The three confirmed cases in Belgium were linked to the Darklands fetish festival in Antwerp.[49] Also on 20 May, Belgium became the first country to introduce a mandatory quarantine for people infected with monkeypox (21 days). Close contacts of infected people do not have to self-isolate, but are told to stay vigilant.[50][51]

Also on 20 May, Health Secretary of the UK Sajid Javid reported that another eleven cases had been confirmed, bringing the total in the country to twenty. Dr Susan Hopkins from the UKHSA urged watchfulness among men who have sex with men, who have made up "a notable proportion" of the recent cases in the UK and Europe.[52] The UK Health Security Agency (UKHSA) advised people who have had close contact with a person infected with monkeypox to self-isolate for 21 days. Self-isolation is not mandatory.[53]

On 21 May, Switzerland and Israel confirmed their first cases.[54][7] Spain reported 23 new cases linked to a gay bathhouse in Madrid, bringing the country's total to 30.[55] Several infections may also be linked to the Maspalomas Gay Pride Festival in Gran Canaria.[56][57] On the same date, Norwegian authorities initiated contact tracing after a person who had visited Norway earlier in the month had tested positive back in his home country (an undisclosed European country).[58][59] A suspected case was reported in Greece, but it was later confirmed to be chickenpox.[60]

On 22 May, Austria confirmed its first case.[61]

On 23 May, Denmark reported its first case in a man who had returned home from the Canary Islands,[62][63] and the following day the second case was confirmed in a person that also had returned home from Spain.[64] Dr. Sue Hopkins, the chief medical adviser for the UK Health Security Agency, announced that 37 new monkeypox cases had been confirmed, more than doubling the total confirmed in the UK to 57 cases.[65] In Canada, Quebec announced a total of 15 confirmed cases in the province.[66]

On 24 May, the Czech Republic confirmed its first case, a female who was at a music festival in Belgium at the beginning of May.[67][68][69] On the same day, United Arab Emirates reported its first case, detected in a 29-year-old female visitor from West Africa.[70] Also on that day, Slovenia confirmed its first case, a man from Canary Islands,[71] while Switzerland reported its second case, a female in the Canton of Geneva.[72] The UK reported 14 more cases, taking the total to 71, including its first case in Scotland.[73][74] In total monkeypox has been confirmed in 19 countries.[75]

On 25 May, Portugal reported an additional 10 confirmed cases.[76] The UKHSA reported 7 additional cases in England, to a total of 78 cases in the UK.[73]

On 26 May, Public Health Wales and the Public Health Agency of Northern Ireland each reported one case, which, coupled with English and Scottish cases, brought the UK total to 90.[77] On the same day, Quebec reported a suspected case in a child of school age, in the Montreal area.[78] Meanwhile, in the United States, an adult female with a recent travel history to Africa became Virginia's first monkeypox case.[79]

On 27 May, Finland confirmed its first case.[80]

On 28 May, the Republic of Ireland confirmed its first case.[81] The Health Service Executive (HSE) said the case was confirmed in the east of the country and the person had not been hospitalised, while a suspected case was also being investigated.[82]

Research

Transmission

The European Centre for Disease Prevention and Control (ECDC) states that monkeypox virus is considered to be moderately transmitted among humans and can be transmitted through droplets and/or contact with infected lesions. The most common thing to transmission is sexual activity, due to intimate contact during sex with infectious skin lesions seems the likely mode of transmission among MSM.[83]

Given the unusually high frequency of human-to-human transmission observed in this event, and the probable community transmission without history of traveling to endemic areas, spread of the virus through close contact is more likely, with sexual activities being the most common. The likelihood of transmission between individuals without close contact is considered to be low.[83]

In Nature, Anne Rimoin and Raina MacIntyre speculate that the higher percentage of MSM affected is a result of coincidental introduction to the community and then sexual activity constituting "close contact" rather than the virus itself becoming sexually transmitted.[84]

The ECDC rates likelihood of transmission due to close contact, including sexual contact, as "high", but, without close contact, considers the risk to the wider public "low".[83]

Genomic changes

The genomic sequence of the virus associated with this outbreak was first published on 19 May by Portuguese researchers.[85] The research confirmed that the monkeypox virus was of the West African clade, related to other previous international outbreaks in 2018–19.[86] Further investigation of the genomic sequence may yield more information regarding "epidemiology, sources of infection, and transmission patterns."[85][87]

Genomic sequencing of a Belgian patient with monkeypox indicated similar results.[88] Further genome data and analysis is expected.[86]

An analysis by the Austrian research company Innophore revealed 10,043 characteristic open reading frames (ORFs) in this genome,[89] and a subsequent BLAST search of the non-redundant protein database and the PDB reduced the number of suspected ORFs to 925 from which 123 protein sequences were modeled to obtain 3D structural models which are available for download.[90]

Vaccination

Smallpox vaccines containing vaccinia such as Imvanex (Jynneos) can provide around 85% effectiveness against monkeypox. This protection level is calculated from studies using first generation[failed verification] smallpox vaccines tested in late 1980 in Africa.[91][92][93] The UKHSA has begun using Imvanex as post-exposure prophylaxis for close contacts of known cases.[94]

On 25 May, disease experts from the NICD in South Africa said they saw no need for mass vaccination, because they believe cases will not explode as they did in the COVID-19 pandemic.[95]

Responses

UN agencies

On 20 May, the World Health Organization (WHO) convened an emergency meeting of independent advisers to discuss the outbreak and assess the threat level.[96] Its European chief, Hans Kluge, expressed concern that infections could accelerate in Europe as people gather for parties and festivals over the summer. The WHO is expected to provide an update on sequencing of the virus genome from different cases to determine the cause.[97]

UNAIDS urged communicators to avoid stigma by taking an evidence-based approach, reiterated that the disease can affect anyone and that risk is by no means limited to men who have sex with men.[98]

Nations

  •  Algeria: The Pasteur Institute of Algeria issued a communiqué in May 2022, in which the Institute described the origins of Monkeypox in Sub-Saharan Africa, and recommended physical distancing, as well as the use of masks in crowded or enclosed places, in addition to avoiding contact with wild animals that may possess the virus.[99]
  •  Bangladesh: The Directorate General of Health Services (DGHS) has issued warnings at every port in the country to prevent the spread of monkeypox. According to the Directorate spokesperson Nazmul Islam, the DGHS has asked all air, land and sea ports to be alert. Suspected cases are instructed to be sent to an infectious disease hospital and kept in isolation.[100][101]
  •  Belgium: The Risk Assessment Group (RAG) and health authorities declared that those infected with monkeypox must self-isolate for 21 days.[102]
  •  Brazil: The Brazilian Ministry of Health started monitoring the Brazilian patient in Germany, requesting more information from the German Ministry of Health. It also created groups of biologists to monitor monkeys and medical groups to monitor possible cases.[103] The Minister of Health of Brazil, Marcelo Queiroga, and his entourage are in Portugal to reach an agreement on medical exchanges in public health and bioethics. After the trip to Portugal, the minister will participate in the 75th World Health Assembly, thus having his return monitored by the proximity to Europe.[104]
  •  Canada: On May 24, the Public Health Agency of Canada stated that they were in the process of extracting Imvamune vaccines from their National Emergency Strategic Stockpile for deployment across the country, starting with the province of Quebec.[105] On May 26, Quebec announced that Imvamune vaccines would be made available to those who have been in close contact with confirmed or suspected monkeypox cases.[106]
  •  Dominican Republic: In May 2022, the Ministry of Public Health of the Dominican Republic issued a preventive epidemiological alert after monkeypox was reported in several countries.[107][108]
  •  Fiji: The country's Centre for Disease Control and Border Health Protection Unit are monitoring the situation. The Ministry of Health has put in place infection prevention protocols at the border.[109][110]
  •  Germany: Fabian Leendertz of the Robert Koch Institute described the outbreak as an epidemic that will not last long: "The cases can be well isolated via contact tracing and there are also drugs and effective vaccines that can be used if necessary."[97]
  •  India: Union Health Minister Mansukh Mandaviya directed the National Centre for Disease Control and the ICMR to keep a close watch and monitor the situation. The Union Health Ministry has also directed airport and port health officers to be vigilant, according to official sources. They have been instructed to isolate and send samples to the National Institute of Virology of any sick passenger with a travel history to infected countries.[111]
  •  Ireland: The Health Service Executive (HSE) has set up a multidisciplinary incident management team to prepare for the possible arrival of monkeypox, and infectious diseases experts are on alert for patients with symptoms of the virus.[112]
  •  Luxembourg: On 21 May, the Ministry of Health said that they are monitoring the situation with its European partners. All suspected cases and persons with symptoms indicative of monkeypox are instructed to contact the National Infectious Diseases Department of the HLC and refrain from close contact activities until the infection has resolved.[113]
  •  Nigeria: The director general of the NCDC, Ifedayo Adetifa, advised the Nigerian population to avoid eating bush meat to prevent new Monkeypox infections, in addition to storing food properly to avoid being contaminated by rodents, as Monkeypox is a viral zoonosis.[114]
  •  Morocco: In May 2022, several regional directors of the Moroccan Ministry of Health are coordinating a surveillance system for Monkeypox with the Directorate of Epidemiology and Disease Control in order to prevent cases of Monkeypox from European countries from spreading to Morocco, according to the Al Akhbar [ar] newspaper.[115] Due to the "Marhaba 2022" operation, an operation that aims to facilitate the travel of Moroccans living abroad by sea when they travel during the summer period,[116] sanitary measures have already been put in place.[117]
  •  Philippines: Health Secretary Francisco Duque III said that the Philippines was intensifying its border control measures amid the threat of the monkeypox virus.[118] The health department stated its exploring pottential sources of monkeypox vaccines and antivirals.[119][120]
  •  United Kingdom: On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines.[121]
  •  United States: On 22 May, President Joe Biden commented "they haven't told me the level of exposure yet but it is something that everybody should be concerned about". National security advisor Jake Sullivan told reporters the US has a vaccine that is relevant to treating monkeypox.[122] On 25 May, the CDC issued an alert for gay and bisexual men to be especially vigilant.[123][124]

Non-governmental organisations

The Terrence Higgins Trust and British Association for Sexual Health and HIV (BASHH) expressed concern about the impact on sexual health services in the United Kingdom.[125][126] Misinformation spread online,[127] including on Weibo.[128]

International agencies

  •  African Union: The Africa Centers for Disease Control and Prevention has alerted several members of the African Union in May 2022 about cases of Monkeypox, including Cameroon. The director of the Africa CDC, Ahmed Ogwell, said that four African countries have reported 1405 endemic cases with 62 deaths during early 2022 to May 2022. The case fatality rate in these four African countries combined is 4.4%.[129]

Vaccine and antiviral procurement

In reaction to the current outbreak of monkeypox, a number of countries have stated they are buying vaccines and/or releasing vaccines from national stockpiles for use in the outbreak.

On 19 May, Spain's Ministry of Health stated that it was in the process of purchasing thousands of doses of smallpox vaccines for off-label use against monkeypox.[130]

On 24 May, Centers for Disease Control (CDC) Deputy Director Jennifer McQuiston confirmed the United States is in the process of releasing some of their Jynneos monkeypox vaccine supply from their Strategic National Stockpile for people who are "high-risk".[131] On 27 May 2022, the CDC specified the indications for the Jynneos vaccine: research laboratory personnel, clinical laboratory personnel performing diagnostic testing for orthopoxviruses, designated response team members, and health care personnel who administer live smallpox Vaccine or care for patients infected with orthopoxviruses.[132]

On 25 May, the German government, due to the current outbreak, announced it was buying 40,000 doses of a smallpox vaccine produced by Bavarian Nordic.[133]

On 26 May, The UK Health Security Agency claimed that it had procured 20,000 doses of the smallpox vaccine produced by Bavarian Nordic in an effort to combat the rise of monkeypox cases.[134]

Cases per country

Cases per country and territory (outside of endemic African countries)
Country Confirmed Suspected Total Last update First confirmed case
 Argentina 2 — 2 27 May 2022[135] 27 May 2022[136]
 Australia 2 — 2 24 May 2022[8][137] 20 May 2022[23]
 Austria 1 — 1 22 May 2022[61][138] 22 May 2022[61]
 Belgium 9 — 9 28 May 2022[139] 19 May 2022[38]
 Bolivia — 2 2 28 May 2022[140] —
 Canada 26 37 63 27 May 2022[141][142][143] 19 May 2022[144]
 Czech Republic 5 — 5 26 May 2022[145] 24 May 2022[67]
 Denmark 2 — 2 25 May 2022[146][147] 23 May 2022[63][148]
 Ecuador — 1 1 27 May 2022[149] —
 Finland 1 — 1 27 May 2022[80][150] 27 May 2022[80]
 France 7 — 7 27 May 2022[151] 20 May 2022[47]
 Germany 16 — 16 27 May 2022[152] 20 May 2022[46]
 Iran — 6 6 27 May 2022[153] —
 Ireland 1 1 2 28 May 2022[81] 27 May 2022[81]
 Israel 2 — 2 28 May 2022[154] 21 May 2022[7]
 Italy 12 1 13 27 May 2022[155] 19 May 2022[156]
 Malta 1 — 1 28 May 2022[157] 28 May 2022[158]
 Mexico 1 — 1 28 May 2022[159] 28 May 2022[159]
 Morocco — 1 1 26 May 2022[160] —
 Netherlands 12 — 12 25 May 2022[161] 20 May 2022[48]
 Portugal 74 — 74 27 May 2022[162] 18 May 2022[33]
 Slovenia 2 — 2 25 May 2022[163] 24 May 2022[164][165]
 Spain 98 — 98 27 May 2022[166] 18 May 2022[167]
 Sudan — 1 1 26 May 2022[160] —
 Sweden 2 — 2 25 May 2022[168] 19 May 2022[169][170]
  Switzerland 4 — 4 27 May 2022[171] 21 May 2022[54][172]
 United Arab Emirates 1 — 1 24 May 2022[6] 24 May 2022[6][173]
 United Kingdom 106 — 106 27 May 2022[174] 6 May 2022[175]
 United States 12 1 13 27 May 2022[176][177] 18 May 2022[178][179]
 Total 399 49 448 —

Social aspects

The Washington Post complained about the lack of attention to the disease when it only affected Africans, compared to the global attention directed at it when a small number of cases started affecting Western countries.[180] Some also objected to pictures used in media coverage of mild illnesses in Europe that featured severe cases in dark-skinned Africans.[180]

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External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=2022–2023_mpox_outbreak&oldid=1090290496"