Seven cases of monkeypox virus in the UK from 2018 to 2021

A retrospective review of monkeypox virus reported in the UK from 2018 to 2021 published in Lancet Infectious Diseases will help inform management of cases linked to the current outbreak. [1]

This includes describing seven cases (four men and three women) who were managed in specialist infectious disease centres in Liverpool, London and Newcastle – highlighting the seriousness of this infection.

Three of the cases acquired MPV in the UK: one was a health worker who developed symptoms 18 days after contact with a patient, despite receiving the Imvanex smallpox vaccine at day 6, and two others were household contacts of an infection caught outside the UK (one adult and one child). The cases acquired outside the UK were from Nigeria. Adults were all aged 30 to 50 and the child was less than 2.

Notably, 5/7 of these cases spent more than 3 weeks in isolation (range 22 to 39 days) as PCR testing continued to be positive. One person also had a mild relapse six weeks after leaving hospital.

Otherwise, people remained in hospital until they were confirmed PCR negative in skin, blood and the respiratory tract with no further lesions.

Other details included swollen lymph nodes in 5/7 cases. The lesions were extensive, ranging from 10 to 150, with 3/7 having more than 100. All 7/7 included lesions on the face, trunk and arms, with 6/7 also on the hands and 5/7 on the genitals. Severe ulcers with delayed healing were reported in 3/7, including two deep tissue accesses.

Treatment included oral brincidofovir (200 mg once a week) in 3/7 cases started a week after the first rash which needed to be stopped early due to increased liver enzymes.

One was treated with oral tecovirimat (200 mg twice daily for 2 weeks) and experienced no adverse effects or side effects. This case had the shortest duration of infection (10 days).

However, the small numbers mean that the authors caution that their report does not prove benefit from treatments or whether earlier intervention is beneficial.

comment

The next few weeks will determine whether MPV cases will continue to increase, or whether rapid responses are sufficient to control case transmission.

i-Base has published a non-technical factsheet on monkeypox that will be updated as needed. [7]

Monkeypox: Q&A and update
https://i-base.info/monkeypox

Reference

1. Adler H et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infectious Diseases, DOI: 10.1016/S1473-3099(22)00228-6. (24 May 2022).
   https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6
2. Monkeypox cases in gay men in the UK: BHIVA and ECDC rapid statements. HTB (19 May 2022).
   https://i-base.info/htb/42896
3. Risk of monkeypox becoming endemic in Europe: ECDC assessment. HTB (23 May 2022).
   https://i-base.info/htb/42948
4. European Centre for Disease Prevention and Control (ECDC). Monkeypox multi-country outbreak: rapid assessment report. (23 May 2022).
   https://www.ecdc.europa.eu/en/publications-data/risk-assessment-monkeypox-multi-country-outbreak (download page)
   https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-multi-country-outbreak.pdf (PDF)
5. US CDC. What Clinicians Need to Know about Monkeypox in the United States and Other Countries. (24 May 2022).
   https://emergency.cdc.gov/coca/calls/2022/callinfo_052422.asp
6. Monkeypox case tracker.
   https://monkeypox.healthmap.org
7. i-Base. Monkeypox: Q&A and update. (25 May2022).
   https://i-base.info/monkeypox

This report was first published on 25 May 2022.