Monkeypox outbreak: Update and further information

Simon Collins, HIV i-Base

MPV blisters (Source: US CDC)

This issue of HTB includes several articles about the recent outbreak of monkeypox (MPX).

WHO has already confirmed over 900 cases in 28 countries where MPX is not endemic.

By 1 June 2022, the UK has so far reported the highest number of cases (220), followed by Spain (135) and Portugal (100). These are nearly all in, or connected to, London, Madrid and Portugal.

The majority of cases (>90%) are in gay men.

Transmission rapidly developed through sexual networks and then international travel, though not as a sexually transmitted infection. Although MPX DNA has been detected in semen (in four early cases in Italy), saliva is more likely is perhaps a more likely route in a sexual setting than genital fluids (both through kissing and oral sex).

Other risks are direct contact with spots/ulcers or from breathing droplets (if sharing poorly ventilated rooms for more than three hours (including in shared households), or sharing clothes, towels and bedding.

Links below include to responses from BHIVA, EACS, other reports and a non-technical Q&A.

i-Base articles

comment

The prompt health care responses in the UK and other countries are focussed not only on tracing and managing cases linked to new network but also on preventing MPV from infecting other animals.

Over the next few weeks it will becomes more clear whether the rapid response has contained infections and prevented the infection from becoming endemic.

UK based general information

NHS. Monkeypox.
https://www.nhs.uk/conditions/monkeypox
Non-technical information about MPV in the UK. This includes who to contact if you are worried about symptoms.

UK Health Security Agency (UK-HSA). Monkeypox virus. (1 June 2022).
https://www.gov.uk/guidance/monkeypox
More detailed information from the UK government about all aspects of MPV including update on the current outbreak.

UK-HSA. Monkeypox cases confirmed in England – latest updates
https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-update
Updated information on UK cases.

Human Animal Infections and Risk Surveillance group (HAIRS).
Qualitative assessment of the risk to the UK human population of monkeypox infection in a canine, feline, mustelid, lagomorph or rodent UK pet. (27 May 2022).
https://www.gov.uk/government/publications/hairs-risk-assessment-monkeypox/qualitative-assessment-of-the-risk-to-the-uk-human-population-of-monkeypox-infection-in-a-canine-feline-mustelid-lagomorph-or-rodent-uk-pet
Includes guidance for isolation from pets.

UK Health Security Agency (UK-HSA). Principles for monkeypox control in the UK: 4 nations consensus statement. (30 May 2022).
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
Includes updated guidelines for continued prevention in the UK.

UK Health Security Agency (UK-HSA). Monkeypox: infected people who are isolating at home: Information for people who have been diagnosed with a monkeypox infection and who have been advised to self-isolate at home. (9 June 2022).
https://www.gov.uk/guidance/guidance-for-people-with-monkeypox-infection-who-are-isolating-at-home

Community and other information

i-Base and UK-CAB. Monkeypox: Q&A and resources.
https://i-base.info/mpox

Prepster and the UK Health Security Agency (HSA). Two UK Community webinars available online.
https://www.youtube.com/watch?v=9_xz-KTMpHk (26 May 2022).
https://www.youtube.com/watch?v=I0o8FG5MYLw (6 June 2022).
Also linked at:
https://www.queerhealth.info/monkeypox
Two excellent early online community discussions.

Monkeypox case tracker.
https://monkeypox.healthmap.org

Other health agencies

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)

US CDC. What clinicians need to know about monkeypox in the United States and other countries.
https://emergency.cdc.gov/coca/calls/2022/callinfo_052422.asp
This US talk on clinical management includes pictures of MPV compared to other common skin reactions.

US CDC. Monkeypox Outbreak — Nine States May 2022. Minhaj FS et al. MMWR Morb Mortal Wkly Rep. ePub.DOI: 10.15585/mmwr.mm7123e1. (3 June 2022).
https://www.cdc.gov/mmwr/volumes/71/wr/mm7123e1.htm

US CDC. Monitoring people who have been exposed.
https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html

US CDC. Home page for information for doctors about MPV.
https://www.cdc.gov/poxvirus/monkeypox/clinicians/index.html

WHO. Multi-country monkeypox outbreak: situation update. (4 June 2022).
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
Detailed review of international cases and guidelines for appropriate monitoring and prevention.

HIV related sources

BHIVA rapid statement on monkeypox virus. (17 May 2022, updated 31 May 2022).
https://www.bhiva.org/BHIVA-rapid-statement-on-monkeypox-virus

EACS/ECDC. Informal webinars given on 24 and 31 May 2022.
https://i-base.info/htb/wp-content/uploads/2022/05/Monkeypox_EACS-ECDC_webinar_310522.pdf (PDF)

Selected research papers

Eurosurveillance, 27(22), (2 June 2022).
https://www.eurosurveillance.org/content/eurosurveillance/browse
Open access publication including papers on risk of sexual transmission and on recent outbreaks in the UK, Portugal and Australia.

Clinical features and management of human monkeypox: a retrospective observational study in the UK. Adler H et al. The Lancet, DOI: 10.1016/S1473-3099(22)00228-6. (May 24 2022).
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6/fulltext
Details of seven MPV cases reported in the UK between 2028 and 2021.

Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Andrea A et al for the INMI Monkeypox Group. Euro Surveill. 2022;27(22):pii=2200421. (2 Jun 2022).
https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200421.

Monkeypox Outbreak — Nine States, May 2022. Minhaj FS et al. MMWR Morb Mortal Wkly Rep 2022;71:764–769. DOI: http://dx.doi.org/10.15585/mmwr.mm7123e1.
This is the first review of the first 17 cases in the US and related healthcare response.

Clinical characteristics of human monkeypox, and risk factors for severe disease. Huhn GD et al. Clin Infect Dis. 2005 Dec 1541(12):1742-51.
https://pubmed.ncbi.nlm.nih.gov/16288398

Clinical Course and Outcome of Human Monkeypox in Nigeria. Ogoina D et al. Clin Infect Dis. 2020 Nov 571(8):e210-e214.3.
https://pubmed.ncbi.nlm.nih.gov/32052029
Includes reports of HIV positive cases.

Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Yinka-Ogunleye A et al CDC Monkeypox Outbreak Team. Lancet Infect Dis. 2019 Aug19(8):872-879.2.
https://pubmed.ncbi.nlm.nih.gov/31285143

This page was first published on 22 May and will be updated as new information becomes available.