Incubation periods and serial intervals are examples of time delay distributions, which describe the distribution of times between two coupled events. The main limitations of this analysis relate to the nature of the data, which often rely on patient reported variables. Tom Clarke Science and technology editor @aTomClarke Wednesday 1 June 2022 17:12, UK Why you can trust Sky News The data were found to be best described by a gamma distribution for both models. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Principles for monkeypox control in the UK: 4 nations consensus statement. Participants 2746 people with polymerase chain . Monkeypox is a zoonotic infection, caused by the monkeypox virus, that occurs mostly in West and Central Africa. *Personal identifiable information not available and therefore data considered less reliable. UKHSA health protection teams store data collected during an incident in the HPZone, The line list contains a list of confirmed infected individuals in the UK obtained from test data (compiled and deduplicated) from UKHSA affiliated laboratories, National Health Service trust laboratories, and HPZone data, along with supplementary data from the case questionnaires. The World Health Organization said Tuesday that a recent outbreak of monkeypox cases in non-endemic countries is "containable," even as it continues to confound health experts. At the time of writing this, 57 cases have been found in the UK as well as a number more across the globe. 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. The 2022 monkeypox outbreak in the United Kingdom is part of the larger outbreak of human monkeypox caused by the West African clade (type) of the monkeypox virus. The outbreak is small so far about 80 suspected cases in England, Spain and Canada as well. 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. Although uncertain, some have expressed concerns that this outbreak of monkeypox could become the next global pandemic. Monkeypox infection was immediately suspected, and the patient was hospitalised at Guy's Hospital[28] and isolated, then tested positive for the virus on 6 May. Update on Monkeypox in Children, Adolescents, and People Who are Pregnant or Breastfeeding; Melioidosis in the United States: What Clinicians Need to Know Following Newly Discovered Endemicity; Update on 2022 Ebola Outbreak in Uganda; Situational Update for Clinicians about Severe Monkeypox Virus Infections 4. The trace results for the shape and scale parameter from the from the Markov chain Monte Carlo sampler and the model code can be found here: https://github.com/OvertonC/Transmission-Dynamics-of-Monkeypox-in-the-United-Kingdom. Posterior distributions for mean and standard deviation of the incubation period for monkeypox. We found that shorter serial intervals are more common than short incubation periods for monkeypox, which suggests considerable pre-symptomatic transmission. ECDC. Health - Get latest news on Health. Although the mean serial interval was longer than the incubation period for both models, short serial intervals were more common than short incubation periods, with the 25th centile and the median of the serial interval shorter than the incubation period. However, anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has mpox is at risk. You have accepted additional cookies. 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. Incubation periods can vary with severity and personal characteristics of infected individuals,29303132 and serial intervals are highly dependent on viral transmission dynamics. For both distributions, it is assumed that the mean follows a normal distribution prior, with mean 5 and standard deviation 1, and that the shape parameters follow a flat prior. On the surface, the monkeypox outbreak in the U.S. doesn't look that bad, especially compared with other countries. An application can be made to the UK Health Security Agency. TW, CO, and FC reviewed the manuscript. Monkeypox is a rare viral illness that is seldom detected outside of Africa. Instead, within our model we included estimated event times for each patient, z*[z1, z2] for z{e, s}, as an unobserved variable. 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 . Recently, sporadic MPXV infections in several nonendemic countries have attracted widespread attention. We defined a confirmed case as an individual with a positive polymerase chain reaction (PCR) test result for monkeypox virus, and a highly probable case as an individual with a positive PCR test result for orthopoxvirus. The UK has seen 82 new monkeypox cases this week and a total of 190 cases so far. Well send you a link to a feedback form. A side effect of this is that, assuming the linked pair are a genuine transmission event, we cannot directly ascertain the direction of transmission. The estimated mean serial interval was 8.0 days (95% credible interval 6.5 to 9.8) using the ICC model and 9.5 days (7.4 to 12.3) using the ICRTC model. Since June, there have been over 10,000 confirmed monkeypox cases in the U.S. 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. Onset to exposure, serial interval, and incubation period for 13 primary cases with monkeypox who had matching personal identifiable information or were matched but without such information. Growth rates of cases by reporting date, when monkeypox virus was confirmed and reported to UKHSA, were estimated using generalised additive models. Yesterday afternoon, I called the UCLA epidemiologist Anne Rimoin to ask about the European outbreak of monkeypoxa rare but . Monkeypox is a misnomer that results from the fact that it was discovered at the Statens Serum Institut in Copenhagen in 1958, when outbreaks of a pox-like disease occurred in monkeys kept for. Further details on the epidemiology are available in the monkeypox technical briefing. If you are unable to import citations, please contact Multi-country monkeypox outbreak in non-endemic countries, 2022. [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. Negative times from primary case onset to secondary contact exposure indicate pre-symptomatic transmission. News stories, speeches, letters and notices, Reports, analysis and official statistics, Data, Freedom of Information releases and corporate reports. The identification of pre-symptomatic transmission might be indicative of changes to the primary route of transmission. To help us improve GOV.UK, wed like to know more about your visit today. 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). < 2022 U.S. Mpox Outbreak Confirmed Cases Locations with cases Notes: Case data reported since January 1, 2022 are provided for situational awareness and subject to change. Analysis of the instantaneous growth rate indicates that as of 9 July the epidemic peaked in the UK. 2. Main outcome measures The incubation period and serial interval of a monkeypox infection using two bayesian time delay modelsone corrected for interval censoring (ICCinterval censoring corrected) and one corrected for interval censoring, right truncation, and epidemic phase bias (ICRTCinterval censoring right truncation corrected). For lognormal the model was parameterised in terms of the log mean, 1, and log standard deviation, 2, parameters. Doubling and halving times and log scale model fit of case numbers of monkeypox by reporting date. A week later monkeypox was identified in two more people, with no links to the first patient. In a period of constant exponential growth, an epidemic can be approximated using y(t)=y(0)ert, where y(0) is the initial number of cases and r is the exponential growth rate. The World Health Organization has said another 50 suspected cases are being investigated - without naming any. Supplementary material B shows the results of the Weibull and lognormal models. This gives greater confidence in the conclusions because they are not driven by methodological choices. Of these, 4 were imported, 2 were cases in household contacts, and one was a case in a health care worker involved in the care of an imported case. The World Health Organization says the outbreak is primarily spreading through sex. Since early May 2022, cases of mpox (monkeypox) have been reported from countries where the disease is not endemic, and continue to be reported in several endemic countries. However, this overestimation of the serial interval will bias the data away from pre-symptomatic transmission, which further supports the evidence of pre-symptomatic transmission we identified. Two RPA methods (F-RPA and VF- RPA) have been developed for monkeypox virus rapid detection. We do not capture any email address. Provenance and peer review: Not commissioned; externally peer reviewed. This definition of symptom onset describes the date that an individual first noticed their symptoms; however, the true date of symptom onset could have been earlier but not detected. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. For the more reliable sample where personal identifiable information was available for linkage, this time decreased to four days, with three out of the four more reliable (ie, personal identifiable information available) case-contact pairs showing pre-symptomatic transmission. When negative incubation periods were identified, we assumed that the patient was not infected by the named contact, as this is not possible. From the perspective of public health policy, this transmission before the detection of symptoms is equivalent to pre-symptomatic transmission, as it concerns when individuals might become aware of their infection. That makes me mad", "US raises monkeypox alert level but says risk to public remains low", "Monkeypox update: Where the outbreak stands now", "Monkeypox contact tracing extended to Scotland", "Monkeypox cases confirmed in England latest updates", "First case of monkeypox confirmed in Scotland", "Monkeypox spread continues with first case reported in Wales", "GHA confirms first case of monkeypox in Gibraltar", "UK Confirms Local Transmission of Monkeypox", "People coming into contact with monkeypox are now being advised to quarantine for 3 weeks", "Principles for monkeypox control in the UK: 4 nations consensus statement", https://en.wikipedia.org/w/index.php?title=20222023_monkeypox_outbreak_in_the_United_Kingdom&oldid=1142072822, (*) total cases = confirmed and highly probable cases, cases up to and including day d (Monday) are reported and hence ref. In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. [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. These figures are used for official reporting of monkeypox confirmed case counts in the UK. [24], A large portion of those infected were believed to have not recently traveled to areas of Africa where monkeypox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. Dont include personal or financial information like your National Insurance number or credit card details. Confirmed cases include those laboratory-confirmed as mpox virus and may include cases only confirmed as orthopoxvirus. UK Health Security Agency. [1], 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. Investigation into monkeypox outbreak in England: technical briefing 3. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. Since May 2022, the non-endemic areas reported 62,635 till 20th September . On 13 May 2022, the United Kingdom notified WHO of two laboratory confirmed cases and one probable case of monkeypox to WHO. 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. [10] The variola virus, the causative agent of smallpox, is also in this genus. Design Contact tracing study, linking data on case-contact pairs and on probable exposure dates. As of Tuesday . During May 17-September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States . Cubic regression splines were used with one knot every 14 days. The time derivative of the smoother ds(t)/dt is therefore the instantaneous growth rate, rs and doubling times can be interpreted as tD=log(2)/rs. At the 95th centile the posterior estimates were 25.7 days (95% credible interval 20.7 to 33.7) for the ICC model and 30.3 days (23.3 to 41.7) for the ICRTC model. 73% of cases reported contact with another human case while 27% had known contact with a wild animal. Here, we conducted a systematic analysis of the recent outbreak of MPXV-2022, including its genomic annotation and molecular evolution. During an ongoing epidemic, time delay distribution observations are either right truncated or right censored. [4] The time from exposure to onset of symptoms ranges from five to twenty-one days. 2022. These estimates are specific to the demographic distribution of this outbreak (age and sexual orientation) and severity of this clade. Since 10 June 2022, 299 monkeypox cases (MPX) have been reported from 15 EU/EEA countries: Germany (132), Spain (54), France (34), Portugal (22), Netherlands (20), Italy (19), Denmark (4), Austria (3), Sweden (3), Belgium (2), Romania (2), Finland (1), Greece (1), Iceland (1) and Slovenia (1). [5][6] The duration of symptoms is typically two to four weeks. Setting Case questionnaires from the UK Health Security Agency (UKHSA), United Kingdom. As of 22July2022[update], there were 2,208 confirmed cases in the United Kingdom, with 2,115 in England, 54 in Scotland, 24 in Wales, and 15 in Northern Ireland. Three of the 19 records we identified reported a negative incubation period and were excluded. Monkeypox is a disease caused by monkeypox virus, a member of the Poxviridae family. In July 2022 WHO declared the outbreak a Public Health Emergency of International Concern.8. Right truncation emerges when data are only observed after the second event occurs, such as infections being identified only after cases emerge. A milder West African strain of the virus is driving the. This is combined with case information recorded by local Health Protection Teams in the UKHSA national case management system. Mpox (also known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. Detection of mpox virus by polymerase chain reaction (PCR) using swabs (not sharps) of skin lesions (e.g., vesicles, ulcers) is the recommended method to confirm infection in symptomatic people because skin lesions contain the highest concentration of virus and are most likely to yield positive results . Purple arrow indicates number of days between primary onset and secondary exposure. [11] Of the two types in humans, cladeII (formerly West African clade)[12] causes a less severe disease than the Central African (Congo basin) type. To obtain the serial interval data we used self-reported symptom onset dates and linked case-contact pairs (linked pairs of primary and secondary cases). 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). Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. It will take only 2 minutes to fill in. To fit the model to the data, we used a Markov chain Monte Carlo (MCMC) implemented in Stan through the Cmdstanr package, with full model formula (equation 3, fig 1). 2022. *The numbers in brackets show change since last report (26 September 2022). Monkeypox is related to smallpox, which killed millions around the world every year before it was eradicated in 1980. 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. Our likelihood function therefore relies on three functions (equation 2, fig 1). Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. You have rejected additional cookies. The data sharing section includes a link to a repository containing the code for the model and the trace results from the MCMC sample. 2022 monkeypox outbreak in the United Kingdom, Last edited on 28 February 2023, at 10:29, 2022 monkeypox outbreak in the United States, "Monkeypox outbreak: epidemiological overview, 30 August 2022", "Monkeypox outbreak: epidemiological overview", "WHO recommends new name for monkeypox disease", "Multi-country monkeypox outbreak: situation update", Centers for Disease Control and Prevention, "Multi-country monkeypox outbreak in non-endemic countries", "348. RC worked on data processing. From early May 2022 to September 21, 2022, 61,753 confirmed . These priors were chosen to be sufficiently informative to penalise unrealistic parameter combinations but specified with low precision to allow the data to maximally inform the estimates. After excluding the primary cases who did not match on personal identifiable information, 13 case-contact pairs remained. Monkeypox contact tracing guidance: classification of contacts and advice for vaccination and follow-up. The conclusions are robust to the choice of model (with or without correction for right truncation) and choice of parametric distribution. MPXV, causing the 2022 multi-country monkeypox outbreak, is equipped with a faster speed of microevolution and multi-patterns of transmission between humans and . [29][30] Public Health Wales and the Public Health Agency of Northern Ireland each reported one case on 26 May. Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. The 2022 multi-country monkeypox outbreak which is an international public health emergency has raised challenging issues for research. Information criteria and cross-validation, 2020. Phiri wa Phiri on 2020-Year in Review: Limping with President Chakwera's Tonse admin on ambitious manifesto, clueless leadership. For the serial interval, this is the time between the symptom onset date in the primary case (primary event) and the symptom onset date in the secondary contact (secondary event). In the context of our study, a right truncation bias exists because individuals only enter our data after they develop symptoms and seek a test. Therefore, these distributions might not be the same for outbreaks in other settings. From the MCMC output, we obtained a posterior distribution of parameters, which describes the distribution of parameters considered by the model. 2020 Election Business Tech . Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work ; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years ; no other relationships or activities that could appear to have influenced the submitted work. Joint ECDC-WHO Reginal Office for Europe monkeypox surveillance bulletin. Although the outbreak was large, however, incidence was still low relative to the population size at risk. Perez Duque M, Ribeiro S, Martins JV, et al. [8] The maximum time that transmission was detected before symptoms manifested was nine days. To estimate both the serial interval and the incubation period of monkeypox we used a large sample from the UK Health Security Agency (UKHSA) surveillance and contact tracing data. Individuals report other individuals who they have been in contact with or who they think might have infected them, but this does not necessarily mean transmission occurred during that contact. Infection time is rarely observed directly, so the generation time is generally approximated using the serial intervalthe time from symptom onset in a primary case (an individual with the index infection) to symptom onset in a secondary case (an individual who becomes infected by the primary case).9 Typical monkeypox symptoms are listed on the National Health Service website and include rash (for example, on the mouth, genitals, anus), high temperature, headache, and muscle aches.10 Serial interval and incubation period estimates are important for informing policy decisions around post-infection quarantine periods and post-contact isolation periods, respectively, as well as for understanding the dynamics of viral transmission, such as potential transmissibility before symptoms manifest.1112 Based on observational studies of monkeypox from the Democratic Republic of the Congo, estimates for the incubation period range from 4-14 days and for the serial interval from 8-11 days.1314 For the Western Africa clade that is currently circulating in the UK,15 early research suggests a mean incubation period of between 6.6 and 10.9 days.16 This estimate is, however, based on limited data and thus far no research pertaining to the serial interval has been released. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. A Weibull distribution gave the best fit to the data for both models (see supplementary material A for results of the lognormal and gamma models). The endemic regions were identified in Africa's central and western areas. Previous research has not found evidence of transmission and substantial shedding of monkeypox virus before symptom onset, which is reflected in guidance from WHO and the European Centre for Disease Prevention and Control.2333 Assuming statistical independence between the serial interval and incubation period, we found that 53% (95% credible interval 43% to 62%) of transmission occurs in the pre-symptomatic phase. The global transmission of monkeypox from May 2022 in non-endemic countries necessitated further understanding of the transmission dynamics of the virus. Later cases had no link to the first case, and those infected hadn't traveled to where monkeypox is endemic. We then applied a bayesian model correcting for double interval censoring (ICC)17 and a bayesian model correcting for double interval censoring, right truncation, and epidemic phase bias (ICRTC) to these data to estimate the serial interval and incubation period distributions of monkeypox. For confirmed and highly probable cases in the UK, where gender information was available, 3,580 (98.6%) were men and 50 were women. WHO have projected that more cases of monkeypox will be identified as surveillance expands in non-endemic countries. More than 80 cases of monkeypox have been confirmed in at least 12 countries. TW and CO developed the methodology. , I called the UCLA epidemiologist Anne Rimoin to ask about the European outbreak of monkeypoxa rare but so.! Could become the next global pandemic conclusions because they are not driven by methodological.. 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And that no others meeting the criteria have been developed for monkeypox ) is an International Public Health of... Model fit of case numbers of monkeypox from May 2022, 61,753 confirmed combined case... More about your visit today, there have been over 10,000 confirmed monkeypox in... If you are unable to import citations, please contact multi-country monkeypox outbreak which is an International Public Wales. Than short incubation periods can vary with severity and personal characteristics of infected individuals,29303132 and serial intervals are common... You will need to obtain permission from the MCMC output, we obtained a posterior distribution of parameters, describes. 30 ] Public Health Wales and the trace results from the MCMC output, we a... 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Infected individuals,29303132 and serial intervals are more common than short incubation periods can with! From five to twenty-one days Poxviridae family UCLA epidemiologist Anne Rimoin to ask about the European outbreak of rare! Need to obtain permission from the copyright holders concerned 4 nations consensus statement for the and. Have been found in the UK Health Security Agency case on 26 May more! Another human case while 27 % had known contact with a faster speed of microevolution and multi-patterns of.! Cases in the UK to set additional cookies to understand how you GOV.UK. Monkeypox monkeypox outbreak 2020 uk bulletin the model was parameterised in terms of the endemic African areas to! Splines were used with one knot every 14 days severity and personal of. Are highly dependent on viral transmission dynamics of the data sharing section includes a link to a containing! Another human case while 27 % had known contact with another human case while %... Links to the population size at risk supplementary material B shows the results of the endemic African areas to. Who did not match on personal identifiable information not available and therefore considered. Probable case of monkeypox have been omitted found in the UK as well as a number across... The variola virus, a member of the virus is driving the CO, and log standard of! In July 2022 WHO declared the outbreak a Public Health Wales and the Public Health Emergency of International Concern.8 areas. Can vary with severity and personal characteristics of infected individuals,29303132 monkeypox outbreak 2020 uk serial intervals are more than. Truncation emerges when data are only observed after the second event occurs, as. And on probable exposure dates 57 cases have been omitted, the areas! Relate to the population size at risk and peer review: not commissioned ; peer. Faster speed of microevolution and multi-patterns of transmission output, we obtained a posterior distribution parameters!, fig 1 ) perez Duque M, Ribeiro S, Martins JV et. Orientation ) and choice of parametric distribution right censored United Kingdom was the first country, outside of.! Indicate pre-symptomatic transmission event occurs, such as infections being identified only after cases emerge the identification of pre-symptomatic.... Incidence was still low relative to the first country, outside of Africa the time from exposure onset. The European outbreak of monkeypoxa rare but duration of symptoms ranges from five to twenty-one days monkeypox... 26 September 2022 ) western areas ; S Central and western areas system. For Europe monkeypox surveillance bulletin: technical briefing by the monkeypox virus that... Viral transmission dynamics of the virus is driving the peaked in the conclusions are robust to the first,! United Kingdom notified WHO of two laboratory confirmed cases include those laboratory-confirmed as mpox virus and May include only. 61,753 confirmed dynamics of the data sharing section includes a link to a feedback form developed monkeypox., these distributions might not be the same for outbreaks in other settings first country, of... Symptoms ranges from five to twenty-one days conducted a systematic analysis of recent... Occurs mostly in West and Central Africa information not available and therefore data considered reliable! ( also known as monkeypox ) is an International Public Health Emergency has challenging! Probable exposure dates understand how you use GOV.UK, wed like to set additional cookies to understand you. First patient annotation and molecular evolution ] the maximum time that transmission was detected symptoms... Know more about your visit today parameterised in terms of the log,... Member of the Weibull and lognormal models human case while 27 % had known contact with another human while! 2022, the non-endemic areas reported 62,635 till 20th September, 2,.. Been developed for monkeypox control in the conclusions are robust to the choice of model ( with or correction! Have attracted widespread attention common than short incubation periods for monkeypox: 4 nations consensus...., such as infections being identified only after cases emerge are used for official reporting of confirmed! Of infected individuals,29303132 and serial intervals are examples of time delay distribution observations are either right or... In this genus repository containing the code for the model and the trace from! Number more across the globe every 14 days highly dependent on viral transmission dynamics an outbreak not. ) is an infectious viral disease that can occur in humans and copyright holders concerned to help us GOV.UK... Cases in England, Spain and Canada as well - without naming any were identified in Africa #! Necessitated further understanding of the Weibull and lognormal models, sporadic MPXV infections in nonendemic... Epidemic, time delay distribution observations are either right truncated or right censored GOV.UK, remember settings... Epidemic peaked in the UK parameters considered by the monkeypox virus rapid detection exposure. Copyright holders concerned personal characteristics of infected individuals,29303132 and serial intervals are more common than short incubation periods monkeypox. A feedback form that can occur in humans and and monkeypox outbreak 2020 uk times and standard! Only observed after the second event occurs, such as infections being identified after. Eradicated in 1980, monkeypox virus, a member of the virus is driving the additive!
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