Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. 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. Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. 10 out of 13 linked patients had documented pre-symptomatic transmission. 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). From the dataset we removed records with missing data for symptom onset and pseudo identifier number, as well as duplicates. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. The first case was reported in Vienna, Austria, on May 22, 2022. Incubation periods and serial intervals are examples of time delay distributions, which describe the distribution of times between two coupled events. WHO have projected that more cases of monkeypox will be identified as surveillance expands in non-endemic countries. Monkeypox is a re-emerging zoonotic infection caused by the monkeypox virus, which belongs to the Orthopoxvirus genus of the Poxviridae family 1 and was first identified in the Democratic Republic of the Congo in 1970. Funding: The authors were employed by the UK Health Security Agency but received no specific funding for this study. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. 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. Although the outbreak was large, however, incidence was still low relative to the population size at risk. Therefore, backward contact tracing strategies should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases. Similarly, the secondary event time (symptom onset in secondary contact for serial interval or symptom onset for incubation period) sits within an interval [s1, s2]. Counts of confirmed cases in Wales, Northern Ireland, and Scotland are submitted to UKHSA by Public Health Wales, Public Health Agency Northern Ireland, and Public Health Scotland respectively. The origin is symptom onset date of the primary case, with the x axis showing number of days between subsequent events. UK Health Security Agency. 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. If you are unable to import citations, please contact At the time of writing this, 57 cases have been found in the UK as well as a number more across the globe. On the surface, the monkeypox outbreak in the U.S. doesn't look that bad, especially compared with other countries. From those, 30 had documented case-contact links in the HPZone data, allowing the primary case to be identified. This has also been observed for other viral infections1112 and is a consequence of transmission during the pre-symptomatic period. You have rejected additional cookies. Cases had the option of answering On what date did your illness begin?, In the 21 days (3 weeks) before first symptom onset did you have contact with anyone with suspected or confirmed monkeypox infection?, and Date of last contact with case. An exposure date was therefore defined as the last date an individual reported contact with a known case in the 21 days before symptoms manifested, and symptom onset was defined as the date symptoms manifested. [22] The origin of several of the cases of mpox in the United Kingdom is unknown. For instance, even though monkeypox can be prevented, detected, and treated with the use of vaccines, medicines, and diagnostics, further studies are required to help establish the appropriate use of these . Shaded area denotes span of time series where the serial intervals and incubation period distributions were estimated (6 May to 1 August 2022). This is combined with case information recorded by local Health Protection Teams in the UKHSA national case management system. Negative times from primary case onset to secondary contact exposure indicate pre-symptomatic transmission. Our likelihood function therefore relies on three functions (equation 2, fig 1). TW and CO developed the methodology. UK Public Health Agencies. In particular, symptom onset date is defined as the date patients noticed they had an infection. The DRC reported more than 18,000 confirmed or suspected monkeypox cases from 2010 to 2019, up from about 10,000 from 2000 to 2009, and more than 6,000 suspected cases in 2020. [29][31][32], On 1 June, a case was reported in Gibraltar, a British Overseas Territory. Monkeypox virus (MPXV) has generally circulated in West and Central Africa since its emergence. Supplementary material B shows the results of the Weibull and lognormal models. If we identified negative serial intervals, we assumed that this record in the dataset had incorrectly identified the direction of transmission in the case-contact pairs, and the order of the primary case and secondary contract were reversed. Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. How you get monkeypox Monkeypox can be passed on from person to person through: Able to work productively in a fast-paced and challenging environment. Monkeypox, a zoonotic disease, was identified in 1958 in monkeys showing signs of a poxvirus.1 The disease is caused by a virus belonging to the orthopoxvirus genus and was first detected in humans in 1970 in the Democratic Republic of the Congo.2 The disease has since become endemic in that region and spread to other central and west African countries. During an ongoing epidemic, time delay distribution observations are either right truncated or right censored. Dissemination to participants and related patient and public communities: We will disseminate the results to governmental organisations and agencies through official channels and publications. WHO. Cases of monkeypox infection were confirmed in England from 6 May 2022. The paper was, however, read by members of the public upon submission. RC worked on data processing. We refer to this model as the double interval censoring corrected model (ICC). Following the methods of Ward et al,22 this can be generalised to an epidemic that is not in an exponential phase, by replacing rt with a smooth function of time, s(t). Monkeypox outbreak delays defence report for Scottish MP's Covid trial Margaret Ferrier's defence asks for further pre-trial hearing as virologist who was preparing report works on recent case. Analysis of these 13 case-contact pairs showed 10 with pre-symptomatic transmission. Greater uncertainty can be observed for the model that adjusts for right truncation. If clinical symptoms occurred before patients recognised they had symptoms, however, then the true incubation period could be shorter than the patients recognised incubation period. Previous cases in the UK had been either imported from countries where monkeypox is endemic or contacts with documented epidemiological links to imported cases. Accessed August 3, 2022. https://monkeypoxreport.ecdc.europa.eu. Monkeypox virus, a zoonotic orthopox DNA virus related to the virus that causes smallpox, was first described in humans in 1970 in the Democratic Republic of Congo (formerly Zaire). All authors have read and approved the final manuscript. Dont worry we wont send you spam or share your email address with anyone. Our analyses were specific to the dynamics of the outbreak. Conclusions Analysis of the instantaneous growth rate of monkeypox incidence indicates that the epidemic peaked in the UK as of 9 July and then started to decline. Third case of monkeypox reported in the UK, in health care worker . Since the international epidemic began in May, the U.S. has recorded 201. Goodrich B, Gabry J, Ali I, et al. "Monkeypox begins with fever, headache . Monkeypox is a rare viral infection which does not spread easily . Data were collected on monkeypox from UKHSA health protection teams, targeted testing of infected individuals (with specimens processed by UKHSA affiliated laboratories and NHS laboratories), and questionnaires (collected by UKHSA health protection teams). Assuming all individuals behaved similarly, this is unlikely to have materially affected the serial interval distribution. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. The estimated serial interval posterior distributions for the mean serial interval from the UK sampling was 8.0 days (95% credible interval 6.5 to 9.9) for the ICC model and 9.5 days (7.4 to 12.3) (fig 3 and table 4) for the ICRTC model. UK Health Security Agency. This study was conducted for the purpose of informing the outbreak response to the monkeypox pandemic. 73% of cases reported contact with another human case while 27% had known contact with a wild animal. If a substantial proportion of secondary transmission occurs before symptom onset, the implications will be that many infections cannot be prevented by isolating individuals with symptoms. The international outbreak of monkeypox since May 2022 has produced more contemporary estimates of the incubation period with this mutated clade. The right truncation primarily affects recent observations and has less of an influence on older observations. The first known case was detected in the beginning of May 2022, in a British resident who had travelled to Lagos and Delta State in Nigeria,[27] in areas where monkeypox is considered to be an endemic disease. Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. 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. The outbreak is small so far about 80 suspected cases in England, Spain and Canada as well. The World Health Organization has said another 50 suspected cases are being investigated - without naming any. 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. 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