Monkeypox: Health agency urges people to look out for symptoms
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Monkeypox — a close relative of smallpox — is a usually rare viral disease that can be contracted from animal bites or the consumption of improperly cooked meat and can spread from person to person by close contact. Initial symptoms of infection can include chills, fatigue, fever, and muscle aches — with more severe cases often presenting with a rash on the face and genitals that can spread elsewhere on the body before scabbing over. The virus is known to cause severe disease among certain vulnerable groups, including young children, people who are immunosuppressed and pregnant women.
As of this morning, the World Health Organization (WHO) has reported 131 confirmed cases of monkeypox worldwide — and a further 106 suspected cases — that have emerged since the first case location outside the countries where it usually spreads was reported on May 7.
Reported cases of the virus in Britain have almost tripled over recent days, reaching a total of 57, with one sole case in Scotland and all the rest having been detected in England.
Health experts have said that the risk to the general public remains low, with the disease unlikely to result in a nationwide epidemic like COVID-19, but have cautioned that it is still “a serious outbreak of a serious disease”.
The European Commissioner for Health and Food Safety, Stella Kyriakides, has said that despite the low risk, it is important to “remain vigilant” and ensure adequate contact tracing and diagnostics capacity is maintained to keep track of the disease’s spread.
At present, there are no specific, licensed treatments for monkeypox — and in the UK, health officials have been working to contain the recent outbreaks by giving close contacts of infected individuals a smallpox jab, Imvanex, which can help to protect against the disease.
In their study, Dr Hugh Adler of the Liverpool University Hospitals NHS Foundation Trust and his colleagues analysed seven cases of monkeypox diagnosed in the UK from 2018–2021 — among which were the first recorded cases of both in-hospital transmission as well as household transmission outside of Africa.
Four of the cases were imported from West Africa, with the remaining three contracted as a result of human-to-human transmission. One patient was a healthcare worker who developed symptoms after exposure to an infected patient.
The patients, who all recovered after isolation and treatment, were given experimental courses of two different antiviral medications — brincidofovir and tecovirimat — which have previously demonstrated potential for treating monkeypox in animals.
The team found little evidence to suggest that the brincidofovir treatments were beneficial, but in contrast, concluded that tecovirimat appears to shorten the duration of monkeypox symptoms and may therefore also reduce the amount of time infected patients are contagious.
Tecovirimat has been licensed within the US and EU for the treatment of monkeypox, but has not yet been authorised by the Medicines and Healthcare products Regulatory Agency (MHRA).
However, given the small cohort analysed in the study, further research on the potential of tecovirimat will be needed to validate the results, the researchers cautioned, before such antivirals might be applied to the current monkeypox outbreaks.
The team also said that it is possible that administration of brincidofovir earlier in the course of the disease — or to a different dosing schedule — might have yielded different results, and so may merit further testing.
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Dr Adler said: “Public health officials are trying to understand what is causing the May 2022 monkeypox outbreaks in Europe and North America.”
These, he explained, “have affected several patients who reported neither travel nor an identified link to a previously known case.
“Our study offers some of the first insights into the use of antivirals for the treatment of monkeypox in humans.
“Although this latest outbreak has affected more patients than we had previously encountered in the UK, historically monkeypox has not transmitted very efficiently between people, and overall the risk to public health is low.”
His colleague Dr Nick Price of Guy’s & St Thomas’ NHS Foundation Trust added: “The cases we observed were challenging and resource-intensive to manage, even in the high-income setting of the UK.
“With international travel returning to pre-pandemic levels, public health officials and healthcare workers around the world must remain vigilant to the possibility of new cases of monkeypox.”
As part of their study, the team also report the detection of monkeypox virus in both blood and by means of throat swabs.
These findings could help global health experts as they endeavour to determine the optimum infection monitoring and control strategies for this disease.
According to the researchers, it will be important to maintain response centres to manage future monkeypox outbreaks.
The full findings of the study were published in the journal The Lancet Infectious Diseases.
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