[4] The time from exposure to onset of symptoms ranges from five to twenty-one days. 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 lead author (TW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The maximum time that transmission was detected before symptoms manifested was nine days. For confirmed and highly probable cases in the UK, where gender information was available, 3,580 (98.6%) were men and 50 were women. This is likely to be true in most cases but will lead to some overestimation of the serial interval because some negative observations will be replaced with positive values. 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). We refer to this model as the double interval censoring corrected model (ICC). In 2020, researchers from the Institut Pasteur discussed efforts to assess monkeypox cases in the DRC after the global eradication of smallpox and subsequent cessation of the smallpox vaccine in the 1980s. Most confirmed cases with travel history reported travel to countries in Europe and North America, rather than West or Central Africa where the mpox virus is endemic. This update is currently published on Tuesdays, using data extracted by 9.30am on Mondays. These two sources of evidence provide greater confidence in the conclusions. In this method, we assume that the primary event (symptom onset in the primary case for serial interval or exposure date for incubation period) for each individual sits within an interval [e1, e2], where e1 is the reported event date and e2 is the day after. On the day of the first reported case of monkeypox in the UK (6 May), we estimated that case numbers were doubling every 9.07 days (95% confidence interval 12.63 to 7.08). 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. For each case-contact pair, we refer to the individual with the primary infection as a primary case, and the individual infected by the primary case as the secondary contact. Since 25 July 2022, the monkeypox case definition recognises those who are orthopox-positive as highly probable cases, and those who test positive on a monkeypox PCR test as confirmed cases. Red arrow indicates number of days between primary onset and secondary onset (serial interval). [25], In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. health, 13, 14. [4][8] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems. The person developed a rash on 29 April while in Nigeria and flew back to the United Kingdom, arriving on 4 May,[28] and presented to hospital later the same day. Under this model (y(t)=y(0)ert), the number of cases at time t, y(t), is proportional to the exponential of the smooth function with time, exp(s(t)). To compare the model fits we calculated the leave-one-out cross validation (LOO) through Pareto smoothed importance sampling, using the LOO package in R.19 We applied MCMC to each model and evaluated its convergence using potential scale reduction factor, or (calculated using Cmdstanr20), where it is desirable to have a value <1.05. Named contacts are therefore likely to correspond to genuine transmission events. 2022. TW, CO, and FC reviewed the manuscript. TW and CO developed the methodology. [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. In the U.S., the first monkeypox case in the current outbreak was identified on May 18, 2022. 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. Updates on EU/EEA countries, the Western Balkans and Trkiye From the dataset we removed records with missing data for symptom onset and pseudo identifier number, as well as duplicates. Since June, there have been over 10,000 confirmed monkeypox cases in the U.S. 2022. 2022. This is due to differences in timings of when the data is compiled, and differences in processing of duplicate data (for example, if a person has tested more than once but insufficient information is provided to identify them). Nigeria has. A survey of over 2000 Board seats of global health organizations shows that less than 3% of the seats are held by nationals of low-income countries [ 8 ]. 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 MCMC algorithm preferentially selects parameters that better describe the data. The 95th centile of the serial interval ranged from 23 to 41 days, which suggests a potential for long infectious periods that are consistent with research of earlier clades. Recentring the priors to alternative means with the same precision yielded consistent results. When negative incubation periods were identified, we assumed that the patient was not infected by the named contact, as this is not possible. Setting Case questionnaires from the UK Health Security Agency (UKHSA), United Kingdom. Using the cumulative distribution function of the serial interval distribution, the median number was 5.0 days (95% credible interval 3.8 to 6.2) for the ICC model and 5.8 days (4.3 to 7.6) for the ICRTC model (table 5). Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. it produces flu-like symptoms followed by a skin rash. At the 95th centile, the posterior estimates were 17.8 days (95% credible interval 15.2 to 21.9) for the ICC model and 18.1 days (15.5 to 22.5) for the ICRTC model. ECDC. The subsamples therefore captured the two key personal characteristics of infected individuals in the outbreak. . To understand the transmission dynamics of the monkeypox outbreak, accurate estimates are needed of the time between subsequent infections (generation time) and time from becoming infected to developing symptoms (incubation period). 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. Since monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. 2022. In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Monkeypox is a rare infection most commonly found in west or central Africa. The global transmission of monkeypox from May 2022 in non-endemic countries necessitated further understanding of the transmission dynamics of the virus. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. RC worked on data processing. From the remaining 16 records, seven primary cases had personal identifiable information in both the questionnaire and the line list, allowing us to verify whether the individual identified by the secondary contact was also the primary case from the case-contact pair. In July 2022 WHO declared the outbreak a Public Health Emergency of International Concern.8. Shaded area denotes span of time series where the serial intervals and incubation period distributions were estimated (6 May to 1 August 2022). Contributors: TW conceived and led the study. The UK Health Security Agency had classified the outbreak as "significant and concerning" but says the risk to people "remains low".. You can change your cookie settings at any time. At the end of the study period, 1 August, case numbers were halving every 29 days (38.02 to 23.44). Please note: your email address is provided to the journal, which may use this information for marketing purposes. We found that shorter serial intervals are more common than short incubation periods for monkeypox, which suggests considerable pre-symptomatic transmission. Although uncertain, some have expressed concerns that this outbreak of monkeypox could become the next global pandemic. 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 mean incubation period and mean serial interval were found to range from 6.6 to 9.2 days and 7.4 to 12.3 days, respectively, when adjusted for right truncation and epidemic phase bias. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. Figure 6 shows the instantaneous growth rate of case numbers over time and log scale model fit to case counts. A high proportion of England cases were London residents (69%, 2,397 of 3,467 with location information). Greater uncertainty can be observed for the model that adjusts for right truncation. United States now has the world's biggest outbreak of monkeypox: . *The numbers in brackets show change since last report (26 September 2022). Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. Instead, within our model we included estimated event times for each patient, z*[z1, z2] for z{e, s}, as an unobserved variable. We do not capture any email address. 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. There may be mild symptoms, and it may occur . UK health chiefs are already modelling how outbreak among humans could start. Further details on the epidemiology are available in the monkeypox technical briefing. Table 3 shows the results of the cumulative distribution function of the incubation period distribution. For lognormal the model was parameterised in terms of the log mean, 1, and log standard deviation, 2, parameters. [34], The UK Health Security Agency (UKHSA) advised people who have had close contact with a person infected with monkeypox to self-isolate for 21 days. < 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. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. Copyright 2023 BMJ Publishing Group Ltd, A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy, Comparison of West African and Congo Basin monkeypox viruses in BALB/c and C57BL/6 mice, Virulence differences between monkeypox virus isolates from West Africa and the Congo basin, On the relationship between serial interval, infectiousness profile and generation time, Presymptomatic transmission of SARS-CoV-2 infection: a secondary analysis using published data, Serial interval of novel coronavirus (COVID-19) infections, Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire, Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo, Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022, Understanding an evolving pandemic: An analysis of the clinical time delay distributions of COVID-19 in the United Kingdom, Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning, Inference from Iterative Simulation Using Multiple Sequences, Estimating a time-to-event distribution from right-truncated data in an epidemic: A review of methods, Growth, reproduction numbers and factors affecting the spread of SARS-CoV-2 novel variants of concern in the UK from October 2020 to July 2021: a modelling analysis, Estimating incubation period distributions with coarse data, Shorter incubation period is associated with severe disease progression in patients with COVID-19, Brief Report: Incubation Period Duration and Severity of Clinical Disease Following Severe Acute Respiratory Syndrome Coronavirus Infection, Association between Severity of MERS-CoV Infection and Incubation Period, Incubation period, severity of disease, and infecting dose: evidence from a Salmonella outbreak, Surveillance, case investigation and contact tracing for monkeypox: interim guidance, 25 August 2022, Transmission dynamics of monkeypox in the United Kingdom: contact tracing study, https://www.gov.uk/government/publications/accessing-ukhsa-protected-data/accessing-ukhsa-protected-data, https://github.com/OvertonC/Transmission-Dynamics-of-Monkeypox-in-the-United-Kingdom, http://creativecommons.org/licenses/by-nc/4.0/, https://www.who.int/news-room/fact-sheets/detail/monkeypox, https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385, https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview/monkeypox-outbreak-epidemiological-overview-13-september-2022, https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern, 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#:~:text=In%20the%20UK%2C%20all%20reported,about%20the%20West%20Afr, https://mc-stan.org/rstanarm/reference/loo.stanreg.html, https://www.ecdc.europa.eu/sites/default/files/documents/Considerations-for-Contact-Tracing-MPX_June%202022.pdf, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1#part-2-epidemiology-update, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-3, https://web.archive.org/web/20220605103903/https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo, https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1#part-3-genomics, https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.3, Birmingham and Solihull Mental Health NHS Foundation Trust: Consultant Psychiatrist General Adult - Northcroft CMHT, Brent Area Medical Centre: Salaried GP - Brent Area Medical Centre, Onebright Ltd: Consultant Psychiatrist (Neurodiversity) - Remote / London, The Royal Hospital for Neurodisability: Clinical Fellow, Womens, childrens & adolescents health. 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