Epidemiological Characteristics and Clinical Features of Confirmed Human Monkeypox Virus Cases in Individuals Attending a Sexual Health Centre in London, United Kingdom

Girometti, Nicolò; Byrne, Ruth; Bracchi, Margherita; Heskin, Joseph; McOwan, Alan; Tittle, Victoria; Gedela, Keerti; Scott, Rodney J.; Patel, Sheel; Gohil, Jesal; Nugent, Diarmuid; Suchak, Tara; Dickinson, Molly; Feeney, Margaret; Mora-Peris, Borja; Stegmann, Katrina; Davies, Gary; Moore, Luke SP; Mughal, Nabeela; Asboe, David; Boffito, Marta; Jones, Rachael; Whitlock, Gary

doi:10.2139/ssrn.4125251

Cited by 15 publications

(14 citation statements)

References 6 publications

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“…Titles and abstracts screened the remaining 1285 references, and 59 articles remained for selection by full-text. After screening, 12 were included for quantitative synthesis (meta-analyses), and 19 studies were included in the qualitative synthesis [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. The main characteristics of all included studies are summarised in Tables 1 and 2, and the study selection process is briefly described in the PRISMA flow diagram (Fig.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Ann Clin Microbiol Antimicrob

109

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Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Benítes-Zapata

Ulloque-Badaracco

Alarcón-Braga

et al. 2022

Ann Clin Microbiol Antimicrob

109

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“…That brings curiosity regarding a possible sexual transmission. For instance, 54 cases presented at one health centre in the UK were all documented amongst MSM [16]. That was similar in Italy, where four documented MSM-MPX cases reported having sexual intercourse without using a condom [17].…”

Section: Potential Sexual Transmissionmentioning

confidence: 78%

“…Furthermore, data from London, UK, reports favour sexual contact transmission as 54 participants, all MSM, tested positive for the MPXV test. Moreover, they presented clinical characteristics, including genital and perianal lesions and appealing sexual transmission [16]. Therefore, given the population of interest, their clinical features and the laboratory results, there is a possible link between MPXV and sexual transmission, thus speculating MPXV is a sexually transmitted infection (STI) despite the paucity of data to document it.…”

Section: Potential Sexual Transmissionmentioning

confidence: 99%

Monkeypox and its Possible Sexual Transmission: Where are we now with its evidence?

Sah¹,

Abdelaal²,

Reda³

et al. 2022

Preprint

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Monkeypox is a rare disease which is rising nowadays in different countries since the first case in the UK was diagnosed on May 6, 2022, by the United Kingdom (UK) Health Security Agency. Then more than 12,500 cases were identified in over 68 countries up to July 18, 2022. In endemic areas, the monkeypox virus (MPXV) is commonly transmitted through zoonosis, while in non-endemic regions, it is spread through human-to-human transmission. Symptoms can include flu-like symptoms, rash, or sores in hands, feet, genitalia, or anus. In addition, people who did not take the smallpox vaccine were more liable to be affected than others. The exact pathogenesis and mechanisms are still unclear; however, most identified cases are reported in men who have sex with other men (MSM). According to the CDC, transmission can happen with any sexual or non-sexual contact with the infected person. However, a recent pooled meta-analysis reported that sexual contact is involved in more than 91% of the cases. Also, it is the first time that semen analysis for many patients has shown positive monkeypox virus DNA. Therefore, in this review, we will describe transmission methods for MPXV while focusing mainly on potential sexual transmission and associated sexually transmitted infections. We will also highlight the preventive measures that can limit the spread of the diseases in this regard.

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“…In the current outbreak, there have been multiple reports of the initial misdiagnosis of patients who were later confirmed to have MPX (88,89) due to atypical clinical manifestation that does not resemble MPX observed in African outbreaks. There have been reports of patients presenting with no rash (90) and no prodrome (88). In cases described in the United Kingdom, 20% of patients with a rash had no prodrome before rash onset, and only 11% of patients even presented with rash (90), the characteristic diagnostic marker for MPX.…”

Section: Atypical Presentationmentioning

confidence: 99%

Atypical and unique transmission of monkeypox virus during the 2022 outbreak: an overview of the current state of knowledge

Riopelle¹,

Munster²,

Port³

2022

Preprint

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An ongoing monkeypox outbreak in non-endemic countries has resulted in the declaration of a Public Health Emergency of International Concern by the World Health Organization (WHO). Though monkeypox has long been endemic in regions of Sub-Saharan Africa, relatively little is known about its ecology, epidemiology, and transmission. Here, we consider the relevant research on both monkeypox and smallpox, a close relative, to make inferences about the current outbreak. Undetected circulation, combined with atypical transmission and case presentation, including mild and asymptomatic disease, have led to the spread of monkeypox in non-endemic regions. Broader availability of diagnostics, enhanced surveillance, and targeted education, combined with a better understanding of the routes of transmission, are critical to identify at-risk populations and design science-based countermeasures to control the current outbreak.

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Epidemiological Characteristics and Clinical Features of Confirmed Human Monkeypox Virus Cases in Individuals Attending a Sexual Health Centre in London, United Kingdom

Cited by 15 publications

References 6 publications

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis

Monkeypox and its Possible Sexual Transmission: Where are we now with its evidence?

Atypical and unique transmission of monkeypox virus during the 2022 outbreak: an overview of the current state of knowledge

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