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Mpox 2022
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The relevance of multiple clinical specimens in the diagnosis of monkeypox virus, Spain, June 2022
A monkeypox virus (MPXV) outbreak has been ongoing worldwide since May 2022. The role of specimens other than skin lesions for MPXV diagnosis is unknown. We evaluated 140 different clinical specimens by real-time PCR. The highest positivity rates (97%) were from skin lesions of any part of the body, followed by plasma, pharyngeal and anal swabs. Testing specimens from multiple sites may improve the sensitivity and reduce false-negative test results.
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Monkeypox: another test for PCR
More LessMonkeypox was declared a public health emergency of international concern by the World Health Organization (WHO) on 23 July 2022. Between 1 January and 23 July 2022, 16,016 laboratory confirmed cases of monkeypox and five deaths were reported to WHO from 75 countries on all continents. Public health authorities are proactively identifying cases and tracing their contacts to contain its spread. As with COVID-19, PCR is the only method capable of being deployed at sufficient speed to provide timely feedback on any public health interventions. However, at this point, there is little information on how those PCR assays are being standardised between laboratories. A likely reason is that testing is still limited on a global scale and that detection, not quantification, of monkeypox virus DNA is the main clinical requirement. Yet we should not be complacent about PCR performance. As testing requirements increase rapidly and specimens become more diverse, it would be prudent to ensure PCR accuracy from the outset to support harmonisation and ease regulatory conformance. Lessons from COVID-19 should aid implementation with appropriate material, documentary and methodological standards offering dynamic mechanisms to ensure testing that most accurately guides public health decisions.
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Paediatric monkeypox patient with unknown source of infection, the Netherlands, June 2022
Since May 2022, an international monkeypox (MPX) outbreak has been ongoing in more than 50 countries. While most cases are men who have sex with men, transmission is not restricted to this population. In this report, we describe the case of a male child younger than 10 years with MPX in the Netherlands. Despite thorough source tracing, a likely source of infection has not been identified. No secondary cases were identified in close contacts.
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Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022
A monkeypox (MPX) outbreak has expanded worldwide since May 2022. We tested 147 clinical samples collected at different time points from 12 patients by real-time PCR. MPX DNA was detected in saliva from all cases, sometimes with high viral loads. Other samples were frequently positive: rectal swab (11/12 cases), nasopharyngeal swab (10/12 cases), semen (7/9 cases), urine (9/12 cases) and faeces (8/12 cases). These results improve knowledge on virus shedding and the possible role of bodily fluids in disease transmission.
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A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022
By 22 June 2022, 521 cases of monkeypox were notified in Germany. The median age was 38 years (IQR: 32–44); all cases were men. In Berlin, where 69% of all cases occurred, almost all were men who have sex with men. Monkeypox virus likely circulated unrecognised in Berlin before early May. Since mid-May, we observed a shift from travel-associated infections to mainly autochthonous transmission that predominantly took place in Berlin, often in association with visits to clubs and parties.
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Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022
Jesús Iñigo Martínez , Elisa Gil Montalbán , Susana Jiménez Bueno , Fernando Martín Martínez , Alba Nieto Juliá , Jesús Sánchez Díaz , Natividad García Marín , Esther Córdoba Deorador , Antonio Nunziata Forte , Marcos Alonso García , Ana María Humanes Navarro , Laura Montero Morales , María José Domínguez Rodríguez , Manuel Carbajo Ariza , Luis Miguel Díaz García , Nelva Mata Pariente , Mercedes Rumayor Zarzuelo , Manuel José Velasco Rodríguez , Andrés Aragón Peña , Elena Rodríguez Baena , Ángel Miguel Benito , Ana Pérez Meixeira , María Ordobás Gavín , María Ángeles Lopaz Pérez and Araceli Arce ArnáezUp to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18–67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.
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Evidence of surface contamination in hospital rooms occupied by patients infected with monkeypox, Germany, June 2022
The extent of monkeypox virus environmental contamination of surfaces is unclear. We examined surfaces in rooms occupied by two monkeypox patients on their fourth hospitalisation day. Contamination with up to 105 viral copies/cm2 on inanimate surfaces was estimated by PCR and the virus was successfully isolated from surfaces with more than 106 copies. These data highlight the importance of strict adherence of hospital staff to recommended protective measures. If appropriate, pre-exposure or early post-exposure vaccination should be considered for individuals at risk.
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Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022
In May 2022, monkeypox outbreaks have been reported in countries not endemic for monkeypox. We estimated the monkeypox incubation period, using reported exposure and symptom-onset times for 18 cases detected and confirmed in the Netherlands up to 31 May 2022. Mean incubation period was 9.0 days* (5th–95th percentiles: 4.2–17.3), underpinning the current recommendation to monitor or isolate/quarantine case contacts for 21 days. However, as the incubation period may differ between different transmission routes, further epidemiological investigations are needed.
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Community transmission of monkeypox in the United Kingdom, April to May 2022
Roberto Vivancos , Charlotte Anderson , Paula Blomquist , Sooria Balasegaram , Anita Bell , Louise Bishop , Colin S Brown , Yimmy Chow , Obaghe Edeghere , Isaac Florence , Sarah Logan , Petra Manley , William Crowe , Andrew McAuley , Ananda Giri Shankar , Borja Mora-Peris , Karthik Paranthaman , Mateo Prochazka , Cian Ryan , David Simons , Richard Vipond , Chloe Byers , Nicholas A. Watkins , UKHSA Monkeypox Incident Management team , Will Welfare , Elizabeth Whittaker , Claire Dewsnap , Allegra Wilson , Yvonne Young , Meera Chand , Steven Riley and Susan HopkinsBetween 7 and 25 May, 86 monkeypox cases were confirmed in the United Kingdom (UK). Only one case is known to have travelled to a monkeypox virus (MPXV) endemic country. Seventy-nine cases with information were male and 66 reported being gay, bisexual, or other men who have sex with men. This is the first reported sustained MPXV transmission in the UK, with human-to-human transmission through close contacts, including in sexual networks. Improving case ascertainment and onward-transmission preventive measures are ongoing.
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Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022
Andrea Antinori , Valentina Mazzotta , Serena Vita , Fabrizio Carletti , Danilo Tacconi , Laura Emma Lapini , Alessandra D’Abramo , Stefania Cicalini , Daniele Lapa , Silvia Pittalis , Vincenzo Puro , Marco Rivano Capparuccia , Emanuela Giombini , Cesare Ernesto Maria Gruber , Anna Rosa Garbuglia , Alessandra Marani , Francesco Vairo , Enrico Girardi , Francesco Vaia , Emanuele Nicastri and the INMI Monkeypox GroupSince May 2022, an outbreak of monkeypox has been ongoing in non-endemic countries. We report four cases in Italy in young adult men reporting condomless sexual intercourse. The patients are in good clinical condition with no need for specific antiviral drugs. Biological samples from seminal fluid were positive for monkeypox viral DNA. For many other viruses found in semen there is no evidence of sexual transmission. The possibility of sexual transmission of monkeypox virus needs to be investigated.
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Monkeypox infection presenting as genital rash, Australia, May 2022
Rapid diagnosis and whole genome sequencing confirmed a case of monkeypox in an HIV-positive individual receiving antiretroviral therapy. The patient had a normal CD4+ T-cell count and suppressed HIV viral load and presented with a genital rash in Melbourne, Australia after return from Europe in May 2022. He subsequently developed systemic illness and disseminated rash and 11 days after symptom onset, he was hospitalised to manage painful bacterial cellulitis of the genital area.
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Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022
Mariana Perez Duque , Sofia Ribeiro , João Vieira Martins , Pedro Casaca , Pedro Pinto Leite , Margarida Tavares , Kamal Mansinho , Luís Miguel Duque , Cândida Fernandes , Rita Cordeiro , Maria José Borrego , Ana Pelerito , Isabel Lopes de Carvalho , Sofia Núncio , Vera Manageiro , Corrado Minetti , Jorge Machado , Joana M Haussig , Roberto Croci , Gianfranco Spiteri , Ana Sofia Casal , Diana Mendes , Tiago Souto , Sara Pocinho , Teresa Fernandes , Ana Firme , Paula Vasconcelos and Graça FreitasUp to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22–51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.
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Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021
Most reported cases of human monkeypox occur in Central and West Africa, where the causing virus is endemic. We describe the identification and public health response to an imported case of West African monkeypox from Nigeria to the United Kingdom (UK) in May 2021. Secondary transmission from the index case occurred within the family to another adult and a toddler. Concurrent COVID-19-related control measures upon arrival and at the hospital, facilitated detection and limited the number of potential contacts.
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Two cases of monkeypox imported to the United Kingdom, September 2018
Aisling Vaughan , Emma Aarons , John Astbury , Sooria Balasegaram , Mike Beadsworth , Charles R Beck , Meera Chand , Catherine O’Connor , Jake Dunning , Sam Ghebrehewet , Nick Harper , Ruth Howlett-Shipley , Chikwe Ihekweazu , Michael Jacobs , Lukeki Kaindama , Parisha Katwa , Saye Khoo , Lucy Lamb , Sharon Mawdsley , Dilys Morgan , Ruth Palmer , Nick Phin , Katherine Russell , Bengü Said , Andrew Simpson , Roberto Vivancos , Michael Wade , Amanda Walsh and Jennifer WilburnIn early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.
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