Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis

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

Abstract

Background: Historically, human monkeypox virus cases in the UK have been limited to imported infections from west Africa. Currently, the UK and several other countries are reporting a rapid increase in monkeypox cases among individuals attending sexual health clinics, with no apparent epidemiological links to endemic areas. We describe demographic and clinical characteristics of patients diagnosed with human monkeypox virus attending a sexual health centre.

Methods: In this observational analysis, we considered patients with confirmed monkeypox virus infection via PCR detection attending open-access sexual health clinics in London, UK, between May 14 and May 25, 2022. We report hospital admissions and concurrent sexually transmitted infection (STI) proportions, and describe our local response within the first 2 weeks of the outbreak.

Findings: Monkeypox virus infection was confirmed in 54 individuals, all identifying as men who have sex with men (MSM), with a median age of 41 years (IQR 34-45). 38 (70%) of 54 individuals were White, 26 (48%) were born in the UK, and 13 (24%) were living with HIV. 36 (67%) of 54 individuals reported fatigue or lethargy, 31 (57%) reported fever, and ten (18%) had no prodromal symptoms. All patients presented with skin lesions, of which 51 (94%) were anogenital. 37 (89%) of 54 individuals had skin lesions affecting more than one anatomical site and four (7%) had oropharyngeal lesions. 30 (55%) of 54 individuals had lymphadenopathy. One in four patients had a concurrent STI. Five (9%) of 54 individuals required admission to hospital, mainly due to pain or localised bacterial cellulitis requiring antibiotic intervention or analgesia. We recorded no fatal outcomes.

Interpretation: Autochthonous community monkeypox virus transmission is currently observed among MSM in the UK. We found a high proportion of concomitant STIs and frequent anogenital symptoms, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact, during sexual activity. Additional resources are required to support sexual health and other specialist services in managing this condition. A review of the case definition and better understanding of viral transmission routes are needed to shape infection control policies, education and prevention strategies, and contact tracing.

Funding: None.

Conflict of interest statement

Declaration of interests LSPM has consulted for or received speaker fees from bioMerieux, DNAelectronics, Eumedica, Dairy Crest, Pfizer, Profile Pharma, Umovis Lab, Kent Pharma, Pulmocide, Sumiovant, and Shionogi, and received research grants from the National Institute for Health Research, CW+ charity, and LifeArc. NG has consulted for or received speaker fees from Viiv Healthcare. JH has received a research grant from the CW+ charity. DA has consulted for or received speaker fees from Viiv Healthcare and Theratechnologies. BM-P has consulted for or received speaker fees from MSD. NM has consulted for or received speaker fees from Pfizer and Shionogi. MBo has consulted for or received speaker fees from Viiv Healthcare, Gilead, GlaxoSmithKline, Pfizer, Cypla, Mylan, and Janssen. MBo has also received research grants from Gilead, Viiv Healthcare, Mylan, Novavax, Janssen, Valneva, Moderna, and Roche. RJ has consulted for or received speaker fees from Viiv Healthcare and Gilead. GW has consulted for or received speaker fees from Viiv Healthcare and Gilead. All other authors declare no competing interests.

Copyright © 2022 Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Single umbilicated pustular lesion on leg
Figure 2
Figure 2
Multiple coalescing lesions on penile sulcus and multiple non-coalescing lesions on penile shaft
Figure 3
Figure 3
Multiple umbilicated pustular lesions
Figure 4
Figure 4
Multiple ulcerative lesions on perianal skin (A) progressing into a large coalescing ulcerative lesion (B) Pictures taken 10 days apart.

References

    1. ICTV Virus taxonomy: 2020 release.
    1. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox—a potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16
    1. Reynolds MG, Yorita KL, Kuehnert MJ, et al. Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis. 2006;194:773–780.
    1. Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis. 2019;13
    1. Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 doi: 10.1016/S1473-3099(22)00228-6. published online March 24.
    1. Vaughan A, Aarons E, Astbury J, et al. Human-to-human transmission of monkeypox virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26:782–785.
    1. UK Health Security Agency Monkeypox cases confirmed in England—latest updates. May 14, 2022.
    1. WHO Multi-country monkeypox outbreak: situation update. June 10, 2022.
    1. Perez Duque M, Ribeiro S, Martins JV, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill. 2022;27:22.
    1. Ferraro F, Caraglia A, Rapiti A, et al. Letter to the editor: multiple introductions of MPX in Italy from different geographic areas. Euro Surveill. 2022;27:23.
    1. Vivancos R, Anderson C, Blomquist P, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill. 2022;27:22.
    1. Heskin J, Belfield A, Milne C, et al. Transmission of monkeypox virus through sexual contact—a novel route of infection. J Infect. 2022 doi: 10.1016/j.jinf.2022.05.028. published online June 1.
    1. Investigation into monkeypox outbreak in England: technical briefing 1. June 10, 2022.
    1. Li Y, Zhao H, Wilkins K, Hughes C, Damon IK. Real-time PCR assays for the specific detection of monkeypox virus west African and Congo Basin strain DNA. J Virol Methods. 2010;169:223–227.
    1. Rare and imported pathogens laboratory. July 1, 2014.
    1. Monkeypox: case definitions. May 20, 2022.
    1. Public health agencies issue monkeypox guidance to control transmission. May 30, 2022.
    1. Yinka-Ogunleye A, Aruna O, Dalhat M, et al. Outbreak of human monkeypox in Nigeria in 2017–18: a clinical and epidemiological report. Lancet Infect Dis. 2019;19:872–879.
    1. Huhn GD, Bauer AM, Yorita K, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis. 2005;41:1742–1751.
    1. Reed KD, Melski JW, Graham MB, et al. The detection of monkeypox in humans in the western Hemisphere. N Engl J Med. 2004;350:342–350.
    1. Ogoina D, Iroezindu M, James HI, et al. Clinical course and outcome of human monkeypox in Nigeria. Clin Infect Dis. 2020;71:e210–e214.
    1. Formenty P, Muntasir MO, Damon I, et al. Human monkeypox outbreak caused by novel virus belonging to Congo Basin clade, Sudan, 2005. Emerg Infect Dis. 2010;16:1539–1545.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅