Clinical features and management of human monkeypox: a retrospective observational study in the UK
- PMID: 35623380
- PMCID: PMC9300470
- DOI: 10.1016/S1473-3099(22)00228-6
Clinical features and management of human monkeypox: a retrospective observational study in the UK
Erratum in
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Correction to Lancet Infect Dis 2022; published online May 24. https://doi.org/10.1016/S1473-3099(22)00228-6.Lancet Infect Dis. 2022 Jul;22(7):e177. doi: 10.1016/S1473-3099(22)00353-X. Epub 2022 May 26. Lancet Infect Dis. 2022. PMID: 35644159 Free PMC article. No abstract available.
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Correction to Lancet Infect Dis 2022; published online May 24. https://doi.org/10.1016/S1473-3099(22)00228-6.Lancet Infect Dis. 2022 Jul;22(7):e177. doi: 10.1016/S1473-3099(22)00372-3. Epub 2022 Jun 2. Lancet Infect Dis. 2022. PMID: 35659001 Free PMC article. No abstract available.
Abstract
Background: Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our aim was to describe the longitudinal clinical course of monkeypox in a high-income setting, coupled with viral dynamics, and any adverse events related to novel antiviral therapies.
Methods: In this retrospective observational study, we report the clinical features, longitudinal virological findings, and response to off-label antivirals in seven patients with monkeypox who were diagnosed in the UK between 2018 and 2021, identified through retrospective case-note review. This study included all patients who were managed in dedicated high consequence infectious diseases (HCID) centres in Liverpool, London, and Newcastle, coordinated via a national HCID network.
Findings: We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22-39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge.
Interpretation: Human monkeypox poses unique challenges, even to well resourced health-care systems with HCID networks. Prolonged upper respiratory tract viral DNA shedding after skin lesion resolution challenged current infection prevention and control guidance. There is an urgent need for prospective studies of antivirals for this disease.
Funding: None.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests JD reports an unremunerated role on a Data Safety and Monitoring Board (DSMB) for an extended access programme for tecovirimat. MGS reports non-remunerated roles in a DSMB for Pfizer's mRNA vaccine programme, the UK Scientific Advisory Group for Emergencies, and New Emerging Respiratory Virus Threats Advisory Group; and reports chairing a Scientific Advisory Board and holding stock or stock options in Integrum Scientific LLC, Greensboro, NC, USA. SHK reports grants (unrelated to the current work) from ViiV, Merck, and Gilead Sciences; advisory board membership for ViiV and Merck; honoraria from ViiV; and being an unremunerated chair of a DSMB for a Gates Foundation-funded trial.
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Comment in
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Should not airborne transmission be ignored in the 2022 monkeypox outbreak?Int J Surg. 2022 Aug;104:106762. doi: 10.1016/j.ijsu.2022.106762. Epub 2022 Jul 5. Int J Surg. 2022. PMID: 35798203 Free PMC article. No abstract available.
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The impact of monkeypox outbreak on mental health and counteracting strategies: A call to action.Int J Surg. 2022 Oct;106:106943. doi: 10.1016/j.ijsu.2022.106943. Epub 2022 Sep 22. Int J Surg. 2022. PMID: 36155257 Free PMC article. No abstract available.
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