- In a new study, researchers describe seven cases of monkeypox that occurred in the UK between 2018 and 2021, the first cases of in-hospital and home transmission outside Africa.
- Monkeypox patients received two antiviral drugs as treatment, one of which reduced the duration of symptoms.
- All patients fully recovered after treatment.
The monkeypox virus, related to smallpox, is endemic to central and western Africa. It can cause a range of symptoms including headache, skin lesions, fever, body aches, swollen lymph nodes, and fatigue.
Since the first report of monkeypox in
Although doctors can reliably identify and diagnose monkeypox, much remains unknown about the virus, including the dynamics of its transmission, the full range of symptoms it causes, and how best to treat it.
In a new clinical study appearing in
They detail the clinical features of the infection and its management, including the use of an antiviral medication that can reduce the length of the infectious period and recovery time.
The report looks at seven cases of monkeypox that occurred in the UK between 2018 and 2021. In three of these cases, individuals contracted the virus in the UK. These are the first cases of monkeypox transmission in hospital and at home outside the UK.Africa. In the remaining cases, individuals contracted the virus in Nigeria.
Dr Nick Price from the NHS Foundation Trust at Guy’s & St Thomas in London, UK, senior author of the paper, explained the importance of sharing this data:
“So far, monkeypox has been a rare and imported case in the UK and the NHS [National Health Service] The High Scores Infectious Diseases Network has treated all seven confirmed cases in the UK until 2021. Outbreaks of the disease outside Africa are unusual, but in recent days, large outbreaks have been reported in several European countries, including the UK, and in regions of others worldwide. Clinical trial data is lacking and we are pleased to share some of our collective experience in managing this previously rare and sporadic condition.”
Symptoms described include fever, headache, night sweats, and skin lesions with complications including deep tissue abscesses, pain, and deterioration in mood. However, none of the patients experienced serious complications from the infection, such as pneumonia or sepsis.
In previous outbreaks, clinicians considered patients to be no longer contagious when all of their skin lesions were crusty. However, this study found viral DNA in the respiratory tracts of many patients for at least 3 weeks – indicating that they were still infectious after the skin lesions had crusted over.
This is an important finding, as most cases of monkeypox have previously occurred in parts of the world where PCR testing is not readily available, and thus these data were also not available.
The study also experimented with the use of two antiviral drugs — brincidofovir and ticoverimate — that doctors have traditionally used to treat smallpox. Tecovirimat is now approved to treat monkeypox in the EU and
Although treatment with brincidofovir resulted in a short-term reduction in viral load, these improvements were not permanent and patients had side effects affecting the liver, meaning their treatment should be stopped early.
One person received tekovirimat, and doctors noted a shorter duration of symptoms and the time that person was contagious.
Although researchers cannot say for sure whether this is a direct result of tecovirimatTreatment, the results suggest that tecovirimat can help prevent progression to severe disease and shorten the time spent in hospital. They recommend a two-week course of treatment to get rid of the virus completely.
Talking to Medical news todayStephen Morse, Professor of Epidemiology at Columbia University Medical Center, and director of the Infectious Disease Epidemiology Certificate Program, noted, “tecovirimat is the most effective known antiviral for orthopoxviruses, which includes smallpox — now officially eradicated — monkeypox, and others.”
He added: “The mechanism of action of the drug, and the relationship between these viruses, suggests that tecovirimat should be equally effective for other orthopoxviruses, but strict comparisons were not possible due to the small case numbers.”
Most of the patients described by the researchers in this study had relatively mild disease and made a full recovery. However, all of the patients were young, had no pre-existing disease conditions, and had the West African series of monkeypox, which is usually milder than the Congo Basin heap.
The fatality rate of the Congo Basin clade from monkeypox is
Despite the patients’ mild symptoms, the authors highlight the challenging nature of managing monkeypox, even in the high-income context of the UK.
They say health care workers should remain alert to the possibility of monkeypox in travelers with fever and rash. They also say networks of specialist treatment centers will be important to help manage monkeypox patients.
“The cases reported in our study, in addition to recent outbreaks, highlight the importance of maintaining a collaborative network of standby centers to manage sporadic outbreaks of high-yielding pathogens, such as monkeypox,” says Dr. Price.
“The cases we observed have been challenging and resource-intensive to manage, so even in the UK’s high-income environment with international travel returning to pre-pandemic levels, public health officials and healthcare workers around the world must remain alert to the possibility of new cases of monkeypox”.
It is important to note that this study is observational and is based on a small number of cases – seven cases in total, and only one patient treated with tecovirimat. The authors say that more research is needed into the use of antivirals to treat the disease.
Dr. Morse also emphasized this aspect. While he called this “an interesting case report series, [with] individual patients […] Well marked,” he cautioned, “the numbers are too small to draw conclusions.”
However, according to him, the study brings care for people who contract monkeypox a step further.
“[T]His paper adds to the suggestion that tecovirimat should be useful in treating human monkeypox infections as well as others. Dr. Morse told us that the drug has an excellent safety profile, tested on human volunteers.