[5][7] The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks. DOI: 10.1001/jamanetworkopen.2022.36993 Corpus ID: 252971060; Using Data From a Short Video Social Media Platform to Identify Emergent Monkeypox Conspiracy Theories @article{Zenone2022UsingDF, title={Using Data From a Short Video Social Media Platform to Identify Emergent Monkeypox Conspiracy Theories}, author={Marco Antonio Zenone and Timothy Caulfield}, journal={JAMA Network Open}, year . Funding: The authors were employed by the UK Health Security Agency but received no specific funding for this study. Recentring the priors to alternative means with the same precision yielded consistent results. Data for both the serial interval and the incubation period are similarly distributed across the monkeypox outbreak in the UK, so temporal changes in reporting should affect both distributions comparably (see supplementary material C). [5][6] The duration of symptoms is typically two to four weeks. To understand the transmission dynamics of the monkeypox outbreak, accurate estimates are needed of the time between subsequent infections (generation time) and time from becoming infected to developing symptoms (incubation period). Figure 5 shows the relative times from the symptom onset date in the primary case (primary case onset) to the date of exposure for the secondary contact (secondary contact exposure), serial interval, and the incubation period of the 13 case-contact pairs for whom all events could be linked. Under this assumption the model becomes simplified (equation 4, fig 1). Investigation into monkeypox outbreak in England: technical briefing 3. Monkeypox was first detected in 1970 in the Democratic Republic of the Congo, The incubation period and serial interval have been estimated from observational studies, Since the international outbreak of monkeypox in May 2022 a study estimated a mean incubation period of 8.5 days; however, the sample size was small (n=18), This study found evidence of pre-symptomatic transmission of monkeypox, using contact tracing data and adjustments for interval censoring, right truncation, and epidemic phase bias, The maximum time that transmission was detected before symptoms manifested for infected individuals who could be linked through reliable personal identifiable information was four days. [4] The time from exposure to onset of symptoms ranges from five to twenty-one days. On the surface, the monkeypox outbreak in the U.S. doesn't look that bad, especially compared with other countries. UK Health Security Agency. Therefore, these distributions might not be the same for outbreaks in other settings. If an individual was identified as a contact by a case and became a case or was already a case, we recorded these as a case-contact pair. As of July 26, 3,591 cases in 46 states, Puerto Rico, and Washington, D.C., have been diagnosed (see . The outbreak has mainly been in gay, bisexual, and men who have sex with men without documented history of travel to. The Food and Drug Administration (FDA) is urging that providers be "judicious" in prescribing the Instead, within our model we included estimated event times for each patient, z*[z1, z2] for z{e, s}, as an unobserved variable. We identified exposure dates for the incubation period from questionnaire data filled out by cases. Considerations for contact tracing during the monkeypox outbreak in Europe, 2022. 2022. 2. 2022. WHO. Following the methods of Ward et al,22 this can be generalised to an epidemic that is not in an exponential phase, by replacing rt with a smooth function of time, s(t). Monkeypox is a misnomer resulting from the fact that it was first discovered at the Statens Serum Institut in Copenhagen in 1958, when outbreaks of a pox-like disease occurred in monkeys kept. Throughout my . If a substantial proportion of secondary transmission occurs before symptom onset, the implications will be that many infections cannot be prevented by isolating individuals with symptoms. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. A total of 220 case-contact pairs were reported in HPZone, 79 with a symptom onset date for both individuals in the case-contact pair, forming our serial interval cohort. 2022 monkeypox outbreak in the United Kingdom, Last edited on 28 February 2023, at 10:29, 2022 monkeypox outbreak in the United States, "Monkeypox outbreak: epidemiological overview, 30 August 2022", "Monkeypox outbreak: epidemiological overview", "WHO recommends new name for monkeypox disease", "Multi-country monkeypox outbreak: situation update", Centers for Disease Control and Prevention, "Multi-country monkeypox outbreak in non-endemic countries", "348. Infection time is rarely observed directly, so the generation time is generally approximated using the serial intervalthe time from symptom onset in a primary case (an individual with the index infection) to symptom onset in a secondary case (an individual who becomes infected by the primary case).9 Typical monkeypox symptoms are listed on the National Health Service website and include rash (for example, on the mouth, genitals, anus), high temperature, headache, and muscle aches.10 Serial interval and incubation period estimates are important for informing policy decisions around post-infection quarantine periods and post-contact isolation periods, respectively, as well as for understanding the dynamics of viral transmission, such as potential transmissibility before symptoms manifest.1112 Based on observational studies of monkeypox from the Democratic Republic of the Congo, estimates for the incubation period range from 4-14 days and for the serial interval from 8-11 days.1314 For the Western Africa clade that is currently circulating in the UK,15 early research suggests a mean incubation period of between 6.6 and 10.9 days.16 This estimate is, however, based on limited data and thus far no research pertaining to the serial interval has been released. Monkeypox - Democratic Republic of the Congo. Data were collected on monkeypox from UKHSA health protection teams, targeted testing of infected individuals (with specimens processed by UKHSA affiliated laboratories and NHS laboratories), and questionnaires (collected by UKHSA health protection teams). The data sharing section includes a link to a repository containing the code for the model and the trace results from the MCMC sample. Our likelihood function therefore relies on three functions (equation 2, fig 1). A rare case of monkeypox has been diagnosed in a patient in England, the UK Health Security Agency said in a statement Saturday. 4. Three of the 19 records we identified reported a negative incubation period and were excluded. Analysis of these 13 case-contact pairs showed 10 with pre-symptomatic transmission. To obtain the serial interval data we used self-reported symptom onset dates and linked case-contact pairs (linked pairs of primary and secondary cases). The counts below combine both of these categories. Check benefits and financial support you can get, Find out about the Energy Bills Support Scheme, Health surveillance and reporting programmes, Monkeypox outbreak: epidemiological overview, Current epidemiological situation as of 3 October 2022, nationalarchives.gov.uk/doc/open-government-licence/version/3, Notifications of infectious diseases (NOIDs) causative agents weekly report, Monkeypox contact tracing guidance: classification of contacts and advice for vaccination and follow-up. Read Breaking News on Health updated and published at health | Page 36 The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. An application can be made to the UK Health Security Agency. We do not capture any email address. Negative times from primary case onset to secondary contact exposure indicate pre-symptomatic transmission. [10] The variola virus, the causative agent of smallpox, is also in this genus. Update on Monkeypox in Children, Adolescents, and People Who are Pregnant or Breastfeeding; Melioidosis in the United States: What Clinicians Need to Know Following Newly Discovered Endemicity; Update on 2022 Ebola Outbreak in Uganda; Situational Update for Clinicians about Severe Monkeypox Virus Infections The paper was, however, read by members of the public upon submission. The 2022 monkeypox outbreak in Austria is part of the larger outbreak of human monkeypox caused by the West African clade of the monkeypox virus. We found that shorter serial intervals are more common than short incubation periods for monkeypox, which suggests considerable pre-symptomatic transmission. In one study involving 18 infected participants, the estimated mean incubation period was 8.5 days (95% credible interval6.6 to 10.9).16 A limitation of this study was the small sample size, and therefore the findings were unlikely to be representative of the full distribution. MPXV, causing the 2022 multi-country monkeypox outbreak, is equipped with a faster speed of microevolution and multi-patterns of transmission between humans and . Under this model (y(t)=y(0)ert), the number of cases at time t, y(t), is proportional to the exponential of the smooth function with time, exp(s(t)). At the 95th centile, the posterior estimates were 17.8 days (95% credible interval 15.2 to 21.9) for the ICC model and 18.1 days (15.5 to 22.5) for the ICRTC model. Similarly, the secondary event time (symptom onset in secondary contact for serial interval or symptom onset for incubation period) sits within an interval [s1, s2]. The estimated serial interval posterior distributions for the mean serial interval from the UK sampling was 8.0 days (95% credible interval 6.5 to 9.9) for the ICC model and 9.5 days (7.4 to 12.3) (fig 3 and table 4) for the ICRTC model. For both distributions, it is assumed that the mean follows a normal distribution prior, with mean 5 and standard deviation 1, and that the shape parameters follow a flat prior. For confirmed and highly probable cases in the UK, where gender information was available, 3,580 (98.6%) were men and 50 were women. The DRC reported more than 18,000 confirmed or suspected monkeypox cases from 2010 to 2019, up from about 10,000 from 2000 to 2009, and more than 6,000 suspected cases in 2020. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. The posterior estimate for the mean incubation period of monkeypox from the UK sampling was 7.6 days (95% credible interval 6.5 to 9.9) for the ICC model and 7.8 days (6.6 to 9.2) (fig 2 and table 2) for the ICRTC model. If an epidemic is stable or declining the right truncation bias has less of an effect on the data. Analysis of the instantaneous growth rate indicates that as of 9 July the epidemic peaked in the UK. The UK Health Security Agency had classified the outbreak as "significant and concerning" but says the risk to people "remains low".. In particular, symptom onset date is defined as the date patients noticed they had an infection. This sample size is small and relies on the completion of an optional case questionnaire and on the cases being linked by contact tracing. Using the cumulative distribution function of the serial interval distribution, the median number was 5.0 days (95% credible interval 3.8 to 6.2) for the ICC model and 5.8 days (4.3 to 7.6) for the ICRTC model (table 5). Stockholm, Sweden: European Centers for Disease Prevention and Control; 2022. Individuals report other individuals who they have been in contact with or who they think might have infected them, but this does not necessarily mean transmission occurred during that contact. Monkeypox is related to smallpox, which killed millions around the world every year before it was eradicated in 1980. However, this overestimation of the serial interval will bias the data away from pre-symptomatic transmission, which further supports the evidence of pre-symptomatic transmission we identified. As the global monkeypox outbreak lingers on, health officials are warning that the virus is mutating at a pace that may soon allow it to become resistant to an antiviral drug used to treat patients at risk of serious illness. Highlights 1. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. Principles for monkeypox control in the UK: 4 nations consensus statement. The mean incubation period and mean serial interval were found to range from 6.6 to 9.2 days and 7.4 to 12.3 days, respectively, when adjusted for right truncation and epidemic phase bias. The outbreak has mainly been in gay, bisexual, and men who have sex with men without documented history of travel to endemic countries. From those, 30 had documented case-contact links in the HPZone data, allowing the primary case to be identified. At the end of the study period, 1 August, case numbers were halving every 29 days (38.02 to 23.44). 2022. Up to 3 October 2022 there were 3,504 confirmed and 150 highly probable monkeypox cases in the UK: 3,654 in total. Since 25 July 2022, the monkeypox case definition recognises those who are orthopox-positive as highly probable cases, and those who test positive on a monkeypox PCR test as confirmed cases. Therefore, backward contact tracing strategies should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases. In the present study the incubation period, ranging from 16 to 23 days after exposure, would be adequate to identify 95% of infected individuals, so would be the required length of post-exposure isolation policies. Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. UKHSA health protection teams store data collected during an incident in the HPZone, The line list contains a list of confirmed infected individuals in the UK obtained from test data (compiled and deduplicated) from UKHSA affiliated laboratories, National Health Service trust laboratories, and HPZone data, along with supplementary data from the case questionnaires. Previous cases in the UK had been either imported from countries where monkeypox is endemic or contacts with documented epidemiological links to imported cases. Counts of confirmed cases in Wales, Northern Ireland, and Scotland are submitted to UKHSA by Public Health Wales, Public Health Agency Northern Ireland, and Public Health Scotland respectively. In 2020, less than 10% of the largest global health organizations were head-quartered in the African region, and very few of the global health organizations are led by African nationals . Although case numbers are declining, increased international transmission would facilitate infection importation and might drive stochastic outbreaks even if vaccination in local networks limits transmission. Since June, there have been over 10,000 confirmed monkeypox cases in the U.S. Information criteria and cross-validation, 2020. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work ; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years ; no other relationships or activities that could appear to have influenced the submitted work. Accessed August 3, 2022. https://monkeypoxreport.ecdc.europa.eu. The 95th centile of the serial interval was between 23 and 41 days, suggesting long infectious periods. As of December 2nd, Austria has confirmed a total of 327 cases. UK Public Health Agencies. There was no documented community transmission in previous outbreaks. Taha, M. J., Abuawwad, M. T., Alrubasy, W. A., Sameer, S. K., Alsafi, T., Al-Bustanji, Y., & Nashwan, A. J. Ocular manifestations of recent viral pandemics: A literature. In July 2022 WHO declared the outbreak a Public Health Emergency of International Concern.8. Since early May 2022, cases of mpox (monkeypox) have been reported from countries where the disease is not endemic, and continue to be reported in several endemic countries. , and Washington, D.C., have been diagnosed in a smallpox-like disease in humans or declining the truncation... Case-Contact links in the UK two to four weeks shorter serial intervals are more common than short periods... With a faster speed of microevolution and multi-patterns of transmission between humans and considerations for contact.! Rico, and Washington, D.C., have been over 10,000 confirmed cases! 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