Monkeypox, upgraded to a notifiable disease

Doctors required to notify health authorities of every case

Labs must tell the UK Health Security Agency (UKHSA)

https://reference.medscape.com/slideshow/monkeypox-6015388?src=mkm_ret_220616_mscpmrk_exclusiveuk_int&uac=127834AR&impID=4337730&faf=1#8

Same legal status as 33 other diseases

https://www.gov.uk/guidance/no....tifiable-diseases-an

Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Monkeypox
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever

40 countries

UK

https://www.gov.uk/government/....news/monkeypox-cases

Cases, 524

Anyone can get monkeypox,

particularly if you have had close contact, including sexual contact, with an individual with symptoms.

Contact followed by rash with blisters

Sudden and unexpected number of cases, previous silent spread

Currently most cases have been in men who are gay, bisexual or have sex with men.

How common is lesbian, gay or bisexual (LGB)

https://www.ons.gov.uk/peoplep....opulationandcommunit

UK population aged 16 years and

2.7% of the UK population aged 16 years and over identified as lesbian, gay or bisexual (LGB) in 2019

(2.2% in 2018)

Between 2018 and 2019

Men identifying as GB increased from 2.5% to 2.9%

Women identifying as LB increased from 2.0% to 2.5%

Monkeypox is being transmitted in geographically diffuse sexual networks.

https://www.gov.uk/government/....publications/monkeyp

Nearly all (98%) of interviewed cases reported sex with other men during the incubation period (5 to 21 days)

First technical briefing

https://www.gov.uk/government/....publications/monkeyp/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1

Level 1
Incursions from rest of the world – small numbers of imported cases with limited onward transmission.

Level 2
Transmission within a defined sub-population with high number of close contacts.

Level 3
Transmission within multiple sub-populations or larger sub-population.

Level 4
Wider significant community transmission – with potential for endemic and local epi-zoonotic disease.

Detailed case interviews, traditional contact tracing is currently challenging,

identify transmission networks

Serial interval, 9.8 days (95% credible interval, 5.9 to 21.4)

(Interval between clinical onsets)

The mutations specific to the current global outbreak clade are distributed across the genome.

There is a small subset of mutations in proteins that are involved in virus transmission, virulence, or interaction with antiviral drugs.

UKHSA has convened an expert group of public health, NHS and academic partners to steer a comprehensive investigation.

Prof David Heymann, infectious disease

UK decision, concern transmission is occurring outside most at-risk groups

So far, gay, bisexual men

Latest outbreak driven by sexual networks

It suggests that they want to focus surveillance on the entire population – not only on the risk groups identified so far

Prof Francois Balloux, University College London Genetics Institute

More infections than cases

This is particularly the case for a disease which can often be mild with fairly unspecific symptoms such as monkeypox.

It is difficult to work out at the moment whether cases are going up, down or plateauing worldwide … but this is not a ‘Covid-level’ health scare