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CDC fears spread of undiscovered monkeypox in UK

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The Centers for Disease Control and Prevention expressed concern about an unusual outbreak of monkey pox in the UK on Tuesday, where there appears to be undetected transmission of the virus, at least over the possibility of the outbreak spreading beyond UK borders. warned about.

We have a level of concern that this is very different from what we normally think of in monkey chickenpox. Jennifer McQuiston, a senior CDC official, told STAT in her interview that she believes there are concerns about the possible spread outside the UK.

Seven confirmed cases and one possible case of monkey chickenpox have been found in the UK since early May. Human monkey chickenpox cases are unusually high, especially given that they are rare outside of West and Central Africa. One case recently traveled to Nigeria, where monkey pox is endemic, while others appear to have contracted the virus in the UK. He was not the source of the infection.

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Complicating the situation and amplifying concerns is the fact that the different cases consist of two distinct groups with no identifiable association with each other. World Health Organization (WHO) expert Maria Van Kerkhove said at a press conference on Tuesday that two of the confirmed cases and one possible case were family. The other four most recently publicized confirmed cases were identified by the UK Health Security Agency as being gay, bisexual or other men who had had sex with three men in London, a fourth man in Newcastle, nearly 300 miles north of the country. Confirmed. The agency said all four may have been infected in London.

It is not known how these people became infected with the virus. Transmission is thought to occur primarily through droplets carrying the virus, but it can also be spread by direct contact with lesions or body fluids of an infected person, or by indirect contact through contaminated clothing or linen.

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Obviously, the fact that there are two unconnected clusters suggests that there may be more than one transport chain in that country, each of which may contain additional cases that have not yet been detected. Van Kerkhove, who heads the Emerging Diseases and Zoological Infectious Diseases department in the WHO’s Health Emergencies Program, said the virus is being sequenced in the UK, trying to determine if the cases are genetically linked. .

There is no indication that monkey pox is spreading to many people in the UK. But evidence that there are likely undiscovered cases fuels concerns about how much transmission there might be and whether the virus has spread farther.

There are two clusters with no associations with other people known to be involved in travel or known outbreaks. McQuiston said it suggests that there is an unknown transport chain. If there seems to be an unknown transmission chain, we are wary of thinking. Could this spread outside the UK?

Although human monkey chickenpox cases are rare outside of Africa, cases have surged in recent years to the United States (two in 2021), the United Kingdom, Israel and Singapore. The four most recent cases have infected two strains of West African monkeys, which cause milder disease than Central African strains, UKHSA said.

Monkeypox is similar to smallpox, which was declared eradicated in 1980, but with mild symptoms. In addition to flu-like symptoms, the infection causes a distinctive rash. Although many conditions can cause a rash, monkey chickenpox rash has some distinctive features. This is especially true of the fact that vesicles can form on the palms.

There is no specific drug or vaccine for monkey pox, but smallpox vaccines have been used in the past to help prevent monkey pox transmission, as in the 2003 outbreak in the United States, which dates back to imported exotic animals. In the outbreak, 71 people in six states contracted monkey pox.

In Africa, monkey pox is fatal in about 1 in 10 cases, and children are more likely to suffer from serious illness and death.

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Public health officials in the UK have warned sexual health clinics to beware of people with unexplained rashes, as cases have been found among gay, bisexual or other men who have had sex with men. McQuiston said the CDC is considering sending a health alert to the US medical community and sexually transmitted disease clinics.

There are many trips between the UK and the US and other global locations. So, given that there are four cases of men who have had sex with men, what we’re concerned about is what to watch out for, what to watch out for in sexually transmitted disease clinics, she said.

Van Kerkhove said the WHO has reached out to European countries through its Copenhagen-based European office to raise awareness of the risk of developing monkey pox.

McQuiston said communications related to outbreaks must be done with caution.

This is certainly a population that has been stigmatized for sexually transmitted diseases like HIV in the past. And I think we’ve learned a bit about how to approach the type of sensitivity required from these experiences.

Public health investigators in the UK are trying to track who the confirmed cases have contacted before they became ill and to determine the cause of the infection. But they also try to identify contacts of an infected person to see if they have passed the virus on to others.

McQuiston said that to date the CDC has not been notified that there are Americans on the UKHSA contact list for these cases. But she said she was monitoring six people in the US because she was on the same plane as a man who traveled from Nigeria to the UK on May 4. She said there was no hint that the individual had direct contact with the man they were sitting on, but she said she would monitor six individuals in the third-row radius of his seat for 21 days.

Ibrahima Soc Fall, WHO’s Deputy Director-General of Emergency Response, said the UK outbreak is a reminder that the epidemiology of the disease is poorly understood and the need to pay more attention to monkey pox.

Clearly, the main issue we need to investigate is to really understand the true extent of monkey pox transmission in Africa and invest in prevention and treatment tools for the most exposed people in Africa, he said.

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