Of these, 4 were imported, 2 were cases in household contacts, and one was a case in a health care worker involved in the care of an imported case. It will take only 2 minutes to fill in. TW, CO, RP, and RC wrote the manuscript revisions. The estimated mean serial interval was 8.0 days (95% credible interval 6.5 to 9.8) using the ICC model and 9.5 days (7.4 to 12.3) using the ICRTC model. Monkeypox is a rare viral infection which does not spread easily . May 19, 2022. Blue arrow indicates number of days between secondary exposure and secondary onset (incubation period). In other populations and with different disease severity, the incubation periods are likely to differ.29303132. Surveillance and laboratory studies have found the Congo Basin clade to the more severe of the two, with higher transmissibility.34 In May 2022, the World Health Organization reported a monkeypox outbreak in several originally non-endemic countries,5 since linked to the Western African clade.6 These cases were of considerable concern as they could not be clearly linked to recent travel from an endemic area. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. From the remaining 16 records, seven primary cases had personal identifiable information in both the questionnaire and the line list, allowing us to verify whether the individual identified by the secondary contact was also the primary case from the case-contact pair. For lognormal the model was parameterised in terms of the log mean, 1, and log standard deviation, 2, parameters. For patients who could be linked through personally identifiable data, four days was the maximum time that transmission was detected before symptoms manifested. We do not capture any email address. Doubling and halving times and log scale model fit of case numbers of monkeypox by reporting date. Nigeria has. Three of the 19 records we identified reported a negative incubation period and were excluded. These estimates are specific to the demographic distribution of this outbreak (age and sexual orientation) and severity of this clade. 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. To obtain data on the incubation period we analysed completed case questionnaires and linked infected individuals to probable exposure dates. EXCLUSIVE: Top scientist calls for Britain to stockpile bird flu antivirals and PPE. 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 virus (MPXV) has generally circulated in West and Central Africa since its emergence. For the seven primary cases with available personal identifiable information, four matched and three did not match. UK Health Security Agency. If you are unable to import citations, please contact 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. When we compared the subsamples obtained through this data processing with the total set of patients (table 1), the mean age and proportion of patients who reported being gay, bisexual, and other men who have sex with men was consistent across all samples. United States now has the world's biggest outbreak of monkeypox: . The other six include the H1N1 influenza pandemic of 2009; the Ebola outbreak in West Africa from 2013 to 2015; the Ebola outbreak in the Democratic Republic of the Congo from 2018 to 2020; the . In particular, symptom onset date is defined as the date patients noticed they had an infection. These two sources of evidence provide greater confidence in the conclusions. The duration of symptoms is typically two to four weeks. The 95th centile of the serial interval was between 23 and 41 days, suggesting long infectious periods. Stockholm, Sweden: European Centers for Disease Prevention and Control; 2022. To estimate this smooth function, we fit a generalised additive model to daily confirmed case counts with a negative binomial error structure and log link. 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]. Recently, sporadic MPXV infections in several nonendemic countries have attracted widespread attention. Monkeypox infection was immediately suspected, and the patient was hospitalised at Guy's Hospital[28] and isolated, then tested positive for the virus on 6 May. [35], Furthermore, to combat the continued spread of the outbreak, the UKHSA has offered doses of the Imvanex smallpox vaccine, also effective against monkeypox, to people having had close contact with people confirmed to having been infected. [25], In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. The two clades, the Congo Basin and Western African, show distinct epidemiological characteristics. Our finding does, however, provide evidence that there are patients who showed pre-symptomatic transmission in the monkeypox outbreak data. Although the mean serial interval was longer than the incubation period for both models, short serial intervals were more common than short incubation periods, with the 25th centile and the median of the serial interval shorter than the incubation period. We did not directly involve patients and members of the public in the design and conception of the study, primarily because of the pace at which this study was conducted to inform the UK governments response to the monkeypox outbreak in the UK. Our analyses were specific to the dynamics of the outbreak. The right truncation primarily affects recent observations and has less of an influence on older observations. Posteriors are reported for the ICC (interval censoring corrected) model and the ICRTC (interval censoring right truncation corrected) model, fit to data from 79 patients using a gamma distribution, Summary statistics of the serial interval for monkeypox, fit to data from 79 patients using a gamma distribution. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. UK Health Security Agency. Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. Data are obtained from three types of questionnaires: A questionnaire administered by health practitioners, An anonymous self-completed questionnaire, All questionnaires are optional, and individuals are not required to complete all questions. Doubling times of cases declined from 9.07 days (95% confidence interval 12.63 to 7.08) on the 6 May, when the first case of monkeypox was reported in the UK, to a halving time of 29 days (95% confidence interval 38.02 to 23.44) on 1 August. Table 3 shows the results of the cumulative distribution function of the incubation period distribution. 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). 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. This finding is consistent with the proportion of pre-symptomatic transmission among the subset of case-contact pairs where transmission can be identified relative to the date of symptom onset after exposure. Monkeypox is a re-emerging zoonotic infection caused by the monkeypox virus, which belongs to the Orthopoxvirus genus of the Poxviridae family 1 and was first identified in the Democratic Republic of the Congo in 1970. The trace results for the shape and scale parameter from the from the Markov chain Monte Carlo sampler and the model code can be found here: https://github.com/OvertonC/Transmission-Dynamics-of-Monkeypox-in-the-United-Kingdom. 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. Joint ECDC-WHO Reginal Office for Europe monkeypox surveillance bulletin. If clinical symptoms occurred before patients recognised they had symptoms, however, then the true incubation period could be shorter than the patients recognised incubation period. Up to 3 October 2022 there were 3,504 confirmed and 150 highly probable monkeypox cases in the UK: 3,654 in total. TW, CO, RP, and RC developed the model code and wrote the original manuscript. [29], On 30 May, the four main public health agencies published a consensus statement describing the principles they will put in use, with the aim of limiting community transmission. 2022. Work was undertaken in line with national data regulations. Main outcome measures The incubation period and serial interval of a monkeypox infection using two bayesian time delay modelsone corrected for interval censoring (ICCinterval censoring corrected) and one corrected for interval censoring, right truncation, and epidemic phase bias (ICRTCinterval censoring right truncation corrected). Monkeypox - Democratic Republic of the Congo. CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[26]. To compare the model fits we calculated the leave-one-out cross validation (LOO) through Pareto smoothed importance sampling, using the LOO package in R.19 We applied MCMC to each model and evaluated its convergence using potential scale reduction factor, or (calculated using Cmdstanr20), where it is desirable to have a value <1.05. Principles for monkeypox control in the UK: 4 nations consensus statement. From those, 30 had documented case-contact links in the HPZone data, allowing the primary case to be identified. With more than 16,800 cases globally, some scientists are calling the monkeypox outbreak a pandemic, albeit with a far lower mortality rate than the COVID-19 pandemic. 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