Sunday, June 26, 2022

Sexual contact likely route of ‘unprecedented’ transmission of monkeypox

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The recent outbreak of monkeypox cases in the UK is “unprecedented”, said one scientist, while others warned there were “gaps in our knowledge” of the disease’s recent spread.

Health officials are scrambling to investigate the links between four new cases identified in London and the north-east of England, none of which have links to the previous three infections discovered by Britain’s Health Security Agency.

As a typically mild, self-limiting viral disease that does not spread easily between people, the risk to the general British population is low, UKHSA said.

But the sudden emergence of cases and uncertainty about how and where individuals contracted the virus has confused scientists, as sexual contact is now considered a likely route of transmission.

“This outbreak of monkeypox is unprecedented in the UK and has prompted urgent public health action,” said Jimmy Whitworth, professor of international public health at the London School of Hygiene & Tropical Medicine.

dr Michael Head, senior research fellow in global health at the University of Southampton, said: “There are currently gaps in our knowledge and the UKHSA’s contact tracing and public health inquiry will no doubt uncover more in due course, for example about the transmission pattern .”

He added: “However, it would be very unusual to see more than a handful of cases in an outbreak and we will not see a Covid-style level of transmission.”

Four out of seven cases in the current outbreak are gay or bisexual, which, according to Mateo Prochazka, an infectious disease epidemiologist at the UKHSA who is leading the agency’s investigation, “strongly suggests spread in sexual networks”.

“This is further suggested by the fact that common contacts have only been identified for 2 of the 4 most recent cases,” he said on Twitter, adding that it was “bizarre” that people appeared to have acquired the infection through sexual contact, given that ” this is a novel mode of transmission’ which has not previously been reported in the UK.

In a statement released by the UKHSA on Monday, Dr. Susan Hopkins, Chief Medical Advisor: “We urge gay and bisexual men in particular to be alert for any unusual skin rashes or lesions and to contact a sexual health service immediately.”

A number of patients suffering from monkeypox, which is caused by a smallpox virus, are receiving medical care in specialist infectious disease units at the Royal Victoria Infirmary in Newcastle upon Tyne and the Royal Free Hospital and Guy’s and St Thomas’s in London.

None of the newly infected people have traveled to a country where monkeypox, which can kill up to 10 per cent of people, is endemic, UKHSA said.

Seven cases have now been identified between May 6 and 15, the first of which had recently returned from Nigeria where they are believed to have contracted the infection.

Amid the lack of certainty about the recent spread of monkeypox, UKHSA is working with the NHS to determine if infections have been missed.

Prof Whitworth said there was “necessary to engage with the risk community of gay and bisexual men to ensure they are aware of the presence of this infection and report any signs and symptoms to health facilities.

“Cases need to be identified, isolated and treated, either in the hospital or at home, depending on the severity and circumstances.”

The seven people diagnosed with monkeypox in Britain have contracted the West African variant of the virus, which is mild compared to the Central African strain, health officials said on Monday.

The UK and other countries have reported “a small number of sporadic travel-related cases” in recent years, said Dr. Michael Skinner, Lecturer in Virology at Imperial College London.

Britain reported its first cases of monkeypox in 2018, when three people contracted the virus after a man returned from Nigeria.

dr Skinner said there are likely two factors behind the international cases that have been uncovered in recent years.

“One is that the cessation of smallpox vaccination after the global eradication of variola virus in 1980 means that the level of cross-reactive immunity to monkeypox has now declined or disappeared, so humans can now be infected with monkeypox virus,” he explained.

“The second is the possibility that the spread of the virus in West African wildlife has changed in some way, possibly increasing or spreading, making humans more likely to be infected. Extensive testing of wild animals in the field would be required to investigate this possibility.”

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