A case of monkey pox reported in Wales was the subject of a newsletter published by the World Health Organization (WHO) on 11 June 2021. This is reproduced below in its entirety.
Description of the episode
On May 25, 2021, the UK notified the WHO of a laboratory-confirmed case of monkeypox (monkey pox). The patient arrived in the UK on May 8, 2021. Prior to his trip, he had lived and worked in Delta State, Nigeria.
Upon arrival in the UK, the patient remained in quarantine with his family due to COVID-19 restrictions. On May 10, the patient developed a rash, starting on the face. He remained in self-isolation for an additional ten days and sought medical attention to relieve his symptoms. The patient was admitted to a referral hospital on May 23. Samples of skin lesions were received by the Public Health England Rare and Imported Pathogens Laboratory May 24. The West African clade of the monkey pox virus was confirmed by polymerase chain reaction (PCR) on May 25.
On May 29, a family member with whom the patient was in quarantine developed lesions clinically compatible with monkeypox and was immediately isolated to an appropriate facility. Monkey pox was confirmed on May 31. Both patients are stable and are recovering.
Public health response
UK health authorities have activated an incident management team and implemented public health measures, including isolation of the index case and secondary case and tracing of close contacts in hospital and in the community.
Contacts of both cases are followed up for 21 days after their last exposure. No close contacts traveled outside of the UK after the exhibition. Post-exposure vaccination has not been offered to contacts.
The information was shared with the Nigeria National IHR Focal Point who initiated an investigation into the outbreak and is collecting additional information regarding the potential source of infection and exposures in Nigeria.
WHO risk assessment
Monkey pox is a sylvatic zoonosis with accidental human infections that usually occur sporadically in the forest regions of Central and West Africa. It is caused by the monkeypox virus and belongs to the orthopoxvirus family. Monkeypox can be transmitted by contact and by exposure to large droplets exhaled. The incubation period for monkeypox is usually 6 to 13 days, but can range from 5 to 21 days. The disease is often self-limiting, with symptoms usually resolving on their own within 14 to 21 days. Symptoms can be mild or severe, and the lesions can be very itchy or painful. Mild cases of monkeypox may go unreported and pose a risk of person-to-person transmission. The animal reservoir remains unknown, but it is likely to be found among rodents. Contact with live or dead animals while hunting and the consumption of game or bushmeat are known risk factors.
There are two clades of the monkey pox virus, the West African clade and the Congo Basin (Central Africa) clade. Although the West African clade of monkeypox virus infection sometimes causes severe illness in some individuals, the disease is usually self-limited. The case fatality rate for the West African clade has been documented to be around 1%, while for the Congo Basin clade it can be as high as 10%.
Currently in the UK, including these two cases, only six cases of monkeypox have been reported, including three cases previously imported from Nigeria, two in September 2018 and one in December 2019. Prior to this report there was also a case of nosocomial transmission in a healthcare professional in England in 2018 due to contact with contaminated bed linen. In this case, the first patient was quarantined with his family members due to COVID-19 restrictions for a ten-day period after his arrival in the country extended by two more days. Contacts that may have been exposed are under surveillance. As soon as monkey pox was suspected, UK authorities promptly took appropriate public health measures, including isolation of the case and contact tracing. The second person was isolated at home until the rash appeared and was subsequently hospitalized. The risk of potential spread in the country is minimized.
In 2017, Nigeria began to experience its first epidemic in 40 years. From the first cases in September 2017 until November 2019, a total of 183 confirmed cases and 9 deaths have been recorded in 18 states (Rivers, Bayelsa, Cross River, Imo, Akwa Ibom, Lagos, Delta, Bauchi, Territory of the federal capital (FCT), Abia, Oyo, Enugu, Ekiti, Nasarawa, Benue, Plateau, Edo, Anambra). The epidemic occurred mainly in the south of the country, particularly in Delta State. Since then, sporadic cases have continued to occur in Nigeria, underscoring the endemicity of the disease. In 2020, there were 14 suspected cases, three confirmed cases and no deaths. In 2021, a total of 32 suspected cases were reported between January and May. Of the suspected cases, 7 have been confirmed in five states: Delta (2), Bayelsa (2), Lagos (1), Edo (1), Rivers (1) and no deaths have been recorded.
Although a vaccine was approved for monkey pox in 2019, and the traditional smallpox vaccine offers cross-protection against monkey pox, these vaccines are not widely available. It is likely that there is little immunity to infection in those exposed, as the endemic disease is geographically limited to West and Central Africa. The increased susceptibility of humans to monkey pox is believed to be related to the decline in immunity due to the cessation of vaccination against smallpox. Populations around the world under the age of 40 or 50 no longer benefit from the protection afforded by previous smallpox vaccination programs.
Monkey pox imports from one endemic country to another country not previously known to have cases have been documented a total of eight times, once in 2003 and the remainder since 2018.
The public health risk from this reported event is low in the UK. Monkey pox remains endemic in parts of West and Central Africa and poses a continuing risk of other local epidemics and travel-related cases. In this case, the confirmed index case traveled from Delta State in Nigeria, where monkey pox has previously been reported. An investigation is underway in Delta State.
WHO advice
Any illness that occurs while traveling or upon return should be reported to a healthcare professional, along with information on all recent travel and vaccination history. Residents and travelers in endemic countries should avoid contact with sick animals, dead or alive, likely to harbor the monkey pox virus (rodents, marsupials, primates) and refrain from eating or handling food. wild game (bushmeat). The importance of hand hygiene with soap and water, or a hydroalcoholic solution, should be emphasized.
A patient with monkey pox should be isolated during the infectious period, that is, during the rash phase of the disease, and contacts should be quarantined. Prompt contact tracing, surveillance measures and education of healthcare providers to emerging imported diseases are essential elements in the prevention of secondary cases and the effective management of outbreaks of monkeypox.
Healthcare professionals caring for patients with suspected or confirmed monkey pox should apply Additional Contact and Droplet Precautions. Samples taken from people and animals suspected of being infected with the monkeypox virus should be handled by trained personnel working in suitably equipped laboratories.
Source: World Health Organization
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