Created by PRI for the NYC Health Department. Latest editions Tuesdays and Thursdays. While we use the language “MPV”, most sources do not, and readers will see the language fluctuate within the report. For questions and feedback, please email email@example.com
Case Counts/Trends and Large Guidance/Response Changes (Limited by latest reporting)
- GLOBAL: From 1 January through 16 October 2022, a cumulative total of 73 437 laboratory-confirmed cases of monkeypox and 29 deaths have been reported to WHO from 109 countries/territories/areas (hereafter ‘countries’[i]) in all six WHO Regions (Table 1). Since the last edition published on 5 October 2022, 4537 new cases (6.6% increase in total cases), and four new deaths have been reported. In the past seven days, 17 countries reported an increase in the weekly number of cases, with the highest increase (7.7%) reported in Peru. Three new countries Mozambique (n=1,) San Marino (n=1), and Vietnam (n=1) reported its first cases in the past seven days. Overall, 49 countries have not reported new cases for over 21 days, the maximum incubation period of the disease; 10 more countries since the last report. (WHO Sit Rep – Latest 10/19/2022 / Dashboard)
- US: Total confirmed MPV cases: 27,635 (10.19.2022). (full version).
- NY State: As of October 16 2022, a total of 3,683 confirmed orthopoxvirus/monkeypox cases – a designation established by the Centers for Disease Control and Prevention (CDC). (NY Sit Rep and County List)
- The US is currently reporting the lowest daily average of MPXV cases since June 29, which is right around the time that infections began climbing, ABC News reports. It’s also down from the seven-day average of 443 cases recorded in early August, CDC data shows.
- Maps & Stats: CDC / Tableau Dashboard (based on global.health) / New York Times
- An article published in STAT News discusses understudied aspects of MPXV infection, primarily long-term impacts and late manifestations, also referred to as “sequela” of the virus. “Charting the long-term consequences of monkeypox infection will take time, but it is a critical task”, said John Brooks, a medical epidemiologist at the US CDC.
- Glasgow scientists to lead major UK monkeypox project (The Herald) Scientists at Glasgow University’s Centre for Virus Research will spearhead the new UK research consortium in collaboration with the Surrey-based Pirbright Institute. In total, the consortium will bring together 25 leading researchers from 12 institutions, including Edinburgh University, to develop better diagnostic tests, identify potential therapies and study vaccine effectiveness and the virus’ spread.
Articles by Category
Ocular Monkeypox — United States, July–September 2022 (Cash-Goldwater et al., MMWR)
As of October 11, 2022, a total of 26,577 monkeypox cases had been reported in the United States. Although most cases of monkeypox are self-limited, lesions that involve anatomically vulnerable sites can cause complications. Ocular monkeypox can occur when Monkeypox virus (MPXV) is introduced into the eye (e.g., from autoinoculation), potentially causing conjunctivitis, blepharitis, keratitis, and loss of vision. This report describes five patients who acquired ocular monkeypox during July–September 2022. All patients received treatment with tecovirimat (Tpoxx); four also received topical trifluridine (Viroptic). Two patients had HIV-associated immunocompromise and experienced delays between clinical presentation with monkeypox and initiation of monkeypox-directed treatment. Four patients were hospitalized, and one experienced marked vision impairment. To decrease the risk for autoinoculation, persons with monkeypox should be advised to practice hand hygiene and to avoid touching their eyes, which includes refraining from using contact lense. Health care providers and public health practitioners should be aware that ocular monkeypox, although rare, is a sight-threatening condition. Patients with signs and symptoms compatible with ocular monkeypox should be considered for urgent ophthalmologic evaluation and initiation of monkeypox-directed treatment. Public health officials should be promptly notified of cases of ocular monkeypox. Increased clinician awareness of ocular monkeypox and of approaches to prevention, diagnosis, and treatment might reduce associated morbidity.
Monkeypox Virus Infection Resulting from an Occupational Needlestick — Florida, 2022 (Mendoza et al., MMWR)
This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP. On July 12, 2022, a Florida county health department (HD) received notification of a nurse who was exposed to MPXV through a needlestick that occurred earlier that day. While obtaining swabs from a patient with suspected monkeypox, the nurse used a needle to create an opening in the vesicular lesion to facilitate direct contact of the swab with fluid in the lesion. The needlestick occurred when recapping the used needle by hand before disposal; it caused a break in the skin on the index finger through the nurse’s gloved hand, accompanied by a small amount of bleeding. The wound was immediately washed with soap and water and drenched with Betadine antiseptic solution (10% povidone-iodine. Later that day, the lesion swab collected from the patient by the nurse tested positive for nonvariola Orthopoxvirus using a PCR assay; a duplicate swab subsequently tested positive for Clade II MPXV. Within approximately 15 hours of the incident, the nurse received the first dose of a 2-dose JYNNEOS vaccination series as postexposure prophylaxis. Ten days after the exposure, a single skin lesion formed at the site of the needlestick. The nurse immediately began isolating at home and kept the lesion covered until it had crusted over, the scab had fallen off, and a new layer of skin had formed beneath the lesion 19 days later. During the next 19 days, the lesion at the needlestick site increased in size (remaining <1 cm in diameter) and became pruritic, deep-seated, and umbilicated, then scabbed over and a new layer of skin formed under the scab. Apart from this single lesion at the puncture site, no additional lesions or other clinical signs or symptoms were reported, and tecovirimat was not indicated. No secondary cases were identified. This report describes the first occupationally acquired MPVX infection in a U.S. health care worker during the 2022 monkeypox outbreak. CDC advises against unroofing, opening, or aspirating monkeypox lesions with sharp instruments (e.g., needles) and recapping used needles because of the risk for sharps injuries.
Protecting hospitals and the community from the current global monkeypox outbreak: Lessons from the COVID-19 pandemic (Chirico et al., Journal of Health and Social Sciences)
Monkeypox is a zoonotic disease caused by the monkeypox virus (MPXV), which produces lesions similar to smallpox among human beings. The MPXV outbreak (which is endemic to rainforest African countries) has emerged as a major global concern. In recent years, exposure to MPXV was reported among certain occupational groups, including veterinary staff, pet store employees, animal distributors, and healthcare workers (HCWs), particularly those who work in frontline positions. Hospitals provide a conducive environment for transmitting infectious diseases(e.g., COVID-19 transmission). This warrants the need to develop an effective infection control management plan. Therefore, the authors of this commentary sought to describe a framework for workplace risk assessment and prevention strategies for controlling infection transmission in occupational settings (e.g. hospitals). Occupational health programs, vaccination campaigns at work sites, and educational initiatives to increase knowledge and awareness about effective infection control measures among medical staff and the general public will be essential to prevent future outbreaks. A comprehensive strategy based on an enhanced and multidisciplinary activity coordinated by occupational health services and close collaboration between occupational and public health stakeholders will be warranted. National outbreak preparedness and global coordination efforts for improving the syndemic surveillance of the current global outbreaks in developing and developed countries, per the “One Health” approach, may tackle even the current MPXV outbreak and prevent the spread of the virus among HCWs and the community.
Monkeypox: what do dental professionals need to know? (Zemouri et al., British Dental Journal)
Infection control is critical for the safe delivery of dental care. Infection control practices must be responsive to emerging and re-emerging infectious diseases and outbreaks, as was clearly seen during the peak of the COVID-19 pandemic. An emerging global outbreak of the monkeypox virus has again raised potential challenges for infection control in dentistry. Monkeypox is an infectious disease, characterised by a rash affecting the skin and soft tissues, including the oral cavity. Previously, cases were mostly seen following contact with infected animals in Central and West Africa, with limited human-to-human transmission within and outside of these areas. However, since May 2022, sustained human-to-human transmission has occurred globally. Monkeypox can be transmitted via close contact with an infected person, contaminated objects and surfaces, or by droplets and possibly aerosols, which is therefore of potential importance to dental settings. This article discusses the relevance of monkeypox to dental professionals, the typical presentation of the disease, its potential impact on infection prevention and control practices and the delivery of dental services. The current monkeypox outbreak highlights the need for a more sustained programme of research into dental infection control that can provide a solid evidence base to underpin preparedness planning for future outbreaks and pandemics.
The re-emerging monkeypox disease (Kipkorir et al., Tropical Medicine and International Health)
On 7th May 2022, human monkeypox was identified in the United Kingdom, a non-endemic zone, with subsequent multi-country outbreaks. About 6 weeks later, the European Centre for Disease Prevention and Control reported 1158 confirmed cases in non-endemic countries scattered within the European Economic Area (EEA), and a total of 1882 cases confirmed worldwide, inclusive of the EEA. These numbers are expected to increase with high alert and amplified surveillance established in non-endemic regions. In light of a looming epidemic, current understanding of the virus, and identification of gaps in the literature remain critical hence warranting a scoping review of available literature. Literature searches were performed through PubMed, SCOPUS, ScienceDirect and Hinari to identify studies eligible for inclusion in accordance with PRISMA guidelines. Seventy-seven articles were included in the review. Majority of the cases were from the Central African clade (n = 29,905) versus the West African clade (n = 252). 6/16 articles that reported vaccination status stated that none of the cases were vaccinated. In the remaining articles, approximately 80%–96% cases were unvaccinated. It was noted that 4%–21% of the vaccinated individuals got infected. The secondary attack rate ranged from 0% to 10.2%, while the calculated pooled estimated case fatality rate was 8.7%. This scoping review provides an extensive look at our current understanding on monkeypox disease. Further studies are needed to better understand its risk factors, genetics and natural history, in order for public health strategists to generate prevention strategies and management decisions.
Persistence of Monkeypox Virus DNA in Clinical Specimens (Li et al., Journal of Infection)
In this study, researchers collected the laboratory detection data of MPX cases from the archived reports which included clear and consistent methods and predict the duration of detecting MPXV DNA in various body fluids through mathematics model analysis. A total of 62 archived MPX cases (49 males, 13 females; median age 31y, range 0.4–50y) from 22 observation studies were included, of which 51 were non-HIV infected MPX cases (38 males, 13 females; median age 32y, range 0.4–49y), and remained 11 were HIV-infected MPX cases (11 males; median age 33y, range 26-50y). They collected the molecular detection data of MPXV by PCR in 62 MPX patients. The parametric Weibull regression models (AFT) was employed to estimate the time until the loss of MPXV DNA detection in each body fluid and reported findings in medians and 95th percentiles using R software with flexsurv, survival, and survminer packages. Additional Lnorm and gamma models were used as to evaluate the sensitivity and stability of Weibull regression models. The time until loss of MPXV DNA detection in variable clinical samples was defined as the number of days after the first negative PCR result after the onset of symptoms. For the cases with intermittent results of MPXV detection, they used the date of the first negative result after the final recorded positive PCR results. A total of 269 specimens of 62 MPX cases were included in this modeling analysis, including 23 urine samples (8.55%), 19 rash or skin lesions samples (7.06%), 17 nasopharyngeal swabs samples (6.32%),17 rectal swabs samples (6.32%), 16 semen samples (5.95%), 15 blood samples (5.58%), 14 fecal samples (5.20%) and 14 saliva samples (5.20%). The results of Weibull models showed that the median time of MPXV DNA persistence ranged from 5.7d to 13.5d in the nasopharynx swabs (8.6d, 95% CI 6.94-10.4d), feces (9.4d, 95% CI 7.15-12.4d), semen (11.4d, 95% CI 8.58-14.9d), urine (13.5d, 95% CI 10.3-17.5d), rash or skin lesions (5.7d, 95% CI 3.86-8.1d), saliva (8.9d, 95% CI 7.14-11.2d), blood (10.6d, 95% CI 6.37-16.9d), and rectal swabs (8.3d, 95% CI 6.58-10.7d) samples, while 11.3d (95% CI 9.88-13.1d) when using all samples data. The additional comparisons of sensitivity and stability among Weibull, Lnorm, and gamma models showed no differences among them (p<0.05). These results provide a reference for the appropriate time for MPXV detection in clinic, which should be considered for clinical diagnostic recommendations, as well as control and prevention of MPXV onward transmission.
Retrospective detection of monkeypox virus in the testes of nonhuman primate survivors (Liu et al., Nature Microbiology)
Close contact through sexual activity has been associated with the spread of monkeypox virus (MPXV) in the ongoing, global 2022 epidemic. However, it remains unclear whether MPXV replicates in the testes or is transmitted via semen to produce an active infection. Here, researchers carried out a retrospective analysis of MPXV-infected crab-eating macaque archival tissue samples from acute and convalescent phases of infection of clade I or clade II MPXV using immunostaining and RNA in situ hybridization. The results indicate that they detected MPXV in interstitial cells and seminiferous tubules of testes as well as epididymal lumina, which are the sites of sperm production and maturation. They also detected inflammation and necrosis during the acute phase of the disease by histological analysis. Finally, the researchers found that MPXV was cleared from most organs during convalescence, including healed skin lesions, but could be detected for up to 37 d post-exposure in the testes of convalescent macaques. They conclude that these findings highlight the potential for sexual transmission of MPXV in humans.