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Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022.

John P Thornhill1, Sapha Barkati1, Sharon Walmsley1

  • 1From the Blizard Institute and the SHARE Collaborative, Queen Mary University of London, and the Department of Infection and Immunity, Barts Health NHS Trust (J.P.T., V.A., C.M.O.), the Department of Genitourinary Medicine and Infectious Disease, Guys and St. Thomas' NHS Trust (A.N.), the Department of Sexual Health, Homerton University Hospital (I.R.), and the Clinical Infection Unit, St. George's University Hospitals NHS Foundation Trust (M.S.H.) - all in London; the Department of Medicine, Division of Infectious Diseases (S.B., L.B.H., M.B.K.), the J.D. MacLean Centre for Tropical Diseases (S.B.), the Research Institute of the McGill University Health Centre (S.B., M.B.K.), and the Chronic Viral Illness Service, Department of Medicine (M.B.K.), McGill University Health Centre, Montreal, and the Department of Medicine, University Health Network, University of Toronto (S.W.), the Division of Infectious Diseases and the MAP Centre for Urban Health Solutions, St. Michael's Hospital (D.T.), and the Department of Medicine, University of Toronto (D.T.), Toronto - all in Canada; University Hospital Bonn, Department of Medicine I, Bonn (J.R., C.B.), the Department of Infectious Diseases, St. Joseph Hospital, Berlin (P.M.), Medizinisches Versorgungszentrum (MVZ) München am Goetheplatz, Munich (S. Noe), and the Infektionsmedizinisches Centrum Hamburg (ICH) Study Center, Hamburg MVZ ICH Stadmitte, Hamburg (C.H.) - all in Germany; the National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome (A.A., F.M.), the Division of Infectious Disease, Luigi Sacco Hospital, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco (D.M.), and the Department of Infectious and Tropical Diseases, IRCCS-Ospedale San Raffaele (S. Nozza), Milan, the Clinic of Infectious Diseases, University of Modena, Modena (C.M.), and the Infectious Diseases Division, Department of Medical Sciences, Azienda Ospedale Universita, Padua (A.C.) - all in Italy; the Department of Infectious Diseases, Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital (R.P., V.P.), and the Department of Infectious Diseases, Saint Louis Lariboisière Hospital, AP-HP, University of Paris Cité (C.P.), Paris, and the Department of Prevention and Community Health, Créteil Intercommunal Hospital, Créteil (C.P.) - all in France; the HIV Cure Research Center, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University and Ghent University Hospital, Ghent (L.V.), and the HIV/STI Clinic, Institute of Tropical Medicine, Antwerp (E.F.) - both in Belgium; the Sackler Faculty of Medicine, Tel Aviv University, and the Israel Department of Infectious Diseases and Infection Control, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (M.Y.); the Department of Dermatology, University Hospital La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Investigación Hospital Universitario La Paz (E.S.), and CIBERINFEC, Instituto de Salud Carlos III (J.L.B.), Madrid, and the Infectious Diseases Service, Hospital Clinic-IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer), University of Barcelona, Barcelona (J.L.B.) - all in Spain; Hospital de Curry Cabral-Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (F.M.M.); Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (A.G.); the Department of Infectious Diseases, University Hospital of Copenhagen, Hvidovre, Denmark (A.-B.E.H.); the Condesa Specialized Clinic, Mexico City (J.I.L.); the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University, Boston (K.M.); and the Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland (J.N.).

The New England Journal of Medicine
|July 22, 2022
PubMed
Summary

This global monkeypox outbreak primarily affected gay and bisexual men, often presenting with rash and systemic symptoms. Early diagnosis and containment are crucial to prevent further spread of this emerging infectious disease.

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • Monkeypox virus (MPXV) infection was historically rare outside endemic African regions before April 2022.
  • A global surge in MPXV cases necessitated a better understanding of transmission, risk factors, and clinical presentation.
  • Limited data existed on the characteristics and outcomes of human MPXV infections in non-endemic settings.

Purpose of the Study:

  • To describe the clinical presentation, course, and outcomes of polymerase-chain-reaction-confirmed monkeypox virus infections.
  • To characterize the epidemiology and risk factors associated with the global MPXV outbreak.
  • To inform public health strategies for containment and management of MPXV.

Main Methods:

  • An international collaborative case series was formed.
  • Data were collected from clinicians contributing polymerase-chain-reaction-confirmed MPXV infections.
  • Analysis included demographics, transmission routes, clinical findings, and outcomes.

Main Results:

  • 528 MPXV infections were reported across 16 countries between April and June 2022.
  • The majority of cases (98%) were among gay or bisexual men, with 41% co-infected with HIV.
  • Common symptoms included rash (95%), anogenital lesions (73%), fever (62%), and lymphadenopathy (56%). Transmission was suspected via sexual activity in 95% of cases.

Conclusions:

  • Monkeypox presents with diverse dermatologic and systemic symptoms, requiring prompt recognition.
  • The global spread highlights the urgent need for rapid case identification and diagnosis to control community transmission.
  • Effective containment strategies are essential to manage the evolving MPXV outbreak.