Investigation into monkeypox outbreak in England: technical briefing 1 - GOV.UK - ISS-G20 Laboratorium Repository

The UK Health Security Agency (UKHSA) is working with the NHS and the public health agencies of the 4 nations to investigate the monkeypox outbreak in the past few weeks. This briefing is produced to share data useful to other public health investigators and academic partners undertaking related work. It includes early evidence and preliminary analyses which may be subject to change.

Potential levels of the outbreak in England

The outbreak can be considered to fall into one of 4 potential levels of transmission. These may be refined with better understanding of modes of transmission. At present, England is judged to be in Level 2 and we are monitoring closely for any evidence of Level 3.

Level 1

Incursions from rest of the world – small numbers of imported cases with limited onward transmission.

Level 2

Transmission within a defined sub-population with high number of close contacts.

Level 3

Transmission within multiple sub-populations or larger sub-population.

Level 4

Wider significant community transmission – with potential for endemic and local epi-zoonotic disease.

Summary

Up to 8 June 2022 there were 336 laboratory confirmed cases of monkeypox in the UK. A high proportion of cases are London residents, and the majority are male.

Given the reporting delay from symptom onset to case ascertainment, we cannot yet determine if transmission has stopped increasing.

Detailed case interviews show that traditional contact tracing is currently challenging, but these interviews identify transmission networks, risk factors and behaviours that can be used to tailor public health communications and target intervention delivery. Epidemiological analysis will identify if these patterns change.

Preliminary estimate of the serial interval is 9.8 days though with high uncertainty (95% credible interval, 5.9 to 21.4).

UKHSA has commenced sharing of genomic data. However, it is recommended that monkeypox genomic data conventions are agreed, including sharing of raw as well as consensus data, given the potential for variation in bioinformatics pipelines and the impact that this may have on downstream analysis.

The mutations specific to the current global outbreak clade are distributed across the genome. There is a small subset of mutations in proteins that are involved in virus transmission, virulence, or interaction with antiviral drugs. Structural modelling is required to assess the impact of the individual mutations on the protein in the first instance.

UKHSA has produced a summary of evidence gaps and is working with partners to address these. UKHSA has convened an expert group of public health, NHS and academic partners to steer a comprehensive investigation.

Entire content available on: https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1