The unprecedented surge in monkeypox cases in the UK and beyond is an outbreak waiting to happen after the end of global smallpox vaccination more than 40 years ago, scientists say.
The UK Health Security Agency announced 14 more cases in England on Tuesday, bringing the total to 70, and another patient in Scotland. No cases have been reported in Wales or Northern Ireland.
Routine vaccination against smallpox stopped in most countries before 1980, when the World Health Assembly declared the disease eradicated. As the vaccine also protects against monkeypox, the campaign also keeps the disease under control, especially in regions of Central and West Africa where the virus is endemic.
In the decades since the end of smallpox vaccination, the proportion of people protected against monkeypox has dropped significantly, allowing the virus to spread more easily from animals to humans and from person to person, fueling the risk of a major outbreak.
“This epidemic was really waiting to happen,” said Dr Romul Breban, a researcher at the Pasteur Institute in Paris. The mathematical modeling of Breban and his team in 2020 found that in the Democratic Republic of the Congo, for example, immunity against monkeypox fell from 85% in the early 1980s to 60% in 2012. With declining immunity, monkeypox represents ” “An ever-increasing threat to health security,” he wrote at the time. In 2020, the DRC had more than 4,000 suspected cases and at least 171 deaths.
“Our level of immunity is almost zero,” Breban said. “People aged 50 and over are probably immunized, but the rest of us are not, so we are very, very susceptible. He believes the outbreak can be controlled and said it is an opportunity to offer vaccination campaigns in countries where the virus is endemic.
To date, only a few cases of monkeypox have been reported in the United Kingdom, all related to travel from Nigeria. Since the first case in the United Kingdom in 2022 was announced on May 7, nearly 300 suspected or confirmed cases have come to light in at least 16 countries.
The increase in cases has raised questions about whether the monkeypox virus has evolved into a more portable form. So far, scientists have found no evidence of this, but researchers are studying DNA to see if mutations in the virus may have changed its behavior. Genetic studies so far show that the virus corresponds to strains that reached the United Kingdom, Singapore and Israel in 2018 and 2019.
Professor David Heyman, a prominent contributor to Chatham House’s global health program, said the epidemic appeared to be more of a coincidence, with the virus intensifying as it entered a community of men who have sex with men.
Graham Medley, a professor of infectious disease modeling at the London School of Hygiene and Tropical Medicine, said it was unlikely to have the same “explosive growth” in infections among the general population that Covid had seen. But he said the epidemic could last several months as tracking of contacts slows down but does not stop the transmission.
“As with Covid, we can expect reversals as the monkey outbreak continues,” he said. “Currently, the transmission chains are mostly in sexually active younger men, but there are other conditions where there is enough contact to spread the monkeypox. The longer the outbreak lasts and the greater the spread, the more likely the monkeypox is to find these other niches. “
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Researchers from the United Kingdom have found promising but preliminary signs that the antiviral agent can help reduce the disease from the virus. In a study published in the Lancet Infectious Diseases, four out of seven patients diagnosed with monkeypox in the UK between 2018 and 2021 received either brincidofovir or tecovirimate, drugs developed to treat smallpox.
The results of the three patients who were given brincidofovir suggest that the drug provided little clinical benefit and did not appear to reduce the duration of the disease. However, the only patient treated with tecovirimat had a shorter hospital stay and appeared to excrete the virus detected by PCR tests in a shorter period of time.
Dr Hugh Adler, co-author of the study at Liverpool University Hospitals, an NHS trust, said that although only one patient was involved, the result for tecovirimate was a “promising signal”.
“Now that we see more cases, unexpectedly, we think it’s important to share,” he said. “This is the sum of human experience with these drugs and monkeypox so far.”
The United Kingdom has provided tecovirimate and offers a smallpox vaccine for close contact with people diagnosed with monkeypox to reduce the risk of symptomatic infection and serious illness. Sources estimate that an additional 20,000 doses of the vaccine have been ordered to add to the UK’s 5,000 stocks.
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