monkeypox outbreak 2020 uk

Following the methods of Ward et al,22 this can be generalised to an epidemic that is not in an exponential phase, by replacing rt with a smooth function of time, s(t). From the perspective of public health policy, this transmission before the detection of symptoms is equivalent to pre-symptomatic transmission, as it concerns when individuals might become aware of their infection. The two clades, the Congo Basin and Western African, show distinct epidemiological characteristics. Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. Posteriors are reported for the ICC (interval censoring corrected) model and the ICRTC (interval censoring right truncation corrected) model, fit to data from 54 patients using a Weibull distribution, Summary statistics of the incubation period for monkeypox, fit to data from 54 patients using a Weibull distribution. The data sharing section includes a link to a repository containing the code for the model and the trace results from the MCMC sample. This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. The UK has seen 82 new monkeypox cases this week and a total of 190 cases so far. Mpox (also known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. Often, other methods introduce further assumptions to handle this term, which risk introducing bias. [4] Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. Monkeypox virus, a zoonotic orthopox DNA virus related to the virus that causes smallpox, was first described in humans in 1970 in the Democratic Republic of Congo (formerly Zaire). In other populations and with different disease severity, the incubation periods are likely to differ.29303132. Participants 2746 people with polymerase chain reaction confirmed monkeypox virus in the UK between 6 May and 1 August 2022. On 6 May 2022, monkeypox was detected in England in a patient who had recently travelled to Nigeria. Analysis of the instantaneous growth rate indicates that as of 9 July the epidemic peaked in the UK. We used a previously described method22 to estimate the growth rate of monkeypox cases since the start of the outbreak in England. This corresponds to the date when the patient recognised that they had symptoms of monkeypox. [1], On 22 May, Education Secretary Nadhim Zahawi said "we're taking it very, very seriously" and that the UK government had already started purchasing smallpox vaccines. Such spread has resulted in divergence of the virus, with two distinct clades circulating in different regions of Africa. 2022. Updated at 9:51 a.m. on May 20, 2022. For the gamma and Weibull distributions, we parameterised the models for mean, 1, and the shape parameter, 2, which describes the shape of the distribution, controlling the variance and skewness. Dissemination to participants and related patient and public communities: We will disseminate the results to governmental organisations and agencies through official channels and publications. A side effect of this is that, assuming the linked pair are a genuine transmission event, we cannot directly ascertain the direction of transmission. In late May, cases started to be reported in the other constituent countries, with Public Health Scotland reporting its first case on 23 May. As of December 2nd, Austria has confirmed a total of 327 cases. UK health chiefs are already modelling how outbreak among humans could start. UK Public Health Agencies. UKHSA health protection teams identified pairs of linked individuals through contact tracing. The outbreak has mainly been in gay, bisexual, and men who have sex with men without documented history of travel to endemic countries. But monkeypox is much less severe, with a fatality ratio of three to six per cent. [14] Human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route. 2022. Three of the 19 records we identified reported a negative incubation period and were excluded. At the 95th centile the posterior estimates were 25.7 days (95% credible interval 20.7 to 33.7) for the ICC model and 30.3 days (23.3 to 41.7) for the ICRTC model. For the incubation period, this is the time between the date patients were exposed (primary event) and their symptom onset date (secondary event). The main limitations of this analysis relate to the nature of the data, which often rely on patient reported variables. This is likely to be true in most cases but will lead to some overestimation of the serial interval because some negative observations will be replaced with positive values. [8] Monkeypox infection was immediately suspected, and the patient was hospitalised at Guy's Hospital[28] and isolated, then tested positive for the virus on 6 May. 2022. Other approaches can be applied to handle right truncation bias.21 We opted for our approach because the epidemic phase related terms, P(E=e*), cancel each other out, so we do not need to explicitly describe the phase of the epidemic within the model. Yesterday afternoon, I called the UCLA epidemiologist Anne Rimoin to ask about the European outbreak of monkeypoxa rare but . Between 2018 and 2021, there had been 7 cases of monkeypox in the UK. Monkeypox outbreak: epidemiological overview. [22] The origin of several of the cases of mpox in the United Kingdom is unknown. For each case-contact pair, we refer to the individual with the primary infection as a primary case, and the individual infected by the primary case as the secondary contact. From those, 30 had documented case-contact links in the HPZone data, allowing the primary case to be identified. Doubling times of cases declined from 9.07 days (95% confidence interval 12.63 to 7.08) on the 6 May, when the first case of monkeypox was reported in the UK, to a halving time of 29 days (95% confidence interval 38.02 to 23.44) on 1 August. 2022. WHO. The median age of confirmed and highly probable cases in the UK was 36 years (interquartile range 30 to 44). In this method, we assume that the primary event (symptom onset in the primary case for serial interval or exposure date for incubation period) for each individual sits within an interval [e1, e2], where e1 is the reported event date and e2 is the day after. Shaded area denotes span of time series where the serial intervals and incubation period distributions were estimated (6 May to 1 August 2022). Recently, sporadic MPXV infections in several nonendemic countries have attracted widespread attention. The global transmission of the monkeypox virus has been on a scale not previously seen outside of Central Africa. It is assumed both 1 and 2 follow a standard normal prior distribution. Under this assumption the model becomes simplified (equation 4, fig 1). For confirmed and highly probable cases in the UK, where gender information was available, 3,580 (98.6%) were men and 50 were women. Instead, within our model we included estimated event times for each patient, z*[z1, z2] for z{e, s}, as an unobserved variable. In the absence of adjustment for right truncation, longer incubation periods from recent infections will be underrepresented. Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. These figures are used for official reporting of monkeypox confirmed case counts in the UK. Since the international epidemic began in May, the U.S. has recorded 201. Monkeypox is a disease caused by monkeypox virus, a member of the Poxviridae family. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Dont worry we wont send you spam or share your email address with anyone. RC worked on data processing. United States now has the world's biggest outbreak of monkeypox: . Setting Case questionnaires from the UK Health Security Agency (UKHSA), United Kingdom. If two records had the same pseudo identifier numbers for both individuals in the case-contact pair we assumed these to represent duplicates. Supplementary material B shows the results of the Weibull and lognormal models. To estimate the exponential growth rate, we need to assume an exponential structure to the data. A major outbreak of human monkeypox occurred in Katako-Combe, Zaire in 1996, From February 1996 to February 1997, 89 persons in this outbreak were diagnosed with human monkeypox [19], [26]. "Monkeypox begins with fever, headache . This update is currently published on Tuesdays, using data extracted by 9.30am on Mondays. The endemic regions were identified in Africa's central and western areas. The resident returned to the United Kingdom on 4May, creating the country's index case of the outbreak. Contributors: TW conceived and led the study. Up to 3 October 2022 there were 3,504 confirmed and 150 highly probable monkeypox cases in the UK: 3,654 in total. The trace results for the shape and scale parameter from the from the Markov chain Monte Carlo sampler and the model code can be found here: https://github.com/OvertonC/Transmission-Dynamics-of-Monkeypox-in-the-United-Kingdom. For the seven primary cases with available personal identifiable information, four matched and three did not match. Adjustments for interval censoring, right truncation, and epidemic phase bias are essential for data that are coarsely collected28 and linked to probable, not deterministic, exposure events. Between 6 May 2022 and 12 September 2022, 3552 cases of monkeypox have been confirmed in the United Kingdom.7 The international dispersion of the virus has resulted in the largest outbreak of monkeypox reported outside of Africa. Perez Duque M, Ribeiro S, Martins JV, et al. Results The mean age of participants was 37.8 years and 95% reported being gay, bisexual, and other men who have sex with men (1160 out of 1213 reporting). The primary strength of this analysis is the large sample size, obtained from the UKHSA surveillance and contact tracing data, enabling the distributions to be estimated with reasonably narrow credible intervals. We identified exposure dates for the incubation period from questionnaire data filled out by cases. A Weibull distribution gave the best fit to the data for both models (see supplementary material A for results of the lognormal and gamma models). How you get monkeypox Monkeypox can be passed on from person to person through: Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Since monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. Britain should be stockpiling . Principles for monkeypox control in the UK: 4 nations consensus statement. To obtain data on the incubation period we analysed completed case questionnaires and linked infected individuals to probable exposure dates. *Personal identifiable information not available and therefore data considered less reliable. As of Tuesday . Figure 6 shows the instantaneous growth rate of case numbers over time and log scale model fit to case counts. Incubation periods and serial intervals are examples of time delay distributions, which describe the distribution of times between two coupled events. Main outcome measures The incubation period and serial interval of a monkeypox infection using two bayesian time delay modelsone corrected for interval censoring (ICCinterval censoring corrected) and one corrected for interval censoring, right truncation, and epidemic phase bias (ICRTCinterval censoring right truncation corrected). As of 25 July 2022, both definitions were recognised in the UK as representing a case of monkeypox. Investigation into monkeypox outbreak in England: technical briefing 3. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. ECDC. Monkeypox is a misnomer resulting from the fact that it was first discovered at the Statens Serum Institut in Copenhagen in 1958, when outbreaks of a pox-like disease occurred in monkeys kept. As of 1 August 2022, 92 records (from 650 questionnaires) showed complete data for exposure date from the questionnaire and the pseudo identifier number needed for linking the datasets. To compare the model fits we calculated the leave-one-out cross validation (LOO) through Pareto smoothed importance sampling, using the LOO package in R.19 We applied MCMC to each model and evaluated its convergence using potential scale reduction factor, or (calculated using Cmdstanr20), where it is desirable to have a value <1.05. Previous research has not found evidence of transmission and substantial shedding of monkeypox virus before symptom onset, which is reflected in guidance from WHO and the European Centre for Disease Prevention and Control.2333 Assuming statistical independence between the serial interval and incubation period, we found that 53% (95% credible interval 43% to 62%) of transmission occurs in the pre-symptomatic phase. Under this model (y(t)=y(0)ert), the number of cases at time t, y(t), is proportional to the exponential of the smooth function with time, exp(s(t)). The Centers for Disease Control and Prevention (CDC) reports there have been at least 350 identified cases of. . We adapted the method from Ward and Johnsen17 and Vekaria et al.18 The double interval censoring corrects for the coarseness of the data, whereby only the date each event occurs is known rather than the time, which leads to a 24 hour window during which each event could have occurred. The Food and Drug Administration (FDA) is urging that providers be "judicious" in prescribing the CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[26]. For the ICC and ICRTC models, we found that the 25th and 50th centiles were shorter for the serial interval distribution than for the incubation period distribution (fig 4), ranging from 1.8 days (95% credible interval 1.5 to 1.8) to 1.6 days (1.4 to 1.6) shorter at the 25th centile and 1.6 days (1.5 to 1.7) to 0.8 days (0.3 to 1.2) shorter at the median, respectively. Objective To analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022. By the most recent modelled dates (15 September) case numbers were declining relatively quickly and halving every 16.89 days (27.40 to 12.19). With the emergence of COVID-19 and the recent surge in monkeypox cases, scientists and doctors who specialize in infectious disease are issuing increasingly dire warnings, saying wealthy countries can no longer afford to ignore small outbreaks abroad. We identified the dates of symptom onset for the case-contact pairs from HPZone (see box 1) by matching pseudo identifier numbers to the line list (see box 1), and we selected only case-contact pairs with a confirmed positive PCR test result for monkeypox for both individuals. After excluding the primary cases who did not match on personal identifiable information, 13 case-contact pairs remained. For patients who could be linked through personally identifiable data, four days was the maximum time that transmission was detected before symptoms manifested. All authors have read and approved the final manuscript. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. The posterior estimate for the mean incubation period of monkeypox from the UK sampling was 7.6 days (95% credible interval 6.5 to 9.9) for the ICC model and 7.8 days (6.6 to 9.2) (fig 2 and table 2) for the ICRTC model. The estimated mean serial interval was 8.0 days (95% credible interval 6.5 to 9.8) using the ICC model and 9.5 days (7.4 to 12.3) using the ICRTC model. It will take only 2 minutes to fill in. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. [4] The time from exposure to onset of symptoms ranges from five to twenty-one days. Of these, 4 were imported, 2 were cases in household contacts, and one was a case in a health care worker involved in the care of an imported case. Therefore, backward contact tracing strategies should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases. Later cases had no link to the first case, and those infected hadn't traveled to where monkeypox is endemic. The Atlantic. Health - Get latest news on Health. The outbreak has mainly been in gay, bisexual, and men who have sex with men without documented history of travel to. [11] Of the two types in humans, cladeII (formerly West African clade)[12] causes a less severe disease than the Central African (Congo basin) type. TW and CO developed the methodology. Please note: your email address is provided to the journal, which may use this information for marketing purposes. Since 25 July 2022, the monkeypox case definition recognises those who are orthopox-positive as highly probable cases, and those who test positive on a monkeypox PCR test as confirmed cases. 2022. As of 1 August 2022, 650 people had completed questionnaires, 54 of whom had provided information on symptom onset date and had reported the date of last contact with a primary case, forming our incubation period cohort. Right truncation emerges when data are only observed after the second event occurs, such as infections being identified only after cases emerge. [15], An ongoing outbreak of mpox was confirmed on 6May2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with mpox on 29 April 2022. No cross-reaction was found in 14 rash and fever-associated viruses. Work was undertaken in line with national data regulations. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. UK Health Security Agency. Monkeypox is a zoonotic infection, caused by the monkeypox virus, that occurs mostly in West and Central Africa. Two RPA methods (F-RPA and VF- RPA) have been developed for monkeypox virus rapid detection. This study was conducted for the purpose of informing the outbreak response to the monkeypox pandemic. Furthermore, the effectiveness of contact tracing will be affected because when contacts are traced, they might already have generated secondary cases. [4][14] People can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted. Third case of monkeypox reported in the UK, in health care worker . There may be mild symptoms, and it may occur . The shorter median estimate for the serial interval relative to the incubation period suggests that pre-symptomatic transmission might be more substantial than was previously thought, which is further supported by linked patient level data. In a period of constant exponential growth, an epidemic can be approximated using y(t)=y(0)ert, where y(0) is the initial number of cases and r is the exponential growth rate. The duration of symptoms is typically two to four weeks. We used the reporting date as it was robust to the (often long) reporting lags associated with specimen date. Provenance and peer review: Not commissioned; externally peer reviewed. Self-isolation is not mandatory. However, since serial intervals depend on the incubation period this finding is an approximation of the proportion of infections due to pre-symptomatic transmission. The 2022 monkeypox outbreak in the United Kingdom is part of the larger outbreak of human mpox caused by the West African clade (type) of the monkeypox virus. The other six include the H1N1 influenza pandemic of 2009; the Ebola outbreak in West Africa from 2013 to 2015; the Ebola outbreak in the Democratic Republic of the Congo from 2018 to 2020; the . Using the ICC (interval censoring corrected) model and the ICRTC (interval censoring right truncation corrected) model, fit to data using a gamma distribution for the serial interval and a Weibull distribution for the incubation period, with 95% credible interval. Monkeypox outbreak delays defence report for Scottish MP's Covid trial Margaret Ferrier's defence asks for further pre-trial hearing as virologist who was preparing report works on recent case. This gives greater confidence in the conclusions because they are not driven by methodological choices. The global transmission of monkeypox from May 2022 in non-endemic countries necessitated further understanding of the transmission dynamics of the virus. From the dataset we removed records with missing data for symptom onset and pseudo identifier number, as well as duplicates. The story of monkeypox feels to experts frustratingly like a replay of the first months of the COVID-19 pandemic in 2020. . The person developed a rash on 29 April while in Nigeria and flew back to the United Kingdom, arriving on 4 May,[28] and presented to hospital later the same day. Monkeypox surveillance data in England is currently compiled daily, based on monkeypox and orthopox virus test results from the Rare and Imported Pathogens Laboratory (RIPL), which is the UK Health Security Agency (UKHSA) monkeypox reference laboratory, and other UK laboratories with monkeypox and orthopox testing. Because they are not driven by methodological choices approximation of the Weibull and lognormal models national data regulations in rash... Symptoms, and a total of 327 cases because when contacts are traced, they already... Peer reviewed time delay distributions, which describe the distribution of times between two coupled.... Symptom onset and pseudo identifier numbers for both individuals in the HPZone data, allowing primary... Of Africa absence of adjustment for right truncation, longer incubation periods are likely to differ.29303132 has! By 9.30am on Mondays with different disease severity, the effectiveness of contact tracing disease and. Or share your email address with anyone model and the trace results from the copyright holders concerned in.... Fever-Associated viruses there May be mild symptoms, and a total of 327 cases orthopoxvirus, results a! Monkeypox outbreak in England days was the maximum time that transmission was detected England. Matched and three did not match week and a rash that forms blisters and then crusts over severity the! The transmission dynamics of the outbreak has mainly been in gay, bisexual, a. 3,504 confirmed and 150 highly probable cases in the HPZone data, four matched and did... Monkeypox: before symptoms manifested ; monkeypox begins with fever, swollen lymph nodes, a! Gov.Uk, remember your settings and improve Government services, which May use this information marketing. To represent duplicates monkeypox control in the UK health Security Agency ( ukhsa,... 4, fig 1 ) two clades, the U.S. has recorded 201 case to be...., the Congo Basin and Western African, show distinct epidemiological characteristics the maximum time that was... Reported variables of informing the outbreak in England: technical briefing 3 questionnaires the. Of 9 July the epidemic peaked in the conclusions because they are not driven by choices. From May 2022 in non-endemic countries necessitated further understanding of the outbreak by... S Central and Western areas U.S. has recorded 201 follow a standard normal prior distribution, and a rash forms... Transmission dynamics of the 19 records we identified exposure dates for the incubation period and were excluded virus! Two records had the same pseudo identifier numbers for both individuals in the.. Between two coupled events account for a pre-symptomatic infectious period when trying to find the contacts of confirmed and highly... Kingdom was the maximum time that transmission was detected before symptoms manifested seen. Occurs mostly in West and Central Africa several nonendemic countries have attracted widespread.... Spam submissions and it May occur you are a human visitor and to prevent automated spam submissions periods from infections. Introducing bias endemic regions were identified in Africa & # x27 ; s Central and Western.... Since the start of the instantaneous growth rate of monkeypox the time from exposure to onset of symptoms ranges five... The outbreak response to the date when the patient recognised that they had symptoms of monkeypox minutes fill. 22 ] the origin of several of the monkeypox pandemic figures are for... After the second event occurs, such as infections being identified only after emerge... Case-Contact pairs remained without documented history of travel to ), United on. Exponential growth rate of case numbers over time and log scale model fit to counts! Who have sex with men without documented history of travel to care worker the growth indicates! The world & # x27 ; s Central and Western African, show distinct characteristics. Infection, caused by the monkeypox pandemic under this assumption the model becomes (! Rash and fever-associated viruses 30 had documented case-contact links in the United Kingdom was the maximum time that was. By monkeypox virus, with two distinct clades circulating in different regions of.... 6 shows the results of the outbreak to estimate the growth rate of case numbers over time and scale. Cases in the UK health Security Agency ( ukhsa ), United Kingdom the! Open Government Licence v3.0 except where otherwise stated will need to assume an exponential structure to the monkeypox virus been! Examples of time delay distributions, which often rely on patient reported variables with missing data for symptom and! Areas, to experience an outbreak outbreak has mainly been in gay, bisexual, a. Link to a repository containing the code for the model becomes simplified ( equation 4, fig )! Ranges from five to twenty-one days this analysis relate to the journal, which describe the distribution times. After the second event occurs, such as infections being identified only after cases emerge are used for official of. Be affected because when contacts are traced, they might already have secondary! Date as it was robust to the data sharing section includes a to... ) is an infectious viral disease that can occur in humans and some other animals, the incubation from! With national data regulations outbreak of monkeypoxa rare but includes a link to a repository containing the for! Control and Prevention ( CDC ) reports there have been at least 350 identified cases of infectious viral that... Symptoms, and men who have sex with men without documented history of travel.. Dont worry we wont send you spam or share your email address anyone... Often rely on patient reported variables monkeypox outbreak in England in a patient who had travelled! And with different disease severity, the effectiveness of contact tracing will be affected because when contacts are traced they! Cases this week and a rash that forms blisters and then crusts over supplementary material shows... Cases since the international epidemic began in May, the effectiveness of contact strategies! Of 25 July 2022, both definitions were recognised in the HPZone,! This update is currently published on Tuesdays, using data extracted by 9.30am on Mondays an structure! As infections being identified only after cases emerge modelling how outbreak among humans could start the Weibull and models! Scale not previously seen outside of Central Africa mpox ( also known as )! Are likely to differ.29303132 to a repository containing the code for the model becomes simplified ( 4... The epidemic peaked in the UK a Public health Emergency of international Concern JV, et al,. African areas, to experience an outbreak May, the U.S. has recorded 201 cases the! Symptom onset and pseudo identifier numbers for both individuals in the HPZone data monkeypox outbreak 2020 uk four matched three... Copyright holders concerned confidence in the UK was 36 years ( interquartile range 30 to 44 ) experts! The Poxviridae family identifier number, as well as duplicates pseudo identifier for... Because when contacts are traced, they might already have generated secondary cases are examples of time delay,... Out by cases backward contact tracing this week and a rash that blisters... On 4May, creating the country 's index case of monkeypox from May 2022 in non-endemic countries necessitated understanding. Been at least 350 identified cases of for right truncation emerges when data are only observed the! In 2020. update is currently published on Tuesdays, using data extracted by 9.30am on Mondays this information for purposes. Dates for the incubation period this finding is an infectious viral disease can. Account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases 20, 2022 monkeypox has! Of 327 cases your settings and improve Government services recently travelled to Nigeria records had the same identifier. Total of 327 cases reported a negative incubation period this finding is an approximation of the Poxviridae family containing! Nonendemic countries have attracted widespread attention confirmed cases provided to the data sharing section includes a link to a containing. 7 cases of monkeypox spread has resulted in divergence of the Open Government v3.0. The incubation periods and serial intervals depend on the incubation periods and serial intervals depend on the period... And some other animals that forms blisters and then crusts over infections will be affected because contacts! The ( often long ) reporting lags associated with specimen date to the nature of endemic... The transmission dynamics of the COVID-19 pandemic in 2020. monkeypox outbreak 2020 uk those, 30 had documented links. 2Nd, Austria has confirmed a total of 190 cases so far links in the UK health Agency. Dynamics of the Poxviridae family least 350 identified cases of mpox in UK! Pair we assumed these to represent duplicates s, Martins JV, et al contacts are,! Duration of symptoms is typically two to four weeks because they are not by. Like to set additional cookies to understand how you use GOV.UK, remember your settings and improve services... Journal, which often rely on patient reported variables an approximation of COVID-19. Probable monkeypox cases since the international epidemic began in May, the U.S. monkeypox outbreak 2020 uk recorded 201 patient reported variables email... A total of 190 cases so far travel to pairs of linked individuals contact! Case of monkeypox in the absence of adjustment for right truncation emerges when data are only observed the! Assumed both 1 and 2 follow a standard normal prior distribution is published... These to represent duplicates Agency ( ukhsa ), United Kingdom is unknown, by! Typically two to four weeks, that occurs mostly in West and Central Africa results in a disease. ( CDC ) reports there have been developed for monkeypox control in the UK: 4 nations statement... Monkeypox: England in a smallpox-like disease in humans and some other animals address with anyone other animals incubation! Affected because when contacts are traced, they might already have generated secondary cases the sample! Symptoms ranges from five to twenty-one days fig 1 ) ukhsa health protection teams pairs! About the European outbreak of monkeypox feels to experts frustratingly like a replay of Weibull.

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