Paper identified the virus as needing more attention two years ago, ahead of current outbreak
Scientists studying 2018-19 monkeypox outbreaks in the UK, Israel and Singapore called for “more study” into the virus and other related orthopox viruses—two years before the current UK and global outbreak.
“Human monkeypox epidemiology has changed,” researchers led by Karl Simpson of the company JKS Bioscience in Southampton noted in a 2020 paper published in the journal Vaccine.
“As monkeypox is no longer a rare disease, there is need for more rigorous epidemiological studies, with particular reference to zoonotic hosts, transmission potential and human case severity.”
The paper was co-authored by more than two-dozen scientists, most of them based in the UK, including at Public Health England and the Defence Science and Technology Laboratory in Porton Down.
The paper followed a June 2019 meeting of an “unofficial group of interested experts” at Chatham House, London, which identified gaps in knowledge in:
- understanding of zoonotic hosts, reservoirs and vectors
- risks associated with transmission
- the full description of the clinical spectrum and the natural history of infection.
“Funding for monkeypox research must be increased,” the researchers said, “and newly emerged orthopox viruses that cause disease in humans…add urgency to this need.”
They also noted waning immunity to such viruses after smallpox vaccination ended following the global eradication of variola virus in 1980. “With the cessation of widespread smallpox vaccination,” they said, “increased study of the monkeypox virus, the human disease it causes, and its epidemiology are important.”
Monkeypox is currently not identified as a priority pathogen by the UK Vaccine Network, which informs government funding.
Current outbreak
The UK Health Security Agency has detected 20 cases of monkeypox in England since 6 May.
UKHSA chief medical adviser Susan Hopkins expects “more cases to be identified in the wider community”.
She said: “We continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals.”
Meanwhile, the World Health Organization reported that, since 13 May, it had been informed of nearly 100 cases in a dozen countries, mostly in Europe, but also in the US and Australia. “The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries,” it said on 21 May.
UKHSA and other health experts have downplayed the likelihood of the outbreak spreading much wider in the community, however. “The virus does not usually spread easily between people,” UKHSA said. “The risk to the UK population remains low.”
Serious infection
Monkeypox is a viral infection usually seen in forested areas in west and central Africa, where it is spread by small mammals. It has likely been imported to the UK by a traveller. It can spread between people through close contact. There are no specific drugs or vaccines for it yet, although smallpox vaccine is thought to be effective against it. Mortality ranges from 1 to 10 per cent depending on the strain.
Michael Head, senior research fellow in global health at the University of Southampton, said monkeypox “can be a serious infection, with mortality rates from this type of monkeypox virus having been around 1 per cent in other outbreaks”.
But he added that “the risks to the wider UK public are extremely low, and we do have healthcare facilities that specialise in treating these tropical infections”.
Gaps in knowledge
Head noted that there are “currently gaps in our knowledge, and the contact tracing and public health investigation being carried out by UKHSA will no doubt reveal more in due course, for example, about…pattern of transmission. However, it would be very unusual to see anything more than a handful of cases in any outbreak, and we won’t be seeing Covid-style levels of transmission.”
He added: “However, with tropical medicine, these imported cases do indicate a wider burden of disease elsewhere in the world. It may be that in a post-pandemic environment, we should be giving more consideration to understanding the local and global implications of Lassa, monkeypox, Ebola and other rare but serious pathogens.”
The 2020 paper said the “experts further agreed on the need for a better understanding of the genomic evolution and changing epidemiology of orthopox viruses, the usefulness of in-field genomic diagnostics, and the best disease-control strategies, including the possibility of vaccination with new generation non-replicating smallpox vaccines and treatment with recently developed antivirals”.
It called for “enhanced fieldwork” to address these issues with particular reference to:
- Identification of wild species that harbour these viruses in different areas of Africa
- A better definition of the clinical spectrum and severity of disease, including asymptomatic carriage and risk factors for acquisition
- An improved description of outbreak patterns by size and duration
- Measurement of risk of transmission associated with different sorts of contact with clinical cases.