British Report Concludes First Monkeypox Infections in April

Tuesday August 16, 2022

British Report Concludes First Monkeypox Infections in April
  (Source:Getty Images)

A report published on the Center for Disease Control's Emerging Infectious Diseases website indicated transmission of the monkeypox virus (MPXV) in England was first identified amongst 45 men in April 2022. It concluded that interventions targeting sex-on-premises venues, geospatial dating applications, and sexual health services are likely to be critical for outbreak control.

The virus is a zoonotic viral infection endemic to West and Central Africa and is spread primarily through close skin-to-skin contact. Prior to this spring, instances of MPXV in Europe were related to travel from monkeypox-endemic areas, but "in May 2022, several countries in Europe reported sustained human-to-human transmission of MPXV, primarily in sexual networks of gay, bisexual, and other men who have sex with men (GBMSM)."

At that time there were 82 cases with known or suspected links to transmission in GBMSM sexual networks. Voluntary interviews of those infected included questions related to "demographics (sex, age, sexual orientation, ethnicity, country of birth); potential exposures in the 21 days before symptom onset (travel history, exposure events, sexual behavior); markers of sexual behavior associated with higher risk of acquiring sexually transmitted infections (STIs) (previous STI, number of sex partners in past 3 months); and HIV prevention and care (status, HIV preexposure prophylaxis [PrEP], HIV treatment)," the site said.

"Nearly all interviewed case-patients self-identified as either gay or bisexual (98%, 44/45). HIV status was reported by 43 case-patients: 74% (32/43) were HIV negative, of which 91% (29/32) were receiving PrEP; 11/43 (26%) reported living with HIV and all were receiving HIV treatment. Although most (29/45, 64%) case-patients reported attending sex-on-premises venues, festivals, private sex parties, or cruising grounds in the 21 days before symptom onset, 16/45 (36%) did not report such exposures (Table). Of those, 12/16 (75%) reported sexual activity with new partners; 10/12 (83%) met via geospatial dating applications."

Amongst the report's conclusions are that "MPXV transmission in sexual networks of GBMSM in England has been occurring since at least April 2022, with potential importations and exportations from other countries in Europe. MPXV transmission in sexual networks has been suggested for outbreak investigations in Nigeria. The origin and prevalence of MPXV infection among GBMSM is unknown, but international dissemination was probably catalyzed by travel and resumption of events after lifting of restrictions associated with the COVID-19 pandemic."

The primary means of transmission was identified as through "sexual contact in dense sexual networks of GBMSM, often between multiple new partners who are probably difficult to contact trace because of one-time contacts."

The findings also "suggest that a substantial element of MPXV transmission in England occurs within sex-on-premises venues. To achieve outbreak control, targeted interventions for venues and their users are vital, including supporting enhanced cleaning of venues to prevent transmission via fomites, targeted health promotion to build awareness and inform risk management, and innovative approaches to support contact tracing of venue attendees. Designing and implementing these interventions requires community and stakeholder engagement."

But "a substantial proportion of case-patients did not report specific exposure settings, stressing the need for wider interventions to reach all GBMSM in these sexual networks. The high use of geospatial dating applications highlights their utility as a platform for health promotion."