Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study
The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection....
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| Published in | The Lancet infectious diseases Vol. 23; no. 2; pp. 196 - 206 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Ltd
01.02.2023
Elsevier Elsevier Limited Elsevier Science ;, The Lancet Pub. Group |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1473-3099 1474-4457 1474-4457 |
| DOI | 10.1016/S1473-3099(22)00651-X |
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| Abstract | The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection.
We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination.
226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18–68; IQR 32–43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36–1659; IQR 500–885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1–8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6–21] for patients with HIV vs median rash burden score 6 [IQR 3–14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status.
Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact.
US Centers for Disease Control and Prevention, International Society of Travel Medicine. |
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| AbstractList | The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection.BACKGROUNDThe early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection.We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination.METHODSWe descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination.226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status.FINDINGS226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status.Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact.INTERPRETATIONClinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact.US Centers for Disease Control and Prevention, International Society of Travel Medicine.FUNDINGUS Centers for Disease Control and Prevention, International Society of Travel Medicine. The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm or 500 cells per mm and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. US Centers for Disease Control and Prevention, International Society of Travel Medicine. The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18–68; IQR 32–43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36–1659; IQR 500–885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1–8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6–21] for patients with HIV vs median rash burden score 6 [IQR 3–14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. US Centers for Disease Control and Prevention, International Society of Travel Medicine. © 2022 Elsevier Ltd. All rights reserved. Background: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. Methods: We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. Findings: 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. Interpretation: Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. US Centers for Disease Control and Prevention, International Society of Travel Medicine Summary Background The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. Methods We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. Findings 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18–68; IQR 32–43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36–1659; IQR 500–885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1–8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6–21] for patients with HIV vs median rash burden score 6 [IQR 3–14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. Interpretation Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. Funding US Centers for Disease Control and Prevention, International Society of Travel Medicine. |
| Author | Larsen, Carsten S Greenaway, Christina Kozarsky, Phyllis Rothe, Camilla Glynn, Marielle Soentjens, Patrick Vanhamel, Jef de Frey, Albie Libman, Michael Goorhuis, Abraham Bottieau, Emmanuel Camprubí-Ferrer, Daniel Grobusch, Martin P Nguyen, Duc Asgeirsson, Hilmir Glans, Hedvig Angelo, Kristina M Whitehill, Florence Aysel Florescu, Simin Díaz Menéndez, Marta Chakravarti, Arpita McCollum, Andrea Muñoz, José Quilter, Laura Florence, Eric Servera-Negre, Guillermo Huits, Ralph Chaussade, Hélène Beadsworth, Michael Desclaux, Arnaud Lloveras, Susana Barkati, Sapha Malvy, Denis Tumiotto, Camille Huber, Kristina L B Popescu, Corneliu Petru Martin, Charlotte Blumberg, Lucille Schwartz, Eli Mendes Pedro, Diogo Guagliardo, Sarah Anne J Licitra, Carmelo Klein, Marina Balerdi-Sarasola, Leire Duvignaud, Alexandre Hamer, Davidson H Smith, Teresa |
| Author_xml | – sequence: 1 givenname: Kristina M surname: Angelo fullname: Angelo, Kristina M email: kangelo@cdc.gov organization: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA – sequence: 2 givenname: Teresa surname: Smith fullname: Smith, Teresa organization: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA – sequence: 3 givenname: Daniel surname: Camprubí-Ferrer fullname: Camprubí-Ferrer, Daniel organization: ISGlobal, Hospital Clinic Universitat de Barcelona, Barcelona, Spain – sequence: 4 givenname: Leire surname: Balerdi-Sarasola fullname: Balerdi-Sarasola, Leire organization: ISGlobal, Hospital Clinic Universitat de Barcelona, Barcelona, Spain – sequence: 5 givenname: Marta surname: Díaz Menéndez fullname: Díaz Menéndez, Marta organization: Department of Tropical Medicine, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid, Spain – sequence: 6 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givenname: Emmanuel surname: Bottieau fullname: Bottieau, Emmanuel organization: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium – sequence: 12 givenname: Christina surname: Greenaway fullname: Greenaway, Christina organization: J D MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC, Canada – sequence: 13 givenname: Martin P surname: Grobusch fullname: Grobusch, Martin P organization: Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands – sequence: 14 givenname: Diogo surname: Mendes Pedro fullname: Mendes Pedro, Diogo organization: Department of Infectious Diseases, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal – sequence: 15 givenname: Hilmir surname: Asgeirsson fullname: Asgeirsson, Hilmir organization: Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden – sequence: 16 givenname: Corneliu Petru surname: Popescu fullname: Popescu, Corneliu Petru organization: Carol Davila University of Medicine and Pharmacy, Bucharest, Romania – sequence: 17 givenname: Charlotte surname: Martin fullname: Martin, Charlotte organization: Department of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium – sequence: 18 givenname: Carmelo surname: Licitra fullname: Licitra, Carmelo organization: Orlando Health Travel Medicine, Orlando, FL, USA – sequence: 19 givenname: Albie surname: de Frey fullname: de Frey, Albie organization: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa – sequence: 20 givenname: Eli surname: Schwartz fullname: Schwartz, Eli organization: Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, Israel – sequence: 21 givenname: Michael surname: Beadsworth fullname: Beadsworth, Michael organization: Liverpool School of Tropical Medicine, Liverpool, UK – sequence: 22 givenname: Susana surname: Lloveras fullname: Lloveras, Susana organization: Francisco J Muñiz Infectious Disease Hospital, Buenos Aires, Argentina – sequence: 23 givenname: Carsten S surname: Larsen fullname: Larsen, Carsten S organization: Department of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark – sequence: 24 givenname: Sarah Anne J surname: Guagliardo fullname: Guagliardo, Sarah Anne J organization: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA – sequence: 25 givenname: Florence surname: Whitehill fullname: Whitehill, Florence organization: Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA – sequence: 26 givenname: Ralph surname: Huits fullname: Huits, Ralph organization: Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 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fullname: Florence, Eric – sequence: 34 givenname: Simin surname: Aysel Florescu fullname: Aysel Florescu, Simin – sequence: 35 givenname: Hedvig surname: Glans fullname: Glans, Hedvig – sequence: 36 givenname: Marielle surname: Glynn fullname: Glynn, Marielle – sequence: 37 givenname: Abraham surname: Goorhuis fullname: Goorhuis, Abraham – sequence: 38 givenname: Marina surname: Klein fullname: Klein, Marina – sequence: 39 givenname: Denis surname: Malvy fullname: Malvy, Denis – sequence: 40 givenname: Andrea surname: McCollum fullname: McCollum, Andrea – sequence: 41 givenname: José surname: Muñoz fullname: Muñoz, José – sequence: 42 givenname: Duc surname: Nguyen fullname: Nguyen, Duc – sequence: 43 givenname: Laura surname: Quilter fullname: Quilter, Laura – sequence: 44 givenname: Camilla surname: Rothe fullname: Rothe, Camilla – sequence: 45 givenname: Patrick surname: Soentjens fullname: Soentjens, Patrick – sequence: 46 givenname: Camille surname: Tumiotto fullname: Tumiotto, Camille – sequence: 47 givenname: Jef surname: Vanhamel fullname: Vanhamel, Jef |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36216018$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:153233618$$DView record from Swedish Publication Index |
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| Snippet | The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic... © 2022 Elsevier Ltd. All rights reserved. Background: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from... Summary Background The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously... |
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| Title | Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study |
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