UK Health Authorities Confirms First Case Of Monkeypox Imported From Nigeria


Health authorities in UK have confirmed that an individual in England has been diagnosed with the rare viral infection monkeypox. 

The patient is believed to have contracted the infection while visiting Nigeria.

The patient was staying in the south west England prior to transfer to the specialist high consequence infectious disease centre at Guy’s and St Thomas’ NHS Foundation Trust, London, where they are receiving appropriate care.

As a precautionary measure, PHE experts are working closely with NHS colleagues to implement rapid infection control procedures, including contacting people who might have been in close contact with the individual to provide information and health advice.

This includes contacting passengers who travelled in close proximity to the patient on the same flight to the UK. If passengers are not contacted, then there is no action they should take.

Dr Meera Chand, Consultant Microbiologist at Public Health England, said:

Monkeypox does not spread easily between people and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary.

PHE and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed to minimise the risk of transmission.

This is not the first time that the virus has been detected in the UK. PHE reported the first UK cases of monkeypox in September 2018.

Monkeypox, an emerging and neglected infectious disease, is caused by the monkeypox virus (MPXV), which belongs to the genus Orthopoxvirus in the family Poxviridae1. The disease has a clinical presentation similar to smallpox, with additional symptoms including adenopathy and maculopapular rash, especially on the palms of the hands and the soles of the feet2. Although there is no specific treatment or vaccine for monkeypox, cross-immunity with smallpox vaccination may offer some protection in human populations3. Nonetheless, the monkeypox lethality rate varies from 1 to 10%4.

Transmission of MPXV in humans occurs either through direct contact with infected animals or through contact with body fluids or respiratory droplets of an infected person, resulting in secondary transmission. Although monkeypox is a zoonotic disease, the animal reservoir has not yet been identified. MPXV has been isolated twice from wild animals: in 1985 from a symptomatic Thomas’s rope squirrel (Funisciurus anerythrus) caught in the Democratic Republic of the Congo (DRC)5 and in 2012 from a sooty mangabey (Cercocebus atys) in Ivory Coast6. More recently, MPXV was sequenced from the feces of chimpanzees in Ivory Coast7. Serological studies have suggested, however, that several rodent species are potential reservoirs8.

In the past two decades, Congo Basin MPXVs have primarily affected two Central African countries, the DRC and the Central African Republic (CAR), at a growing case rate 3,9,10,11. In 2018, monkeypox human cases were also reported in western Cameroon 12, near the border with the Nigeria.

The sequence of the ATI gene (639 bp) was obtained from one of these cases. Given the close phylogenetic relationship identified between the Cameroonian (for the 2018 strain) and Nigerian isolates, the close geographical proximity of the affected regions and the absence of human cases in Cameroon since 1989, the origin of this isolate is likely an import from Nigeria (West Africa). However, as also suggested by the authors, the hypothesis of a natural circulation within Cameroon cannot be completely ruled out12.

Monkeypox cases caused by the West African clade of MPXV have recently been identified outside of the African continent13,14. Three human cases were diagnosed in the United Kingdom (UK), the first of which involved a person traveling through Paris from Nigeria, and the second resulting in a nosocomial transmission to a health worker in the UK15. Additional cases have recently been imported into Israel and Singapore from Nigeria16,17.

Many MPXV genomes have been sequenced from previous outbreaks in the DRC and Nigeria, but no genomic data is currently available for MPXV detected over the past two decades in the CAR. In Central Africa, the Congo Basin is a large block of tropical rainforests covering, from West to East, Equatorial Guinea, Gabon, southern Cameroon, the southern and northern parts the Republic of the Congo (R. Congo), the northern half of the DRC, and several southern regions of the CAR (Sangha-Mbaéré, southern Mambéré-Kadéï, southern Lobaye, southern Mbomou; see details in Fig. 1).

By contrast, northern regions of the CAR are mainly composed of savannah habitat-types. Obtaining genomic data from viruses isolated between 2001 and 2018 in the CAR can be therefore very interesting to better understand how outbreaks emerged at the ecotone between rainforests and savannahs.

figure 1
Geographic origin of the 56 monkeypox virus (MPXV) isolates analysed in this study (a). The 10 MPXV isolates collected in the CAR and specially sequenced for this study are indicated in the map of (b). The localities of reporting and years of these MPXV cases are indicated in white. As detailed in Fig. 2, the MPXV isolates belong to the West African clade (orange) or to the Central African groups I (blue), II (white), III (yellow), IV (green) and V (pink). The map was created with ggmap v3.0.0 under R 4.0.456. Maps Data: Google, 2021 NASA/TerraMetrics.

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