Fund
Cases of human smallpox are rarely seen outside of West and Central Africa. There is little data on viral kinetics or duration of viral spread and no authorized treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for the treatment of smallpox and have been shown to be effective against smallpox in animals. Our goal was to describe the longitudinal clinical course of monkeypox in a high-income setting, along with viral dynamics and any adverse events related to new antiviral therapies.
Methods
In this retrospective observational study, we report clinical features, longitudinal virological findings, and out-of-label antiviral response in seven monkeypox patients who were diagnosed in the UK between 2018 and 2021, identified by retrospective review. of case notes. This study included all patients who were managed in centers dedicated to high-impact infectious diseases (HCID) in Liverpool, London and Newcastle, coordinated through a national HCID network.
Discoveries
We reviewed all cases from the start of the HCID (air) network between August 15, 2018 and September 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a healthcare worker who acquired the virus nosocomially and one patient who acquired the virus abroad transmitted it to an adult and a child within their group. domestic. Notable features of the disease included viremia, prolonged detection of monkeypox virus DNA in upper respiratory tract swabs, low reactive mood, and one patient had a PCR-positive deep tissue abscess. of the smallpox virus. Five patients spent more than 3 weeks (range 22 to 39 days) isolated due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes that led to discontinuation of therapy. One patient was treated with tecovirimate (200 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral spread and disease (10 days hospitalization) compared with six other patients. One patient experienced a mild relapse 6 weeks after hospital discharge.
Interpretation
Human smallpox poses unique challenges, even for well-equipped healthcare systems with HCID networks. Prolonged removal of viral DNA from the upper respiratory tract after resolution of skin lesions challenged the current infection control and prevention guideline. There is an urgent need for prospective antiviral studies for this disease.
Financing
Cap.