The study reports the first use of antiviral drugs in patients with monkeypox

A new retrospective study of seven patients diagnosed with monkeypox in the UK between 2018 and 2021 suggests that some antiviral drugs can reduce symptoms and reduce the time a patient is contagious. The cases analyzed in the study published in Infectious Diseases of the Lancet The journal reports the first cases of nosocomial and domestic transmission outside Africa, and reports a patient’s reaction to the first misuse of two different antiviral drugs – brintsidafovir and tecavirimate – for the treatment of the disease.

The study found little evidence that brincidafovir is clinically beneficial, but concluded that further studies of the potential of tecavirimate would be warranted. The authors also report detection smallpox monkeys virus in swabs from the pharynx and blood. As optimal strategies for infection control and treatment have not yet been established, the study data may aid in a global effort to further understand the clinical features of the disease as well as the dynamics of transmission.

“As health officials try to understand what caused the May 2022 monkey outbreaks in Europe and North America, which affected several patients who reported neither travel nor an identified connection to a previously known case,” our study suggests some of the first ideas in the use of antiviral drugs to treat monkeypox in humans, “said Dr Hugh Adler of Liverpool University Hospital’s NHS Foundation Trust, lead author of the article. monkeys are not transmitted very efficiently between humans, and are generally at risk for public health low “.

“The cases reported in our study, in addition to recent outbreaks, underscore the importance of maintaining a joint network of centers on standby to combat sporadic outbreaks of high-impact pathogens such as monkeypox. The cases we observed were complex and resourceful. intensively manage even in the UK with high incomes.With international travel returning to pre-pandemic levels, health officials and healthcare professionals around the world need to be vigilant about the possibility of new cases of monkeypox, ”says Dr. Nick Price of the NHS Foundation Guy & St Thomas’, senior author of the article.

They add: “So far, monkeypox has been a rare, imported disease in the UK, and the NHS High Infectious Diseases Network has treated all seven confirmed cases in the UK by 2021. Outbreaks outside Africa are unusual but have been significant in recent days. Outbreaks have been reported in countries including the United Kingdom and the rest of the world. Clinical data are lacking and we are happy to share some of our collective experience in combating this previously rare and sporadic disease. “

Smallpox, a close relative of the smallpox virus, is a rare disease classified as an infectious disease with high consequences (HCID) UK Health Agency. Currently, there are no licensed treatments for monkeypox, and there are limited data on the duration of its infectivity, the incubation period is five to 21 days. Patients are usually left in isolation in a specialized hospital to prevent the spread of the virus to others.

Smallpox is transmitted from animals to humans, usually from animal bites or the consumption of improperly cooked meat. In rare cases, the virus can spread from person to person. The first case of human ape infection was reported in 1970 in the Democratic Republic of the Congo and is rare outside Central and West African countries. To date, few studies of monkeypox have been conducted in high-income countries.

Reported symptoms of monkeypox include fever, rash, and swollen lymph nodes. Complications have also been reported, including pneumonia, encephalitis, dangerous vision corneal inflammation, and secondary bacterial infections. Published mortality rates vary widely: from 1 to 10% in the Congo Basin and less than 3% in Nigeria. Most deaths from monkeypox occur in children and people living with HIV.

Of the seven monkeypox cases in the UK analyzed in this study, four were imported from West Africa and three more occurred due to human-to-human transmission in clustered cases. The study authors observed clinical data along with laboratory results of nose and throat blood and smear tests to describe the duration and clinical features of monkeypox in high-income settings. The researchers also reported patients’ reactions to antiviral drugs developed to treat smallpox – brintsidofovir and tecovirimate – which have previously shown some efficacy against monkeypox in animals.

Between 2018 and 2019, four patients observed in this study were treated for monkeypox in HCID offices in England. Three of these cases were imported from West Africa. The fourth case occurred in a health worker 18 days after the initial exposure to the virus and was the first example of monkeypox transmission in a hospital outside Africa.

The first three patients were treated with brincidafovir seven days after the initial onset of the rash. Bryncidofovir was not observed to be convincing clinical benefit in the treatment of monkeypox and changes in liver blood tests were observed. The researchers note that it is not known whether the administration of brincidafovir earlier in the course of the disease or with a different regimen would lead to different clinical outcomes. Despite this, all three patients, as well as the fourth patient who was referred to the hospital, were completely cured.

In the UK, in 2021, three more cases of monkey infection were reported in a family that came from Nigeria, and two of these cases were the first examples of household infections outside Africa. One such case occurred in a child who was closely monitored due to the higher probability of mortality from monkeypox in children. Fortunately, this man suffered a mild illness and was completely cured.

One of the patients from the UK in 2021 received treatment with tecavirimate and experienced a shorter duration of symptoms and excretion of the virus from the upper respiratory tract than other cases in this cluster. However, the authors note that it is impossible to draw conclusions about the antiviral efficacy against monkeypox in such a small cohort, which calls for further research on antiviral drugs to treat this neglected tropical disease.

All patients experienced mild disease and were treated in an inpatient setting to control the infection rather than because of the severity of the infection. No patient had generally recognized severe complications of monkeypox, such as pneumonia or sepsis, but one patient had a mild relapse six weeks after discharge from the hospital, and another developed a deep tissue abscess that required drainage. It was also found that patients experience low mood, probably due to isolation in HCID facilities.

“In previous outbreaks of monkeypox, patients were considered infectious until all the lesions were closed. In these seven cases, the virus was observed in the UK for at least three weeks after infection. However, data on infectivity remain limited and are important for future research.” , – says Dr. Catherine Hooligan of the UK Health Agency and University College London, one of the co-authors of the article. [1]

The authors acknowledge some of the limitations of this study, primarily its observational nature and the small number of cases analyzed. The researchers also failed to confirm positive PCR results for monkeypox using laboratory samples of the virus, meaning that continuous isolation of the contagious virus could not be verified.