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Commentary

Travel-Related Monkeypox Outbreaks in the Era of COVID-19 Pandemic: Are We Prepared?

1
Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
2
World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
3
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
4
Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD 4067, Australia
5
Department of Medical Biochemistry, Eko University of Medicine and Health Sciences, Ijanikin 102004, Lagos State, Nigeria
6
College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
*
Author to whom correspondence should be addressed.
Academic Editor: Jônatas Abrahão
Viruses 2022, 14(6), 1283; https://doi.org/10.3390/v14061283
Received: 21 May 2022 / Revised: 2 June 2022 / Accepted: 10 June 2022 / Published: 13 June 2022
(This article belongs to the Section Human Virology and Viral Diseases)

Abstract

Several neglected infectious pathogens, such as the monkeypox virus (MPXV), have re-emerged in the last few decades, becoming a global health burden. Despite the incipient vaccine against MPXV infection, the global incidence of travel-related outbreaks continues to rise. About 472 confirmed cases have been reported in 27 countries as of 31 May 2022, the largest recorded number of cases outside Africa since the disease was discovered in the early 1970s.
Keywords: travel medicine; communicable disease control; monkeypox; COVID-19; orthopoxvirus travel medicine; communicable disease control; monkeypox; COVID-19; orthopoxvirus

1. Introduction

Monkeypox virus (MPXV) is a re-emerging zoonotic virus caused by orthopoxvirus and results in a smallpox-like condition in humans [1,2]. Since the first human cases of monkeypox were discovered in the Democratic Republic of the Congo (DRC) in 1970, the disease has spread to other Central and West African countries, with cases outside of Africa emerging in recent years [3]. The exportation of cases of monkeypox has been linked to recent outbreaks in Nigeria, which began in 2017 with a total of 88 cases [4]. Subsequently, sporadic cases of monkeypox in Nigeria have been reported in 2018, 2019, 2020, 2021 and 2022 (49, 47, 8, 34 and 21 cases, respectively) [5]. At the time of writing this report, the first death associated with the virus was recorded in Nigeria [5]. The most recent travel-related incidence of MPXV was in the UK in April/May 2022 [6].
Currently, there are multiple outbreaks in Europe, the Americas and Australia [7]. It is important to note that the initial imported cases originated from Nigeria. While travel plays a vital role in infectious disease outbreaks, as seen in the case of COVID-19 [8], interestingly, MPXV has spread across different countries, with more recent cases not related to travel to endemic regions (Figure 1) [9]. The ongoing MPXV outbreak has been reported in 27 countries, and about 472 cases have been confirmed (31 May 2022), thus the largest number recorded outside of Africa since the disease was discovered in the 1970s (Table 1).
Historically, the first outbreak outside Africa was reported in 2003 in the US [18,19,20]; no other travel-related cases were reported until 2018. From 2018 to April 2022, nine travel-related MPXV events have been recorded in four countries (UK, Singapore, Israel, and the US), resulting in at least eleven laboratory-confirmed cases (Table 2). In 2018, three events occurred outside Africa, two in the UK and one in Israel, resulting in four cases of human MPXV; in 2019, two cases from two outbreaks were recorded in Singapore and the UK [4]. There were no travel-related outbreaks reported in 2020. However, three outbreaks were recorded in 2021, one in the UK and two in the US (n = 5 cases) [4].
To better understand the disease, a genomic analysis of ten MPXV isolates was conducted during the outbreak in 2017 and 2018, when the first cases of exported MPX were reported [4]. The samples comprised five local (Nigerian) MPXV cases, four exported cases (UK1, UK2, Israel, Singapore) and one nosocomial transmission case within the UK (UK3) [4]. The study showed that the exported cases during the outbreak belonged to the West African clade and shared a common ancestor with a local case in Bayelsa State with a travel history to Bayelsa, Delta or Rivers State [4].
During this current outbreak, a genomic sequence conducted in Portugal suggests that the 2022 virus belongs to the West African clade and may be related to the 2018 and 2019 MPX viruses exported from the region [17]. However, it is interesting to note that the more recent cases in other parts of the world have not been associated with travel to endemic areas or mapped epidemiologically to West or Central Africa [9]. Given this new development, the disease is now topical, indicating a possible community spread of the disease in an environment where it is not endemic. Based on current available data, 98% (214/217) of confirmed cases who indicated their gender were men [10]. Furthermore, some of the ongoing outbreak clusters have been reported among men who have sex with men [7]. This pattern is considered unusual as there have been no previous reports of possible sexual transmission of the disease [7].

2. Impact of COVID-19 on Monkeypox Surveillance in Nigeria

Amid the monkeypox outbreak, the first COVID-19 case in Nigeria was reported in March 2020 [29,30]. The onset of COVID-19 limited international travel and movement, which may account for the few cases of MPVX reported in 2020 and no record of travel-related or exported cases [30]. The focus on COVID-19 may have been a disadvantage in the fight against monkeypox and other endemic diseases as most Nigerian states laid emphasis on the surveillance and monitoring of the pandemic [30]. In addition, the fear associated with COVID-19 may have led to people not seeking care in health facilities, resulting in missed cases [30]. Current estimates show that there are currently 21 cases of MPVX and one death in Nigeria [5], which calls for concern, given that countries are lifting restrictions on COVID-19. Borders are reopened, it is no longer a requirement to wear masks outdoors in some places, and rules on social gatherings have been relaxed [31]. The surge in the number of exported cases of monkeypox may not be unrelated to these changes. However, it is unknown if COVID-19 restrictions impacted the spread of MPXV and warrant further research. Given the recent number of travel-related cases overseas and the current number of cases, it is evident that several factors may drive the outbreak. These include the waning herd immunity from smallpox vaccination which offered cross-protection for MPXV, contact with wild animals including the sale and consumption of bushmeat, poor community knowledge and lack of awareness of the disease [32,33].

3. Recommendations and Considerations for Future Research

Monkeypox is incorporated into Nigeria’s Integrated Disease Surveillance and Response System (IDSR), and a one health approach is currently being used to manage the outbreak [34]. However, there are gaps in knowledge about the epidemiology, host reservoir, transmission, role of environmental factors and genetic diversity of the disease [4,35,36]. Thus, Nigeria and other African countries need to increase the surveillance and detection of monkeypox cases to aid the understanding of this resurging disease [37]. While the global focus is on reducing the incidence of COVID-19, it may be worthwhile to consider a similar collaborative effort internationally to reduce the incidence of MPXV. It is vital to realize that diseases have no borders, especially with globalization and increased travel [4]. With the increasing number of travel-related outbreaks of monkeypox amid this pandemic, the burden of this crisis cannot be overemphasized. In addition, the outbreaks in other non-endemic countries emphasize the need for a concerted global effort focusing on the surveillance and rapid identification of cases, which are crucial for outbreak containment, while scaling up response to curb any further spread [38].
Furthermore, the dearth of knowledge and studies on monkeypox from Africa warrants the need for more research studies on monkeypox. Although there is no specific treatment for monkeypox infection, the present JYNNEOS vaccine licensed in the United States for monkeypox and smallpox should be deployed for targeted intervention in the high-risk regions [39].

Author Contributions

Conceptualization, O.A.A.; methodology, O.A.A., M.E.C., F.O.A. and T.I.E.; validation, O.A.A., M.E.C., F.O.A., A.P. and T.I.E.; investigation, O.A.A., M.E.C., F.O.A., A.P., H.C.E., K.H. and T.I.E.; resources, O.A.A.; data curation, O.A.A. and M.E.C.; writing—original draft preparation, O.A.A., M.E.C., F.O.A., A.P., H.C.E. and T.I.E.; writing—review and editing, O.A.A., M.E.C., F.O.A., A.P., H.C.E. and T.I.E.; visualization, O.A.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data used in this study are publicly available at https://github.com/globaldothealth/monkeypox (accessed on 15 December 2021).

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Rimoin, A.W.; Mulembakani, P.M.; Johnston, S.C.; Smith, J.O.L.; Kisalu, N.K.; Kinkela, T.L.; Blumberg, S.; Thomassen, H.A.; Pike, B.L.; Fair, J.N. Major Increase in Human Monkeypox Incidence 30 Years after Smallpox Vaccination Campaigns Cease in the Democratic Republic of Congo. Proc. Natl. Acad. Sci. USA 2010, 107, 16262–16267. [Google Scholar] [CrossRef] [PubMed][Green Version]
  2. Tumewu, J.; Wardiana, M.; Ervianty, E.; Anggraeni, S.; Widia, Y.; Amin, M.; Sulichah, S.R.O.; Kuntaman, K.; Lusida, M.I. An Adult Patient with Suspected of Monkeypox Infection Differential Diagnosed to Chickenpox. Infect. Dis. Rep. 2020, 12, 33–35. [Google Scholar] [CrossRef] [PubMed]
  3. World Health Organization. Monkeypox: Current Status in West and Central Africa; WHO: Geneva, Switzerland, 2017; p. 18. [Google Scholar]
  4. Mauldin, M.R.; McCollum, A.M.; Nakazawa, Y.J.; Mandra, A.; Whitehouse, E.R.; Davidson, W.; Zhao, H.; Gao, J.; Li, Y.; Doty, J.; et al. Exportation of Monkeypox Virus From the African Continent. J. Infect. Dis. 2022, 225, 1367–1376. [Google Scholar] [CrossRef] [PubMed]
  5. Nigeria Centre for Disease Control. Situation Report: Update on Monkeypox (MPX) in Nigeria April 30, 2022. Serial Number 04, Epi-Week 17. 2022. Available online: https://ncdc.gov.ng/themes/common/files/sitreps/ed4f642dd1b5b1f1adf277e1d48a98f8.pdf (accessed on 14 May 2022).
  6. UK Health Security Agency. Monkeypox Cases Confirmed in England—Latest Updates. Monkeypox Case Confirmed in England. 7 May 2022. Available online: https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates#seven-may (accessed on 14 May 2022).
  7. World Health Organization. Statement—Investigations Ongoing into Atypical Cases of Monkeypox Now Reported in Eight Countries in Europe. Available online: https://www.euro.who.int/en/media-centre/sections/statements/2022/statement-investigations-ongoing-into-atypical-cases-of-monkeypox-now-reported-in-eight-countries-in-europe (accessed on 22 May 2022).
  8. Adegboye, O.A.; Adekunle, A.I.; Pak, A.; Gayawan, E.; Leung, D.H.; Rojas, D.P.; Elfaki, F.; McBryde, E.S.; Eisen, D.P. Change in Outbreak Epicentre and Its Impact on the Importation Risks of COVID-19 Progression: A Modelling Study. Travel Med. Infect. Dis. 2021, 40, 101988. [Google Scholar] [CrossRef]
  9. European Centre for Disease Prevention and Control. Epidemiological Update: Monkeypox Outbreak. Available online: https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak (accessed on 1 June 2022).
  10. Monkeypox 2022 Repository. Global health Monkeypox. Available online: https://github.com/globaldothealth/monkeypox/ (accessed on 31 May 2022).
  11. López-Gatell Ramírez, H. Twitter. 29 May 2022. Available online: https://twitter.com/HLGatell/status/1530558118962286593 (accessed on 31 May 2022).
  12. Times of Malta. Malta Detects First Monkeypox Case. Available online: https://timesofmalta.com/articles/view/malta-detects-first-monkeypox-case.958072 (accessed on 1 June 2022).
  13. Clarín. Viruela del Mono: Se Confirmó el Primer Caso en la Argentina y Analizan un Posible Segundo Enfermo. Available online: https://www.clarin.com/sociedad/confirmo-primer-caso-viruela-mono-argentina_0_1d7tp6v2Hh.html (accessed on 31 May 2022).
  14. National Insitute for Health. First Patient with Monkeypox in the Netherlands. Available online: https://www.rivm.nl/en/news/first-patient-with-monkeypox-in-netherlands (accessed on 21 May 2022).
  15. MacIntyre, R. Monkeypox in Australia: What Is It and How Can We Prevent the Spread? The Conversation 2022. Available online: https://theconversation.com/monkeypox-in-australia-what-is-it-and-how-can-we-prevent-the-spread-183526 (accessed on 21 May 2022).
  16. Philippe Selhorst, A.M.R.; de Block, T.; Coppens, S.; Smet, H.; Mariën, J.; Hauner, A.; Brosius, I.; Liesenborghs, L.; Bottieau, E.; Florence, E.; et al. Belgian Case of Monkeypox Virus Linked to Outbreak in Portugal. Available online: https://virological.org/t/belgian-case-of-monkeypox-virus-linked-to-outbreak-in-portugal/801 (accessed on 21 May 2022).
  17. Joana Isidro, V.B.; Pinto, M.; Ferreira, R.; Sobral, D.; Nunes, A.; Santos, J.D.; José Borrego, M.; Núncio, S.; Pelerito, A.; Cordeiro, R.; et al. First Draft Genome Sequence of Monkeypox Virus Associated with the Suspected Multi-Country Outbreak, May 2022 (Confirmed Case in Portugal). Available online: https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799 (accessed on 21 May 2022).
  18. Centers for Disease Control Prevention. Multistate Outbreak of Monkeypox—Illinois, Indiana, and Wisconsin, 2003. MMWR. Morb. Mortal. Wkly. Rep. 2003, 52, 537–540. [Google Scholar]
  19. Croft, D.R.; Sotir, M.J.; Williams, C.J.; Kazmierczak, J.J.; Wegner, M.V.; Rausch, D.; Graham, M.B.; Foldy, S.L.; Wolters, M.; Damon, I.K. Occupational Risks during a Monkeypox Outbreak, Wisconsin, 2003. Emerg. Infect. Dis. 2007, 13, 1150. [Google Scholar] [CrossRef] [PubMed]
  20. Anderson, M.G.; Frenkel, L.D.; Homann, S.; Guffey, J. A Case of Severe Monkeypox Virus Disease in an American Child: Emerging Infections and Changing Professional Values. Pediatric Infect. Dis. J. 2003, 22, 1093–1096. [Google Scholar] [CrossRef]
  21. World Health Organization. Disease Outbreak News—United States of America. 25 November 2021. 2021. Available online: https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON344 (accessed on 15 December 2021).
  22. Hobson, G.; Adamson, J.; Adler, H.; Firth, R.; Gould, S.; Houlihan, C.; Johnson, C.; Porter, D.; Rampling, T.; Ratcliffe, L.; et al. Family Cluster of Three Cases of Monkeypox Imported from Nigeria to the United Kingdom, May 2021. Eurosurveillance 2021, 26, 2100745. [Google Scholar] [CrossRef]
  23. Public Health England (PHE). Monkeypox Case Confirmed in England. Available online: https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england (accessed on 15 December 2021).
  24. Kyaw, W.M.; Vasoo, S.; Ho, H.J.A.; Chan, M.; Yeo, T.W.; Manauis, C.M.; Ang, H.; Pratim De, P.; Ang, B.S.P.; Chow, A.L.P. Monitoring Healthcare Professionals after Monkeypox Exposure: Experience from the First Case Imported to Asia. Infect. Control. Hosp. Epidemiol. 2020, 41, 373–375. [Google Scholar] [CrossRef][Green Version]
  25. Yong, S.E.F.; Ng, O.T.; Ho, Z.J.M.; Mak, T.M.; Marimuthu, K.; Vasoo, S.; Yeo, T.W.; Ng, Y.K.; Cui, L.; Ferdous, Z.; et al. Imported Monkeypox, Singapore. Emerg. Infect. Dis. 2020, 26, 1826–1830. [Google Scholar] [CrossRef]
  26. Erez, N.; Achdout, H.; Milrot, E.; Schwartz, Y.; Wiener-Well, Y.; Paran, N.; Politi, B.; Tamir, H.; Israely, T.; Weiss, S. Diagnosis of Imported Monkeypox, Israel, 2018. Emerg. Infect. Dis. 2019, 25, 980. [Google Scholar] [CrossRef] [PubMed][Green Version]
  27. Vaughan, A.; Aarons, E.; Astbury, J.; Balasegaram, S.; Beadsworth, M.; Beck, C.R.; Chand, M.; O’connor, C.; Dunning, J.; Ghebrehewet, S. Two Cases of Monkeypox Imported to the United Kingdom, September 2018. Eurosurveillance 2018, 23, 1800509. [Google Scholar] [CrossRef] [PubMed]
  28. Vaughan, A.; Aarons, E.; Astbury, J.; Brooks, T.; Chand, M.; Flegg, P.; Hardman, A.; Harper, N.; Jarvis, R.; Mawdsley, S.; et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg. Infect. Dis. 2020, 26, 782–785. [Google Scholar] [CrossRef] [PubMed]
  29. Adegboye, O.A.; Adekunle, A.I.; Gayawan, E. Early Transmission Dynamics of Novel Coronavirus (COVID-19) in Nigeria. Int. J. Environ. Res. Public Health 2020, 17, 3054. [Google Scholar] [CrossRef]
  30. Nnaji, N.D.; Onyeaka, H.; Reuben, R.C.; Uwishema, O.; Olovo, C.V.; Anyogu, A. The Deuce-Ace of Lassa Fever, Ebola Virus Disease and COVID-19 Simultaneous Infections and Epidemics in West Africa: Clinical and Public Health Implications. Trop. Med. Health 2021, 49, 102. [Google Scholar] [CrossRef]
  31. Chris Stokel-Walker. COVID Restrictions Are Lifting—What Scientists Think. Nature News, 7 March 2022. [Google Scholar]
  32. Yinka-Ogunleye, A.; Aruna, O.; Dalhat, M.; Ogoina, D.; McCollum, A.; Disu, Y.; Mamadu, I.; Akinpelu, A.; Ahmad, A.; Burga, J.; et al. Outbreak of Human Monkeypox in Nigeria in 2017–18: A Clinical and Epidemiological Report. Lancet Infect. Dis. 2019, 19, 872–879. [Google Scholar] [CrossRef]
  33. Durski, K.N.; McCollum, M.A.; Nakazawa, Y.; Petersen, B.W.; Reynolds, M.G.; Briand, S.; Djingarey, M.H.; Olson, V.; Damon, I.K.; Khalakdina, A. Emergence of Monkeypox—West and Central Africa, 1970–2017. MMWR Morb. Mortal. Wkly. Rep. 2018, 67, 306–310. [Google Scholar] [CrossRef]
  34. Nigeria Centre for Disease Control. National Monkeypox Public Health Guidelines; Federal Ministry of Health: Abujam, Nigeria, 2019. Available online: https://ncdc.gov.ng/themes/common/docs/protocols/96_1577798337.pdf (accessed on 22 May 2022).
  35. Womi-Eteng, E.; Mandra, A.; Doty, J.; Yinka-Ogunleye, A.; Aruna, S.; Reynolds, M.G.; McCollum, A.M.; Davidson, W.; Wilkins, K.; Saleh, M.; et al. Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach—Nigeria, 2017–2018. MMWR Morb. Mortal. Wkly. Rep. 2018, 67, 1040–1041. [Google Scholar] [CrossRef][Green Version]
  36. Petersen, E.; Abubakar, I.; Ihekweazu, C.; Heymann, D.; Ntoumi, F.; Blumberg, L.; Asogun, D.; Mukonka, V.; Lule, S.A.; Bates, M.; et al. Monkeypox—Enhancing Public Health Preparedness for an Emerging Lethal Human Zoonotic Epidemic Threat in the Wake of the Smallpox Post-eradication Era. Int. J. Infect. Dis. 2019, 78, 78–84. [Google Scholar] [CrossRef]
  37. Bunge, E.M.; Hoet, B.; Chen, L.; Lienert, F.; Weidenthaler, H.; Baer, L.R.; Steffen, R. The Changing Epidemiology of Human Monkeypox—A Potential Threat? A Systematic Review. PLoS Negl. Trop. Dis. 2022, 16, e0010141. [Google Scholar] [CrossRef]
  38. World Health Oragnization (WHO) Africa. WHO is Supporting African Countries to Strengthen Monkeypox Surveillance and Response Actions. Available online: https://www.afro.who.int/news/who-supporting-african-countries-strengthen-monkeypox-surveillance-and-response-actions (accessed on 1 June 2022).
  39. Costello, V.; Sowash, M.; Gaur, A.; Cardis, M.; Pasieka, H.; Wortmann, G.; Ramdeen, S. Imported Monkeypox from International Traveler, Maryland, USA, 2021. Emerg. Infect. Dis. 2022, 28, 1002. [Google Scholar] [CrossRef] [PubMed]
Figure 1. Geographical distribution of the ongoing monkeypox virus (MPXV) outbreaks. MPXV endemic countries have had sporadic epidemics since 2017. Nigeria (15), Cameroon (3), Central African Republic (8), Democratic Republic of Congo (1238), Sierra Leone (0). Note: Non-endemic countries: Argentine (AR), Australia (AU), Austria (AT), Belgium (BE), Canada (CA), Czech Republic (CZ), Denmark (DK), Finland (FI), France (FR), Germany (DE), Ireland (IE), Israel (IL), Italy (IT), Malta (MT), Mexico (MX), The Netherlands (NL), Portugal (PT), Slovenia (SI), Spain (ES), Sweden (SE), Switzerland (CH), United Arab Emirates (AE), UK (GB), USA (US). Endemic countries: Cameroon (CM), Central African Republic (CF), Democratic Republic of the Congo (CD), Liberia (LR), Nigeria (NG), the Republic of the Congo (CG) and Sierra Leone (SL).
Figure 1. Geographical distribution of the ongoing monkeypox virus (MPXV) outbreaks. MPXV endemic countries have had sporadic epidemics since 2017. Nigeria (15), Cameroon (3), Central African Republic (8), Democratic Republic of Congo (1238), Sierra Leone (0). Note: Non-endemic countries: Argentine (AR), Australia (AU), Austria (AT), Belgium (BE), Canada (CA), Czech Republic (CZ), Denmark (DK), Finland (FI), France (FR), Germany (DE), Ireland (IE), Israel (IL), Italy (IT), Malta (MT), Mexico (MX), The Netherlands (NL), Portugal (PT), Slovenia (SI), Spain (ES), Sweden (SE), Switzerland (CH), United Arab Emirates (AE), UK (GB), USA (US). Endemic countries: Cameroon (CM), Central African Republic (CF), Democratic Republic of the Congo (CD), Liberia (LR), Nigeria (NG), the Republic of the Congo (CG) and Sierra Leone (SL).
Viruses 14 01283 g001
Table 1. List of laboratory-confirmed cases of human monkeypox (MPX) outside of Africa in May, 2022. Few cases linked to West African clade .
Table 1. List of laboratory-confirmed cases of human monkeypox (MPX) outside of Africa in May, 2022. Few cases linked to West African clade .
CasesOriginDestinationRoute of TransmissionRef
1NetherlandsMexicoResident New York, probably acquired in the Netherlands[10,11]
1UnknownMaltaPatient recently travelled to a country with MPX cases[10,12]
1EuropeFinland [10]
1UnknownIreland [10]
2SpainArgentinaBoth cases had travelled to Spain[10,13]
5BelgiumCzech RepublicIndex case had travelled to Antwerp, Belgium[10]
2SpainSloveniaBoth cases had travelled to Spain[10]
2SpainDenmarkBoth cases had travelled to Spain[10]
1UnknownAustria [10]
4SpainSwitzerlandSecond confirmed case had travelled to Spain[10]
2Western EuropeIsraelIndex case had travelled to Western Europe[10]
26BelgiumThe NetherlandsIndex case had travelled to Belgium[10,14]
2UKAustraliaIndex case had a recent travel to the UK[10,15]
22Spain, PortugalGermany At least three cases linked to travel to Portugal, Spain or other regions of Europe[7,10]
8Lisbon, PortugalBelgium Index case had a recent travel to Portugal[10,16]
16SpainFranceFourth confirmed case had travelled to Spain[7,10]
12Spain, GermanyItalyAt least four cases linked to travel to Spain or/and Germany[7,10]
2UnknownSwedenUnknown[7,10]
14Canada, Africa, EuropeUSAAt least five cases linked to travel to West Africa, Canada, Europe[7,10]
26UnknownCanadaUnknown[7,10]
116UnknownSpainUnknown[7,10]
96UnknownPortugal Unknown[10,17]
106NigeriaUKIndex case had a recent travel to Nigeria[6,10]
Table 2. Laboratory-confirmed cases of human monkeypox outside of Africa (2018–2021). NA = Not available.
Table 2. Laboratory-confirmed cases of human monkeypox outside of Africa (2018–2021). NA = Not available.
Month/
Year
CasesPossible Source of InfectionOriginDestinationCladeRoute of TransmissionSecondary TransmissionContacts InvestigatedRef
November,2021 1NANigeriaMD, USAWest AfricanTravel via Istanbul and Washington DCNoNA [21]
July, 20211NALagos, NigeriaTX, USAWest AfricanUSA-Nigeria-USA. Stayed in Lagos and in Ibadan, Oyo StateNo>200 [21]
May, 202131 case: unknown, 2–3 cases: human-to-human transmissionDelta, NigeriaUKWest AfricanTwo adults and one toddler. Travel via
Istanbul, Turkey.
Yes (2 HH of index case)38 [22]
December, 20191NANigeriaUKNAVery scarce information about this case. UnknownNA [23]
May, 20191Ingestion of barbecued bushmeat that might have been contaminated.NigeriaSingaporeWest African No27 HCWs (close contacts) [24,25]
October, 20181Disposed of 2 rodent carcasses at his residence.NigeriaIsraelWest African No5 HH + 11 HCWS [26]
September, 20182Case 1: contact with an individual with a monkeypox-like rash and consumption of bushmeat. Case 2: changing of potentially contaminated bedding.NigeriaUKWest AfricanTravel via Paris, FranceYes (HCW)158 low risk, 125 intermediate-risk, 5 high risk [27,28]
September, 20181NAAbuja, NigeriaCornwall, UKWest AfricanTravel from London to Cornwall by trainNANA [27]
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