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Monkeypox can spread before symptoms appear, British researchers said on Wednesday, providing the first evidence that the virus can spread this way.
Monkeypox was previously thought to be transmitted almost exclusively by people who are already sick, although presymptomatic transmission has not been ruled out, and some routine screening has identified asymptomatic cases.
Monkeypox, a relatively mild viral disease endemic in several countries in West and Central Africa, exploded around the world earlier this year in dozens of countries where it had never been seen before.
Since then, there have been nearly 78,000 confirmed cases and 36 deaths, according to the U.S. Centers for Disease Control and Prevention. Although cases have peaked in many countries, the World Health Organization said this week that the outbreak remains a global health emergency.
Also read: Children 8 or younger have higher monkeypox risk: study
The virus is known to spread through close contact and causes symptoms including fever, body aches and often painful, pus-filled skin lesions.
To learn more about how monkeypox spreads in the UK, a team from the UK Health Security Agency used routine surveillance and contact tracing data from 2,746 people in the country who tested positive between May and August.
Their average age was 38, and 95 percent of patients reported being gay, bisexual, or MSM.
The researchers analysed the “consecutive interval” – the time from the onset of symptoms in the first case to the onset of symptoms in related cases – and the incubation period, the typical time from exposure to the virus to the onset of symptoms.
Using two statistical models, they found that the median sequence interval was shorter than the median latency. This suggests “considerable” transmission occurs before symptoms appear or are detected, the researchers wrote in their paper published in the British Medical Journal.
Four days was the longest time transmission was detected before symptoms began, and the team said up to 53 percent of transmission could occur before symptoms began.
The study raises questions about the global response to monkeypox, including whether requiring people to quarantine if they develop symptoms is enough to stop the virus from spreading.
Many wealthier countries have vaccinated high-risk groups to contain the outbreak, but vaccines are limited and none are available in Africa.
Independent experts say the findings, if supported by other research, could have important implications for global infection control.
Also read: WHO says monkeypox remains a global health emergency
“These are pressing questions,” said Boghuma Kabisen Titanji, assistant professor of medicine at Emory University in Atlanta.
Other scientists say the work is robust but requires clinical data before it can be labelled authoritative or applied globally.
“It’s an important piece of the communication puzzle,” said Jack Dunning, a senior research fellow at Oxford University’s Institute for Epidemiological Sciences, “but I personally would like to see it combined with other pieces.”
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