Monkeypox Outbreak: Weekly Update (September 26, 2022)

The rise of new monkeypox cases continues to decline globally. A new study suggests that air, surface, and dust contamination with monkeypox viral load in a room with a monkeypox patient is the highest during the first eight days of the illness.

As of September 23, there were 24,846 confirmed monkeypox cases in the US and one death due to the infection.

Downward trend continues

During the week of September 12 to 18, total monkeypox cases increased by 16.5%, with 8,757 new cases being reported, according to the World Health Organization (WHO) report. In addition, five more deaths were reported globally in the previous week.

However, the organization says that the number of monkeypox cases reported in Europe and the Americas continues to be on a downward trend. To date, there are more than 60,000 laboratory-confirmed cases and at least 23 deaths due to monkeypox worldwide.

"The trend is encouraging, but as with COVID-19, this is not the time for any country or community to assume those trends will continue. This is the time to keep doing what works," said the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.

The virus remains on surfaces

A new study from Singapore that has not been peer-reviewed yet examined the air, surface, dust, and water contamination in a room occupied by a male monkeypox patient. He was admitted to the hospital on day five of the infection with skin lesions and fever. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of his illness, with an additional air sample on day 15.

In a room designed to be ventilated at 12 air changes per hour, air contamination with monkeypox viral load was highest during the first week of illness and gradually declined over the following two weeks.

Surface sampling was conducted before the daily cleaning and disinfection of the room. The level of contamination peaked on day 8 of his illness, and the highest viral load was detected in the bowl of the sink in the patient's bathroom. The virus was also sampled on the room floor and call bell. However, all samples collected from the anteroom and clean corridor were negative for monkeypox virus DNA.

Vacuumed dust contamination had the highest viral load on day seven of patient illness and in the toilet floor dust samples. Researchers say that monkeypox DNA was also detected from wastewater in the sink traps, which "provides direct evidence for the possible utility of wastewater-based surveillance of monkeypox virus."

Monkeypox in a young infant

The Centers for Disease Control and Prevention (CDC) reported a case of confirmed monkeypox disease in an infant pediatric patient less than two months old. The patient was admitted to a hospital in Florida with cellulitis and a rash on the arms, legs, and trunk, which later progressed into lesions over the body.

The infant had no history of travel, no history of acute infections in the three weeks preceding rash onset, no known immunocompromising conditions, did not attend a childcare facility, and had no caregivers outside the home.

One of the infant's caregivers also tested positive for monkeypox. The child had daily close contact with this caregiver for six weeks before the rash onset. According to CDC, possible routes of transmission included shared bed linens and skin-to-skin contact through holding and daily care activities.

The child was first seen in the emergency department on day five of the rash illness and was tested for chickenpox, HIV, and herpes simplex virus. When the rash progressed to include many umbilicated lesions two days later, the patient returned to the hospital and was admitted with a diagnosis of molluscum contagiosum.

After starting antibiotics, the child's rash became pustular, at which time swabs tested for monkeypox were positive. The baby was then treated with oral tecovirimat and Vaccinia Immune Globulin Intravenous. The treating physicians also prescribed prophylactic trifluridine drops for an eyelid lesion. The child had no fever and remained stable throughout the hospitalization and fully recovered.

To date, 27 confirmed cases of monkeypox in pediatric patients aged 0–15 years have been reported in the US in 2022.

Resources:

WHO. Multi-country outbreak of monkeypox, External situation report #6 - 21 September 2022.

WHO. LIVE: Media briefing on #COVID19 and other global health issues with @DrTedros.

medRxiv. Viable Monkeypox virus in the environment of a patient room.

CDC. Monkeypox in a Young Infant — Florida, 2022.

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