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Lancet study finds antiviral drugs can reduce symptoms of monkeypox and shorten contagious phase

Certain antiviral drugs could have the potential to shorten monkeypox symptoms and reduce how long a patient is contagious, according to a study of seven patients diagnosed with the rare viral disease in the UK between 2018 and 2021.

The cases analyzed in the study, published in the journal The Lancet Infectious Diseases on Tuesday, represent the first cases of hospital and home transmission outside Africa.

The research also reported patient response to the first off-label use of two different antiviral drugs – brincidofovir and tecovirimat – to treat the disease. The study found little evidence that brincidofovir was clinically beneficial, but concluded that further research into the potential of tecovirimat would be warranted.

Researchers also report detection of monkeypox virus in blood and throat swabs. As the optimal infection control and treatment strategies for this disease are yet to be established, the study data could help inform global efforts to better understand the clinical features of the disease as well as transmission dynamics. , they said.

“As public health officials try to understand what is causing the May 2022 monkeypox outbreaks in Europe and North America – which affected several patients who had no reported travel or identified link to a previously known case – our study offers some of the first insights into the use of antivirals for the treatment of monkeypox in humans,” said Hugh Adler of Liverpool University Hospitals NHS Foundation Trust, UK.

“While this latest outbreak has affected more patients than we have seen before in the UK, historically monkeypox has not been transmitted between people very efficiently, and overall the risk for public health is low,” said Adler, lead author of the paper.

As international travel returns to pre-pandemic levels, public health officials and healthcare workers around the world must remain vigilant for the possibility of new cases of monkeypox, Guy’s & St Thomas’ Nick Price said. NHS Foundation Trust, lead author of the article.

Of the seven UK monkeypox cases analyzed in the study, four were imported from West Africa and a further three cases occurred due to human-to-human transmission within the case clusters.

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Monkeypox, a close relative of the smallpox virus, is a rare disease classified as a High Consequence Infectious Disease (HCID) by the UK Health Security Agency. There is currently no approved treatment for monkeypox and data on how long it is infectious is limited, with the incubation period ranging from five to 21 days.

The study authors observed clinical data alongside laboratory results of blood tests and nose and throat swabs to describe the duration and clinical characteristics of monkeypox in a high-income setting. The researchers also reported patient response to antiviral drugs developed to treat smallpox – brincidofovir and tecovirimat – which have already shown some efficacy against monkeypox in animals.

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

The first three patients were treated with brincidofovir seven days after initial rash onset. The study found that brincidofovir had no compelling clinical benefit in the treatment of monkeypox and liver blood test alterations were observed.

The researchers noted that it is unclear whether administering brincidofovir earlier in the course of the disease or at a different dosing schedule would have resulted in different clinical outcomes. Despite this, all three patients, along with the fourth hospitalized patient, made full recoveries, they said.

Three further cases of monkeypox were reported in the UK in 2021 in a family traveling from Nigeria, with two of these cases being the first examples of domestic transmission outside of Africa. One of the 2,021 UK patients was treated with tecovirimat and had shorter duration of symptoms and upper respiratory viral shedding than the other cases in this group, the researchers said.

However, they note that it is impossible to draw conclusions about antiviral efficacy against monkeypox in such a small cohort, calling for further research on antivirals to treat this neglected tropical disease. “In previous outbreaks of monkeypox, patients were considered infectious until all the lesions covered each other,” said Catherine Houlihan, of the UK Health Security Agency and University College London, one of the co-authors of the article.

“In these seven UK cases, viral shedding was observed for at least three weeks after infection. However, data on infectivity remains limited and is an important area for future studies,” Houlihan said. The authors recognize certain limitations to this study, mainly its observational nature and the small number of cases analysed.

They were also unable to confirm positive monkeypox PCR test results with laboratory samples of the virus, meaning continued shedding of contagious virus could not be verified.

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