International Outbreak Research Articles

Training for outbreak response through the Global Outbreak Alert and Response Network

Abstract The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.

The Spread of Mycobacterium chimaera from Heater-Cooler Units and Infection Risk in Heart Surgery: Lessons from the Global Outbreak?

Mycobacterium chimaera (MC), a member of the Mycobacterium avium complex, can cause infections in patients after open-heart surgery due to contaminated heater-cooler units (HCUs). The transmission route of HCU-related MC infection is non-inhalational, and infection can occur in patients without previously known immune deficiency. Patients may develop endocarditis of the prosthetic valve, infection of the vascular graft, and/or manifestations of disseminated mycobacterial infection (splenomegaly, arthritis, hepatitis, nephritis, myocarditis, etc.). MC infections have serious outcomes (30-50% recurrence rate, 20-67% mortality rate). In 2015, an international outbreak of M. chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T HCUs (formerly Stöckert 3T heater-cooler system, London, United Kingdom). In response to the global outbreak, many international agencies have issued directives and recommendations in order to reduce the risk of MC infection in cardiac surgery. Whole-genome sequencing (WGS) technology can be used to describe the global spread and dynamics of MC infections, to characterize local outbreaks, and also to identify sources of infection in hospital settings. In order to minimize the risk of contamination of HCUs and reduce the risk of patient infection, it is imperative that healthcare facilities establish a program of regular cleaning and disinfection maintenance procedures as well as monitoring of the water used and the air in the operating room, in accordance with the manufacturer's procedure.

International outbreak of acute pediatric hepatitis: Was acetaminophen the missing link?

International outbreak of acute pediatric hepatitis: Was acetaminophen the missing link?

The critical success factors of smart port digitalization development in the post-COVID-19 era

The international outbreak of the new coronavirus (COVID-19) at the end of 2019 has caused an indelible impact on the global economy. However, it has grown against the trend in unmanned distribution and online consumption. In recent years, the maritime industry has gradually introduced artificial intelligence, blockchain, the Internet of Things, and big data. Through literature review and expert interviews, this research figures out the development status of smart ports at home and abroad and the digital development barriers of ports and then uses the Fuzzy Delphi and the Fuzzy Analytic Hierarchy Process method to identify three dimensions and thirteen key factors target companies. The survey targets shipping companies, shipping agencies, and port management companies. The paper conducted the questionnaires to identify the critical success factors of port digitization. It was found that the “digital solutions” dimension had the highest weight value among the three dimensions and the top five critical factors in the overall ranking were based on the order of “carbon emission management,” “enhancing port safety”, “technology standardization,” “digital asset management,” and “optimization of the supply chain.” The result of this study can help port operators and shipping companies identify critical success factors of smart ports and adopt port digital development strategies for operation efficiency improvement and climate change mitigation.

Multiple introductions of monkeypox virus to Ireland during the international mpox outbreak, May 2022 to October 2023.

BackgroundMpox, caused by monkeypox virus (MPXV), was considered a rare zoonotic disease before May 2022, when a global epidemic of cases in non-endemic countries led to the declaration of a Public Health Emergency of International Concern. Cases of mpox in Ireland, a country without previous mpox reports, could reflect extended local transmission or multiple epidemiological introductions.AimTo elucidate the origins and molecular characteristics of MPXV circulating in Ireland between May 2022 and October 2023.MethodsWhole genome sequencing of MPXV from 75% of all Irish mpox cases (182/242) was performed and compared to sequences retrieved from public databases (n = 3,362). Bayesian approaches were used to infer divergence time between sequences from different subclades and evaluate putative importation events from other countries.ResultsOf 242 detected mpox cases, 99% were males (median age: 35 years; range: 15-60). All 182 analysed genomes were assigned to Clade IIb and, presence of 12 distinguishable subclades suggests multiple introductions into Ireland. Estimation of time to divergence of subclades further supports the hypothesis for multiple importation events from numerous countries, indicative of extended and sustained international spread of mpox. Further analysis of sequences revealed that 92% of nucleotide mutations were from cytosine to thymine (or from guanine to adenine), leading to a high number of non-synonymous mutations across subclades; mutations associated with tecovirimat resistance were not observed.ConclusionWe provide insights into the international transmission dynamics supporting multiple introductions of MPXV into Ireland. Such information supported the implementation of evidence-informed public health control measures.

High-Selectivity-Based Novel Split-Gate VTFET Biosensor for Identification of SARS-CoV-2

The World Health Organization (WHO) has officially declared the international outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), often known as Coronavirus Disease 2019 (COVID-19), a global pandemic based on the significant and sudden increase in human infections worldwide. With suitable treatment and early diagnosis, this outbreak can be controlled to a certain extent. In the present research, the performance of a novel dielectrically modulated heterojunction-based splitgate double cavity vertical TFET biosensor for detecting SARS-CoV-2 with reference to the virus spike, DNA and envelope proteins has been thoroughly investigated. The suggested sensor’s sensitivity has been evaluated through the computation of the deviation in drain current. We model the hybridized biomolecules in the nanogaps as the dielectric constant equivalent of the viral proteins. Additionally, sensing speed and selectivity analysis pertaining to the various biomolecules are also investigated. The proposed sensor exhibits a notably high sensitivity (on the order of 108), high sensing speed, and high selectivity (on the order of 106), indicating its potential as a superior sensor. This study also examines the influence of variations in DNA charge density on the performance of the device. Ultimately, the proposed sensor is evaluated in comparison to its sensitivity and selectivity of a variety of FET-based biosensors previously documented in the literature.

(203) Awareness of Monkeypox Virus Among International Urology Faculty and Trainees is Low: Implications for Early Recognition and Diagnosis

Abstract Introduction The recent international outbreak of Monkeypox virus (Mpox), has raised concerns regarding the recognition and management of this disease among healthcare professionals. The genitourinary presentation of Mpox as variable cutaneous lesions poses a unique challenge for Urologists in its prevention, diagnosis, and management. Objective To assess the understanding and recognition of Mpox among international urologists and urology trainees. Methods A survey relating to the presentation, transmission, and management of Mpox was distributed to urologists and urology trainees during the joint 23rd Sexual Medicine Society of North America (SMSNA)/ 23rd International Society for Sexual Medicine (ISSM) conference. Results Out of 960 attendees, 97 (10.1%) responded to the survey. The rate of respondents who correctly identified a Mpox lesion from a series of cutaneous lesions was 25.8%. A similarly low number of respondents were able to identify the likelihood of having anogenital lesions and oral bleeding on presentation with Mpox at 15.5% and 19.6% respectively. A higher number of respondents accurately noted that diagnosis of Mpox may be made with PCR (79.4%) and that men with multiple male sexual partners are at the highest risk of transmission (72.2%) (Table 1). Conclusions When surveyed regarding the presentation, transmission, and management of Mpox, urologists and urology trainees were generally unable to accurately identify Mpox from a series of cutaneous lesions or the rate at which Mpox may present with anogenital lesions. The limited recognition of its presentation, appropriate diagnostic methods, and distinguishing features from sexually transmitted lesions raises concerns about potential missed diagnoses and delayed treatment. Continued education within the urology community may be necessary for the appropriate detection of and intervention against Mpox. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Antares Pharma, Clarus Therapeutics.

Multinational collaboration in solving a European Salmonella Braenderup outbreak linked to imported melons, 2021.

A genomic cluster of Salmonella Braenderup ST22, a serovar of Salmonella enterica subsp. enterica which causes symptoms of gastrointestinal illness, was notified by Danish authorities to the European Centre for Disease Prevention and Control (ECDC) on 3 May 2021. By 6 July 2021, S. Braenderup outbreak cases (n=348) had been reported from 12 countries in the European Union/European Economic Area (EU/EEA) and the United Kingdom (UK), including 68 hospitalised cases. With support from affected EU/EEA countries, and in partnership with the European Food Safety Authority (EFSA), ECDC established an international outbreak investigation team to rapidly identify the source and prevent outbreak spread. Consumption information was shared with affected countries through a standard line list, revealing that 124 of 197 cases (63%) reported having eaten (any) melons within 7 days prior to disease onset. The speed and completeness of the investigation, which identified the outbreak vehicle as galia melons imported from Honduras in June 2021, was a direct result of extensive collaboration and information sharing between countries' national food safety and public health authorities. This article describes the outbreak and the benefits, successes, and challenges of multi-country collaboration for consideration in future large foodborne outbreaks across Europe.

Outbreak response capacity of the Global Outbreak Alert and Response Network across WHO's South-East Asia and Western Pacific regions.

The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies. Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted. Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support. GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study.

The application of biosecurity practices for preventing avian influenza in North-Eastern Italy turkey farms: An analysis of the point of view and perception of farmers

IntroductionItalian and international outbreaks of highly pathogenic avian influenza (HPAI), particularly in densely populated poultry areas (DPPAs), have increased over the past few decades. These emerging risks, which endanger both human and animal health and the entire poultry industry, can be effectively limited by biosecurity measures implemented at human-animal food chain interfaces. Some problems, however, persist in the application of these measures on the part of poultry farmers, prompting the need to explore those aspects and causes that limit their implementation. Material and methodsA qualitative approach was selected for the study and a semi-structured interview technique was applied to collect data among turkey farmers (n = 29) working in the north-east of Italy. The aim of this technique was to gather data on farms in order to understand the biosecurity practices adopted and the reasons for and impediments to farmer implementation, or lack thereof. This article presents and discusses the main data collected. ResultsThe study revealed that farmers were familiar with the biosecurity measures necessary to contain avian influenza (AI) and other poultry diseases; personal disinfection and animal isolation practices were particularly prominent. Based on the reported procedures, managerial, economic, and psychosocial factors were among the barriers behind the failure to implement biosecurity measures. These obstacles were variously intertwined and associated with the different action settings. In particular management factors, such as lack of time to apply the rules and difficulties contingent on the farm’s structural characteristics, mediate the application of biosecurity measures. In terms of communication channels, the company, particularly its technicians, proved to be the primary source of information for farmers in case of emergencies, as well as the primary source of information on the application of biosecurity measures. However, other sources of information were indicated, such as word of mouth among farmers or other non-institutional figures (relatives and acquaintances). ConclusionsWhat emerged, was the need to improve not only the biosecurity management skills, but also to implement forms of cooperation among the various key stakeholders in the poultry sector. The information presented in this pilot study needs to be discussed among competent authorities, public and company veterinarians, company technicians, and farmers. Furthermore, this information will help in participatory co-planning of risk prevention and communication strategies to implement a long-term, sustainable, effective approach to address future epidemic emergencies.

Investigation of a monophasic Salmonella Typhimurium outbreak linked to chocolate products as part of wider international outbreak: A matched case–control study, Ireland, 2022

AbstractBackgroundIn March 2022, an outbreak investigation was initiated in Ireland after identifying a cluster of monophasic Salmonella Typhimurium cases, affecting primarily small children. Microbiological investigations revealed that the cluster was part of a wider international outbreak.MethodsA total of 18 Irish outbreak cases were identified. We undertook a matched case–control study using the case–case method to determine if exposure to the implicated products was associated with illness.ResultsIn univariable analysis, the highest odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were obtained for a chocolate Product A of Brand A [matched odds ratio (mOR) = 7.77, 95% confidence intervals (CI): 0.89–67.20]. When grouping the implicated products in a composite variable, the odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were 10.5 times higher with a consumption of at least one of the implicated products [mOR = 10.50, 95% CI: 1.24–88.60, p = 0.031].ConclusionThis analytical study supported the internationally generated hypothesis which led to the implementation of control measures. Owing to the high levels of chocolate purchasing with Easter approaching, early outbreak identification and involvement in the internationally coordinated investigation was essential to an efficient response and to minimise the risk of further harm to a particularly vulnerable population group.

The Difference of Survival Rate COVID-19 in Patients with Initiated Hemodialysis and Regularly Hemodialysis

Background: Since December 2019, a novel coronavirus called SARSCoV-2 (severe acute respiratory syndrome coronavirus) has caused an international outbreak of respiratory illness described as COVID-19. This study aimed to describe the difference in the survival rate of COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis in Dr. M Djamil General Hospitals. Also, in this review, we provide a comprehensive overview of data on the factors that may be affected by COVID-19 survival rates in patients with COVID-19 induced AKI with hemodialysis and COVID-19 in patients with CKD on hemodialysis. This study was conducted to analyze the survival of COVID-19 with initiated or regular HD patients in Dr. M. Djamil General Hospital, Padang, Indonesia.
 Methods: This study was conducted from January 2021 to July 2021 in Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia. Data for this study was collected through medical records of patients admitted for COVID-19 with CKD in hemodialysis and acute renal failure induced by COVID-19 to show the demographics, comorbidities, and survival rates of the patients who underwent hemodialysis.
 Results: Factors associated with survival in COVID-19 with hemodialysis were COVID-19 severity and abnormal potassium serum level (Table 3). Moderate COVID-19 patients tend to survive than severe COVID-19 patients (OR 60; 95% CI 16.034 – 224.525). There was no significant difference in survival between initiated and regular HD (p = 0.829).
 Conclusion: There is no difference in clinical outcome from patients with COVID-19 who initiated hemodialysis or regularly HD to the survival rates.

Foodborne Botulism, Canada, 2006-20211.

During 2006-2021, Canada had 55 laboratory-confirmed outbreaks of foodborne botulism, involving 67 cases. The mean annual incidence was 0.01 case/100,000 population. Foodborne botulism in Indigenous communities accounted for 46% of all cases, which is down from 85% of all cases during 1990-2005. Among all cases, 52% were caused by botulinum neurotoxin type E, but types A (24%), B (16%), F (3%), and AB (1%) also occurred; 3% were caused by undetermined serotypes. Four outbreaks resulted from commercial products, including a 2006 international outbreak caused by carrot juice. Hospital data indicated that 78% of patients were transferred to special care units and 70% required mechanical ventilation; 7 deaths were reported. Botulinum neurotoxin type A was associated with much longer hospital stays and more time spent in special care than types B or E. Foodborne botulism often is misdiagnosed. Increased clinician awareness can improve diagnosis, which can aid epidemiologic investigations and patient treatment.

MONKEYPOX VIRUS (MPXV) INFECTION AND SEXUALLY TRANSMITTED INFECTIONS (STIs): A CROSS-SECTIONAL STUDY FROM A SECONDARY HOSPITAL IN THE MAY-SEPTEMBER 2022 INTERNATIONAL OUTBREAK.

The aim of our study is to describe the characteristics of patients infected by MPXV in our setting, determine the prevalence of MPXV in samples which are classically used for diagnosing sexually transmitted infections (STIs) such as anal, urethral, pharyngeal and urine, and assess the prevalence of coinfection with STIs in the same samples. A cross-sectional study was conducted, collecting all confirmed cases of MPXV between June and July 2022 using polymerase chain reaction (PCR). Sociodemographic data, HIV and other STIs status, prevalence of MPXV and STIs in urethral, anal, pharyngeal or urine samples, were collected. Data from 22 patients were extracted, all of whom were MSM and 54,5% were previously HIV positive. The median age was 43 years. All the skin samples were positive for MPXV, followed by anal samples (n = 10) (45,5%). MPXV was isolated in 2 or more samples simultaneously in 12 (54%) cases. 9 (41%) patients were positive for an STI and 4 of them had more than one STI (18,2%). Human monkeypox has been epidemiologically significant among MSM. MPXV should be investigated not only in skin lesions but also in samples classically used for STI. MPXV, like other STIs, share ways of transmission and coinfection may be underdiagnosed.

Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022.

BackgroundSince May 2022, an mpox outbreak affecting primarily men who have sex with men (MSM) has occurred in numerous non-endemic countries worldwide. As MSM frequently reported multiple sexual encounters in this outbreak, reliably determining the time of infection is difficult; consequently, estimation of the incubation period is challenging.AimWe aimed to provide valid and precise estimates of the incubation period distribution of mpox by using cases associated with early outbreak settings where infection likely occurred.MethodsColleagues in European countries were invited to provide information on exposure intervals and date of symptom onset for mpox cases who attended a fetish festival in Antwerp, Belgium, a gay pride festival in Gran Canaria, Spain or a particular club in Berlin, Germany, where early mpox outbreaks occurred. Cases of these outbreaks were pooled; doubly censored models using the log-normal, Weibull and Gamma distributions were fitted to estimate the incubation period distribution.ResultsWe included data on 122 laboratory-confirmed cases from 10 European countries. Depending on the distribution used, the median incubation period ranged between 8 and 9 days, with 5th and 95th percentiles ranging from 2 to 3 and from 20 to 23 days, respectively. The shortest interval that included 50% of incubation periods spanned 8 days (4-11 days).ConclusionCurrent public health management of close contacts should consider that in approximately 5% of cases, the incubation period exceeds the commonly used monitoring period of 21 days.

International Travel-Related COVID-19 Infection and Outbreak from Wedding Ceremony: First Case in Turkey

SARS-CoV-2 virus is a new and highly contagious respiratory virus that transmission by droplet route. Here we reported international travel-related SARS CoV-2 transmission, and then cause an outbreak by the wedding ceremony. Two index passenger groups include three families who come from Paris to İstanbul to attend the wedding ceremony transmitted COVID-19 infection to Turkey. During the wedding ceremony and later period, they were in close contact with about 350 persons. Clinical pictures COVID-19 infection occurred in 53 relatives. PCR positivity was found in 35 hospitalized cases. The infection spread to four cities in Turkey. The most frequent symptoms of 35 confirmed cases were dizziness (77%), fever (57.1%), joint and muscle pain (57.1%), loss of smell (45.7%) and loss of taste (42.9%), and shore throat (37.1%), dry cough (34.3%), diarrhea (25.7%), rhinorrhea (14.3%) and dyspnea (8.5%). 48 cases (90.5%) were mild-moderate. Severe pneumonia was developed, intensive care and intubation need in five cases (9.4%), and four of them were died (7.5%). 
 COVID-19 virus can be easily acquired during plane travel and transmitted to other persons with unprotected contact. The infection prevention rules should be strictly applied for the protection from disease. Persons should avoid attend gatherings, even with their family or relatives, and should stay at home. The wedding and other social activities should be postponed after the pandemic.

Effectiveness of JYNNEOS Vaccine Against Diagnosed Mpox Infection - New York, 2022.

In 2022, an international Monkeypox virus outbreak, characterized by transmission primarily through sexual contact among gay, bisexual, and other men who have sex with men (MSM), resulted in 375 monkeypox (mpox) cases in the state of New York outside of New York City (NYC).*,† The JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), licensed by the U.S. Food and Drug Administration (FDA) against mpox as a 2-dose series, with doses administered 4 weeks apart,§ was deployed in a national vaccination campaign.¶ Before this outbreak, evidence to support vaccine effectiveness (VE) against mpox was based on human immunologic and animal challenge studies (1-3). New York State Department of Health (NYSDOH) conducted a case-control study to estimate JYNNEOS VE against diagnosed mpox in New York residents outside of NYC, using data from systematic surveillance reporting. A case-patient was defined as a man aged ≥18 years who received a diagnosis of mpox during July 24-October 31, 2022. Contemporaneous control patients were men aged ≥18 years with diagnosed rectal gonorrhea or primary syphilis and a history of male-to-male sexual contact, without mpox. Case-patients and control patients were matched to records in state immunization systems. JYNNEOS VE was estimated as 1 - odds ratio (OR) x 100, and JYNNEOS vaccination status (vaccinated versus unvaccinated) at the time of diagnosis was compared, using conditional logistic regression models that adjusted for week of diagnosis, region, patient age, and patient race and ethnicity. Among 252 eligible mpox case-patients and 255 control patients, the adjusted VE of 1 dose (received ≥14 days earlier) or 2 doses combined was 75.7% (95% CI = 48.5%-88.5%); the VE for 1 dose was 68.1% (95% CI = 24.9%-86.5%) and for 2 doses was 88.5% (95% CI = 44.1%-97.6%). These findings support recommended 2-dose JYNNEOS vaccination consistent with CDC and NYSDOH guidance.

Rapid detection of Salmonella enterica subsp. enterica serovar Thompson by real-time fluorescence loop-mediated isothermal amplification (LAMP) and colorimetric LAMP combined without DNA extraction in the field

Salmonella enterica subsp. enterica serovar Thompson (S. Thompson) has caused numerous international outbreaks of foodborne disease in recent years. Despite the need for methods to control and prevent these outbreaks, many researchers continue to focus on Salmonella species, and few studies have focused on S. Thompson. In this study, we developed the new loop-mediated isothermal amplification (LAMP) assay with the novel primers that targets highly specific hsdS gene for the detection of S. Thompson. The LAMP assay yielded 100% positive results for S. Thompson strains and observed no cross-reaction with 55 other strains. The sensitivity was determined to be 10 colony-forming units (CFU)/mL in pure and artificially contaminated chicken samples. The LAMP assays were further improved to develop a direct LAMP assay for on-site detection that could complete the entire process within 45 min without the need for DNA isolation. After 60 min of enrichment, artificially contaminated chicken samples (initial concentration of 3 CFU/g) were detectable by direct LAMP assay, and this assay was also effectively used for testing commercial meat samples. The proposed LAMP assay has potential applications for on-site detection of S. Thompson and for rapid tracing of contamination sources in laboratories with limited resources.

Whole-Genome Sequence of a Human Monkeypox Virus Strain Detected in Egypt.

Monkeypox virus has recently been detected in multiple countries. Two cases of monkeypox virus were reported in Egypt as part of an ongoing international outbreak. We report the whole-genome sequence of a monkeypox virus that was retrieved from the first confirmed case in Egypt. The virus was fully sequenced on the Illumina platform, and phylogenetic analysis demonstrated that the current monkeypox strain is closely related to clade IIb, which caused recent multicountry outbreaks.

An opportunity seized: rapid clinical research provides insights into monkeypox virus dynamics and durations of infectiousness.

Monkeypox is not a new disease; it was first detected in humans in the Democratic Republic of the Congo in 1970. Clinicians and scientists in countries in west and central Africa have previously reported the course of disease and virological findings from a number of clade I and clade II monkeypox virus outbreaks.1–3 However, the unprecedented international outbreaks in 2022, caused by clade IIb monkeypox virus, and driven by human-to-human transmission, have provided additional opportunities to describe clinical manifestations and investigate viral dynamics in individuals with monkeypox.