{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T01:57:16Z","timestamp":1794362236454,"version":"4.9.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Commun"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In May 2022, individuals infected with the monkeypox virus were detected in the UK without clear travel links to endemic areas. Understanding the clinical characteristics and infection severity of mpox is necessary for effective public health policy. The study period\u00a0of this paper, from the 1<jats:sup>st<\/jats:sup> June 2022 to 30<jats:sup>th<\/jats:sup> September 2022, included 3,375 individuals that tested positive for the monkeypox virus. The posterior mean times from infection to hospital admission and length of hospital stay were 14.89 days (95% Credible Intervals (CrI): 13.60, 16.32) and 7.07 days (95% CrI: 6.07, 8.23), respectively. We estimated the modelled Infection Hospitalisation Risk to be 4.13% (95% CrI: 3.04, 5.02), compared to the overall sample Case Hospitalisation Risk (CHR) of 5.10% (95% CrI: 4.38, 5.86). The overall sample CHR was estimated to be 17.86% (95% CrI: 6.06, 33.11) for females and 4.99% (95% CrI: 4.27, 5.75) for males. A notable difference was observed between the CHRs that were estimated for each sex, which may be indicative of increased infection severity in females or a considerably lower infection ascertainment rate. It was estimated that 74.65% (95% CrI: 55.78, 86.85) of infections with the monkeypox virus in the UK were captured over the outbreak.<\/jats:p>","DOI":"10.1038\/s41467-024-45110-8","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T17:02:29Z","timestamp":1710176549000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Understanding the infection severity and epidemiological characteristics of mpox in the UK"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8801-747X","authenticated-orcid":false,"given":"Thomas","family":"Ward","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Overton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Paton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Christie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus","family":"Cumming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn","family":"Fyles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"45110_CR1","unstructured":"WHO. Monkeypox, 2022. Online Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/monkeypox."},{"key":"45110_CR2","unstructured":"WHO. Multi-country monkeypox outbreak in non-endemic countries. Online Available from: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON385 (2022)."},{"key":"45110_CR3","doi-asserted-by":"publisher","first-page":"2661","DOI":"10.1099\/vir.0.81215-0","volume":"86","author":"AM Likos","year":"2005","unstructured":"Likos, A. M. et al. A tale of two clades: monkeypox viruses. J. Gen. Virol. 86, 2661\u20132672 (2005).","journal-title":"J. Gen. Virol."},{"key":"45110_CR4","unstructured":"CDC, 2022 Monkeypox Outbreak Global Map. Online Available from: https:\/\/www.cdc.gov\/poxvirus\/monkeypox\/response\/2022\/world-map.html (2022)."},{"key":"45110_CR5","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1093\/infdis\/154.4.551","volume":"154","author":"Z Jezek","year":"1986","unstructured":"Jezek, Z. et al. Human monkeypox: a study of 2510 contacts of 214 patients. J. Infect. Dis. 154, 551\u2013555 (1986).","journal-title":"J. Infect. Dis."},{"key":"45110_CR6","unstructured":"Yinka-Ogunleye, A. et al. Outbreak of human monkeypox in Nigeria in 2017\u201318: a clinical and epidemiological report. Lancet Infect. Dis. 19, 872\u2013879 (2019)."},{"key":"45110_CR7","unstructured":"UKHSA. Investigation into monkeypox outbreak in England: technical briefing 8. Online Available from: https:\/\/www.gov.uk\/government\/publications\/monkeypox-outbreak-technical-briefings\/investigation-into-monkeypox-outbreak-in-england-technical-briefing-8 (2022)."},{"key":"45110_CR8","unstructured":"UKHSA. Investigation into monkeypox outbreak in England: technical briefing 1. Online Available from: https:\/\/www.gov.uk\/government\/publications\/monkeypox-outbreak-technical-briefings\/investigation-into-monkeypox-outbreak-in-england-technical-briefing-1 (2022)."},{"key":"45110_CR9","unstructured":"UKHSA. Investigation into monkeypox outbreak in England: technical briefing 7. Online Available from: https:\/\/www.gov.uk\/government\/publications\/monkeypox-outbreak-technical-briefings\/investigation-into-monkeypox-outbreak-in-england-technical-briefing-7 (2022)."},{"key":"45110_CR10","doi-asserted-by":"publisher","first-page":"e073153","DOI":"10.1136\/bmj-2022-073153","volume":"379","author":"T Ward","year":"2022","unstructured":"Ward, T., Christie, R., Paton, R. S., Cumming, F. & Overton, C. E. Transmission dynamics of monkeypox in the United Kingdom: contact tracing study. BMJ 379, e073153 (2022).","journal-title":"BMJ"},{"key":"45110_CR11","doi-asserted-by":"publisher","unstructured":"Snyder, R. et al. \u2018Sexual exposures associated with mpox infection: California, November 2022 to June 2023,\u2019 medRxiv. Online https:\/\/doi.org\/10.1101\/2023.08.07.23293793 (2023).","DOI":"10.1101\/2023.08.07.23293793"},{"key":"45110_CR12","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1016\/j.jiac.2023.06.018","volume":"29","author":"T Kubo","year":"2023","unstructured":"Kubo, T., Hayakawa, K., Akiyama, Y., Morioka, S. & Ohmagari, N. A case of confirmed pre-symptomatic transmission of mpox. J. Infect. Chemother. 29, 1008\u20131009 (2023).","journal-title":"J. Infect. Chemother."},{"key":"45110_CR13","doi-asserted-by":"publisher","first-page":"e28769","DOI":"10.1002\/jmv.28769","volume":"95","author":"I Brosius","year":"2023","unstructured":"Brosius, I. et al. Presymptomatic viral shedding in high-risk mpox contacts: a prospective cohort study. J. Med. Virol. 95, e28769 (2023).","journal-title":"J. Med. Virol."},{"key":"45110_CR14","doi-asserted-by":"publisher","first-page":"e0010141","DOI":"10.1371\/journal.pntd.0010141","volume":"16","author":"EM Bunge","year":"2022","unstructured":"Bunge, E. M. et al. The changing epidemiology of human monkeypox\u2014A potential threat? A systematic review. PLOS Negl. Trop. Dis. 16, e0010141 (2022).","journal-title":"PLOS Negl. Trop. Dis."},{"key":"45110_CR15","doi-asserted-by":"publisher","first-page":"428","DOI":"10.4269\/ajtmh.2005.73.428","volume":"73","author":"LA Learned","year":"2005","unstructured":"Learned, L. A. et al. Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003. Am. J. Trop. Med. Hyg. 73, 428\u2013434 (2005).","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"45110_CR16","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.3201\/eid1610.100713","volume":"16","author":"P Formenty","year":"2010","unstructured":"Formenty, P. et al. Human monkeypox outbreak caused by novel virus belonging to Congo Basin clade, Sudan, 2005. Energising Infect. Dis. 16, 1539\u20131545 (2010).","journal-title":"Energising Infect. Dis."},{"key":"45110_CR17","doi-asserted-by":"crossref","unstructured":"Kalthan, E. et al. Epid\u00e9mie de 12 cas de maladie \u00e0 virus monkeypox dans le district de Bangassou en R\u00e9publique Centrafricaine en d\u00e9cembre 2015. \u00c9pid\u00e9miologie. 109, 385\u2013363 (2016).","DOI":"10.1007\/s13149-016-0516-z"},{"key":"45110_CR18","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1086\/498115","volume":"41","author":"GD Huhn","year":"2005","unstructured":"Huhn, G. D. et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin. Infect. Dis. 41, 1742\u20131751 (2005).","journal-title":"Clin. Infect. Dis."},{"key":"45110_CR19","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1086\/505880","volume":"194","author":"MG Reynolds","year":"2006","unstructured":"Reynolds, M. G. et al. Clinical manifestations of human monkeypox influenced by route of infection. J. Infect. Dis. 194, 773\u2013780 (2006).","journal-title":"J. Infect. Dis."},{"key":"45110_CR20","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-26709-7","volume":"12","author":"TK Tsang","year":"2021","unstructured":"Tsang, T. K., Wang, C., Yang, B., Cauchemez, S. & Cowling, B. J. Using secondary cases to characterize the severity of an emerging or re-emerging infection. Nat. Commun. 12, 6372 (2021).","journal-title":"Nat. Commun."},{"key":"45110_CR21","unstructured":"Mathieu, E., Spooner, F., Dattani, S., Ritchie, H. & Roser, M. Mpox our world in data, 2023. Online Available from: https:\/\/ourworldindata.org\/monkeypox."},{"key":"45110_CR22","unstructured":"WHO. Multi-country outbreak of mpox, External Situation Report 28. Online Available from: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20230919_mpox__external-sitrep-28.pdf?sfvrsn=2654b9d2_5&download=true (2023)."},{"key":"45110_CR23","doi-asserted-by":"publisher","first-page":"e1010554","DOI":"10.1371\/journal.pcbi.1010554","volume":"18","author":"CE Overton","year":"2022","unstructured":"Overton, C. E. et al. Novel methods for estimating the instantaneous and overall COVID-19 case fatality risk among care home residents in England. PLOS Comp. Biol. 18, e1010554 (2022).","journal-title":"PLOS Comp. Biol."},{"key":"45110_CR24","doi-asserted-by":"publisher","first-page":"101710","DOI":"10.1016\/j.eclinm.2022.101710","volume":"54","author":"ME DeWitt","year":"2022","unstructured":"DeWitt, M. E. et al. Global monkeypox case hospitalisation rates: A rapid systematic review and meta-analysis. EClinicalmedicine 54, 101710 (2022).","journal-title":"EClinicalmedicine"},{"key":"45110_CR25","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","volume":"400","author":"EJ Tar\u00edn-Vicente","year":"2022","unstructured":"Tar\u00edn-Vicente, E. J. et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet 400, 661\u2013669 (2022).","journal-title":"Lancet"},{"key":"45110_CR26","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1056\/NEJMoa2207323","volume":"387","author":"JP Thornhill","year":"2022","unstructured":"Thornhill, J. P. et al. Monkeypox virus infection in humans across 16 countries \u2014 April\u2013June 2022. N. Engl. J. Med. 387, 679\u2013691 (2022).","journal-title":"N. Engl. J. Med."},{"key":"45110_CR27","unstructured":"ECDC. Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin. Online Available from: https:\/\/monkeypoxreport.ecdc.europa.eu\/ (2022)."},{"key":"45110_CR28","doi-asserted-by":"publisher","first-page":"764","DOI":"10.15585\/mmwr.mm7123e1","volume":"71","author":"FS Minhaj","year":"2022","unstructured":"Minhaj, F. S. et al. Monkeypox outbreak\u2014nine states, May 2022. MMWR Morb. Mortal. Wkly Rep. (MMWR) 71, 764\u2013769 (2022).","journal-title":"MMWR Morb. Mortal. Wkly Rep. (MMWR)"},{"key":"45110_CR29","doi-asserted-by":"publisher","first-page":"102417","DOI":"10.1016\/j.tmaid.2022.102417","volume":"49","author":"D Moschese","year":"2022","unstructured":"Moschese, D. et al. Hospitalisation for monkeypox in Milan, Italy. Travel Med. Infect. Dis. 49, 102417 (2022).","journal-title":"Travel Med. Infect. Dis."},{"key":"45110_CR30","first-page":"847","volume":"28","author":"BS Rodr\u00edguez","year":"2022","unstructured":"Rodr\u00edguez, B. S., Herrador, B. R. G., Franco, A. D. & S\u00e1nchez-Seco, M. P. Epidemiologic features and control measures during monkeypox outbreak, Spain, June 2022. Emerg. Infect. Dis. 28, 847\u20131851 (2022).","journal-title":"Emerg. Infect. Dis."},{"key":"45110_CR31","doi-asserted-by":"publisher","first-page":"e072410","DOI":"10.1136\/bmj-2022-072410","volume":"378","author":"A Patel","year":"2022","unstructured":"Patel, A. et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ 378, e072410 (2022).","journal-title":"BMJ"},{"key":"45110_CR32","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1111\/bjd.21790","volume":"187","author":"A Catal\u00e0","year":"2022","unstructured":"Catal\u00e0, A. et al. Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases. Br. J. Dermatol 187, 765\u2013772 (2022).","journal-title":"Br. J. Dermatol"},{"key":"45110_CR33","unstructured":"N. H. S. England. Update on High Consequence Infectious Disease (HCID) Status of mpox. Online Available from: https:\/\/www.england.nhs.uk\/long-read\/update-on-high-consequence-infectious-disease-hcid-status-of-mpox\/ (2023)."},{"key":"45110_CR34","unstructured":"NHS. Digital. Hospital Episode Statistics (HES). Online Available from: https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/hospital-episode-statistics (2022)."},{"key":"45110_CR35","unstructured":"NHS. Digital. Emergency Care Data Set (ECDS). Online Available from: https:\/\/digital.nhs.uk\/data-and-information\/data-collections-and-data-sets\/data-sets\/emergency-care-data-set-ecds (2022)."},{"key":"45110_CR36","unstructured":"WHO. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Online Available from: https:\/\/icd.who.int\/browse10\/2010\/en#\/ (2010)."},{"key":"45110_CR37","first-page":"409","volume":"5","author":"CE Overton","year":"2020","unstructured":"Overton, C. E. et al. Using statistics and mathematical modelling to understand infectious disease outbreaks: COVID-19 as an example. Infect. Dis. Model. 5, 409\u2013441 (2020).","journal-title":"Infect. Dis. Model."},{"key":"45110_CR38","doi-asserted-by":"publisher","first-page":"20180670","DOI":"10.1098\/rsif.2018.0670","volume":"16","author":"T Britton","year":"2019","unstructured":"Britton, T. & Scalia Tomba, G. S. Estimation in emerging epidemics: biases and remedies. J. R. Soc. Interface 16, 20180670 (2019).","journal-title":"J. R. Soc. Interface"},{"key":"45110_CR39","unstructured":"Wood, S. \u2018mgcv: Mixed GAM Computation Vehicle with Automatic Smoothness Estimation\u2019 CRAN. Online Available from: https:\/\/cran.r-project.org\/web\/packages\/mgcv\/index.html (2023)."},{"key":"45110_CR40","unstructured":"Gelman, A. Prior choice recommendations. Online Available from: https:\/\/github.com\/stan-dev\/stan\/wiki\/Prior-Choice-Recommendations (2020)."},{"key":"45110_CR41","unstructured":"Gabry, J. & \u010ce\u0161novar, R. CmdStanR. Online Available from: https:\/\/mc-stan.org\/cmdstanr\/ (2022)."}],"container-title":["Nature Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41467-024-45110-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-024-45110-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-024-45110-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T17:04:21Z","timestamp":1710176661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41467-024-45110-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,11]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["45110"],"URL":"https:\/\/doi.org\/10.1038\/s41467-024-45110-8","relation":{},"ISSN":["2041-1723"],"issn-type":[{"value":"2041-1723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,11]]},"assertion":[{"value":"30 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"UKHSA have an exemption under regulation 3 of section 251 of the National Health Service Act (2006) to allow identifiable patient information to be processed to diagnose, control, prevent, or recognise trends in communicable diseases and other risks to public health.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"2199"}}