Clinical features and management of individuals admitted to hospital with monkeypox and associated complications across the UK: a retrospective cohort study
Douglas Fink, Helen Callaby, Helen Callaby, W.J.G. Beynon, Helena Bond, Eleanor Y. Lim, Eleanor Y Lim, Jospeh Heskin, Margherita Bracchi, Balram Rathish, Iain Milligan, Geraldine O’Hara, Stephanie Rimmer, Joanna Peters, Lara Payne, Nisha Mody, Nisha Mody, Penny Lewthwaite, Rebecca Lester, Stephen Woolley, Ann Sturdy, Ashley Whittington, Leann Johnson, Nathan Jacobs, John Quartey, Brendan Payne, Stewart Crowe, Ivo A M Elliott, Thomas Harrison, Thomas Harrison, Katie Beard, Tomas-Paul Cusack, Imogen Jones, Rishi Banerjee, Tommy Rampling, Jake Dunning, Douglas Fink, Iain Milligan, Douglas L Fink, Alison Rodger, Sanjay Bhagani, Lucy Lamb, Rachel Moores, Simon F K Lee, Colin Brown, Susan Hopkins, Stephen Mepham, Simon Warren, Aoife Molloy, Ian Cropley, Alex Kew, Natasha Karunaharan, Antonia Scobie, Jennifer Hart, Dianne Irish, Tanzina Haque, Hamid Jalal, Robin Smith, Damien Mack, Tristan Barber, Fiona Burns, Robert F. Miller, Eleanor Hamlyn, Pedro Simoes, Breda Athan, Jennifer Abrahamsen, Jessica Joyce, Caroline Taylor, Sally Reddecliffe, Chloe Miller, Brooke Reeve, Hugh Kingston, Tim Crocker-Buqué, Nicolas Massie, Ankush Dhariwal, Angelina Jayakumar, Robert Hammond, Alexandra Bramley, Tanmay Kanitkar, Laura Maynard-Smith, Eliza Gil, Cavan O'Connor, Derek Cocker, Wendy Spicer, Marisa Lanzman, Meera Thacker, Zoe O Anorson, Dharmesh Patel, Alan Williams, Catherine Houlihan, Dominic Wakerley, Claire N Gordon, Helen Callaby, Daniel J. Bailey, Jenna Furneaux, A Bown, Elizabeth J Truelove, Marian J. Killip, D.A. Jackson, Tracy L B Beetar-King
Abstract
Background The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. Methods In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. Findings 156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30–44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm 3 (IQR 349–828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2–9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. Interpretation Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital. Funding None.