Monkeypox: EpiMPX Surveillance System and Open Data with a Special Focus on European and Italian Epidemic

Abstract

Background: The current out-of-Africa 2022 outbreak of Monkeypox requires a coordinated, international response through the rapid sharing of data and research results, as we have seen with COVID-19 and the previous Ebola and Zika outbreaks, which demonstrated how important real-world data are to inform public health, to create surveillance systems, to determine policy decisions and to improve clinical trials.

Objectives: To support global response efforts by providing public access to real-time Monkeypox-related data for effective use of open data that could accelerate scientific knowledge and discoveries in terms of understanding, preventing, and treating the disease. In practice, to create a new surveillance system easy to consult and utilize.

Study design: This work aims to build a surveillance system, namely EpiMPX, that allows researchers and policymakers to monitor the impact of Monkeypox in Europe, with a special focus on the epidemic trends in the Italian regions, based on an open-access database containing information on the laboratory confirmed Monkeypox cases reported by EU/EEA countries and updated once a week. In addition, users will be provided open-access R codes to estimate key epidemiological parameters such as the reproduction number (updating the Serial Interval distribution when new estimates will be published) and produce real-time results on their devices.

Results: EpiMPX monitors the space-time distribution of cases and their characteristics, such as age, gender, symptoms, clinical status, and sexual orientation, when available. Even if it is currently too early for reliable calculation of epidemiological parameters, we estimated reproduction number $R_t$ in European countries with more than 28 days of observed incidence, assuming that the Serial Interval (SI) early estimate in Italy is valid for other countries too. This provides a direct visual assessment of the geographic distribution of risk areas as well as insights into the evolution of the outbreak over time. Italian data were evaluated concerning gender, region prevalence and cumulative data.

Conclusions: The proposed EpiMPX surveillance system provides an overview of the European and Italian Monkeypox epidemiological situation with an open-access database to support epidemiological understanding of the origins and transmission dynamics of the disease with informative graphical outputs. These data confirmed the prevalent expression of Monkeypox within males, both in Europe and Italy. European MSM patients were affected by Monkeypox in a high percentage, confirming close sexual contact and possible sexual transmission. For the first time, Italian data on the regional distribution of cases and gender distribution were graphically evaluated. The data and research results are freely available and can be easily enriched to provide a prompt response to the scientific community and accelerate global efforts to contain the Monkeypox virus.

Keywords: Emerging viruses; Monkeypox; Public health; Virus surveillance.

Fig. 1

Early estimate of Serial Interval : (A) Cumulative Density Function with 95% CI; (B) Normal distribution of mean parameter $\mathrm{\mu }$; (C) Probability Density Function mean and 95% CI; (D) Normal distribution of standard deviation parameter $\mathrm{\sigma }$.

Fig. 2

Early estimate of effective reproduction number ${\mathrm{R}}_{\mathrm{t}}$ in European countries with more than 28 days incidence: (A) Austria, (B) Belgium, (C) Denmark, (D) France, (E) Germany, (F) Hungary, (G) Ireland, (H) Israel, (I) Italy, (L) Netherlands, (M) Norway, (N) Poland, (O) Portugal, (P) Slovenia, (Q) Spain, (R) Sweden, (S) Switzerland, (T) United Kingdom.

Fig. 3

Epidemiological curve of weekly confirmed cases of Monkeypox (MPX) in Italy, from 20 May 2022 to 16 August 2022. (A) Total MPX cases by region. (B) Distribution of MPX cases by gender. (C) New cases and (D) cumulative cases of MPX in the most affected Italian regions.