Monkeypox is a zoonotic disease caused by monkeypox virus which belongs to the orthopoxviruses genus which make it closely related to the variola virus the causative agent for smallpox [1]. genetically there are two clades for the monkeypox virus, west African clade (WA clade II) and the more severe Congo basin (CB clade I) [2]. It was observed that smallpox vaccination was protective against monkeypox by approximately 85% [3]. After the eradication of smallpox, the vaccine was no longer mandated [4] .The first description of the disease was in 1958 with two outbreaks of a pox-like disease among cynomolgus monkeys in Denmark[5]. The first human infection of monkeypox was reported in 1970 in a 9-month-old boy in the democratic republic of Congo DRC [6] . monkeypox remain endemic in DRC and spreading to other African regions [7]. after several years of sporadic occurrences in Africa, a worldwide outbreak of human monkeypox happened in May 2022 involving 104 countries most of has no epidemiological connection with the known endemic regions [8]. Which lead the world health organization to declare the ongoing monkeypox outbreak a Public Health Emergency of International Concern [9]. Confirmed Cases from non-endemic areas were predominantly males with mean age of 29.92 years [10] who has a history of sexual contact with other men [11]. All these cases confirmed by PCR to be from west African clade [12].
The aim of this report is Describe the monkeypox outbreak in Jeddah, Saudi Arabia, from March 26 to May 9, 2023, in terms of case epidemiology, mode of transmission, clinical presentations, extent of spread, risk factors, evaluation of control measures, and recommendations to strengthen future preparedness and response strategies.
All cases confirmed in Jeddah by positive result of Mpox virus polymerase-chain-reaction (PCR) assay in a specimen from skin lesions or a throat swab. Variables for cases include age, gender, nationality, occupation, symptoms onset, confirmation date, reporting hospital and location. Variables For the contacts of each case include total contacts, high risk contacts, number of healthcare workers, last date of contact, first dose of vaccination, second dose of vaccination, follow up duration, and symptomatic contacts. Microsoft Excel and Epi Info 7.2.5.0 were used for the analysis.
The first case was discovered on March 28, a 31-year-old Bangladeshi driver who visited the Saudi hospital in Jeddah, complaining of fever, headache, muscle pain and rash, he was suspected, and sample was collected on March 26, 2023, and confirmed on the 28/03/2023. he was isolated in the Saudi hospital in Jeddah.
Since then, six additional cases have been reported in Jeddah (table 1), bringing the total to seven, including three Saudi nationals, three Pakistani nationals (two confirmed outside the KSA).
All patients were hospitalized and received the necessary treatment in Jeddah hospitals.
Among the 7 confirmed cases, the affected age group was 26 to 41 years, indicating that a relatively small age group is affected.
A total of 61 contacts have been identified and are currently being monitored. 29 of these contacts are considered high risk. In addition, healthcare workers who have contacted confirmed cases are followed to minimize and mitigate the risk of potential spread (table 2).
The route of transmission for this outbreak is not confirmed for all cases, as just two cases reported prior sexual interaction before symptom start, and none reported contact with animals. Investigations into probable origins of transmission are continuing. There is currently no evidence linking the monkeypox cases and Umrah nor to travelling abroad.
Monitoring the situation is ongoing and taking the appropriate precautions to prevent the spread of monkeypox. Healthcare professionals and the public must be cautious and follow recommended preventive measures, including proper hygiene procedures and reporting any suspected cases to local health authorities.
We recommend a preparedness plan to face any increase in cases or if other cases appear in the western region.
Table 1: timeline of confirmed monkeypox cases in Jeddah from March 26 to May 9, 2023
| Confirm Date | Description |
| March 28 |
1st case a 31-year-old Bangladeshi national working in a company was suspected on 26-Mar-2023 and confirmed on the 28-Mar-2023. he was isolated in the Saudi hospital in Jeddah. |
| April 17 | 2nd case a 29-year-old Pakistani national working as private driver, reported to Taha Bakhsh hospital on 15-April-2023 after having rash, sample was collected on the same day and on 17/04/2023 the case was confirmed and isolated in East Jeddah hospital. |
| April 19 |
3rd case a 27-year-old Saudi national. visited dermatology clinic in united doctors’ hospital on 17-April-2023 complaining of high fever, headache, asthenia, and rash for the past week, sample collected and confirmed on 19-April-2023 isolated and treated in East Jeddah hospital. History of sexual contact 2 weeks prior to the onset of symptoms. |
| April 27 |
4th case a 40-year-old Saudi national. patient went to Al-Rayan private hospital on 18-April-2023 after suffering from fever, severe headache, and asthenia where he received voltaren. On 21-April-2023 symptoms returned, so he visited a dermatology clinic in united doctors’ hospital after suffering from rash for 3 days, sample collected and confirmed positive on 27-April-2023. isolated and treated in east Jeddah hospital. History of sexual contact 2 weeks ago prior to onset of symptoms |
| May 5 |
5th case a 26-year-old Saudi national. on 26-April-2023 patient noticed Rash, 5 days later he started having a high fever, he went to east Jeddah hospital to seek treatment. The first sample was on May 2nd which was rejected by lab, 2nd sample was collected on May 4th and confirmed on 5th. patient isolated and treated in east Jeddah hospital. He is a close contact with the third confirmed case. |
| April 20 |
6th case is reported in Pakistan. The patient is a 41-year-old Pakistani national who departed Jeddah to Pakistan on 15-April-2023 On April 17 he visited a healthcare facility after suffering from rash on face, hands, legs, chest and genitals area with sore throat and asthenia with no fever or cough, sample collected and confirmed on April 20. Didn’t visit any health facility in Saudi Arabia in the 14 days prior to his departure. |
| May 4 |
7th case is reported in Pakistan. The patient is a 36-year-old Pakistani national who is working as a private driver. He departed Jeddah to Masqat, Oman on 03-May-2023. According to the family: The patient didn’t suffer from any symptoms prior to his departure. No knowledge of the patient’s contact with any case. No knowledge of the patient’s vaccination status. Confirmed in Pakistan on 4-May-2023. |
Table 2 : summary for contacts with confirmed monkeypox cases in Jeddah from March 26 to May 9, 2023.
|
Case No. |
Total | High Risk | HCW | Last Date of Contact |
First Dose vaccination |
Second Dose vaccination |
Follow-up | Symptomatic |
| 1 | 13 | 13 | 0 | 25-Mar-2023 | 02-Apr-2023 | 27-Apr-2023 | 3 weeks | 0 |
| 2 | 16 | 5 | 6 |
30-Mar-2023, 12-Apr-2023, 15-Apr-2023 |
18-Apr-2023 | 16-May-2023 | 3 weeks | 0 |
| 3 | 5 | 2 | 3 |
17-Apr-2023, 19-Apr-2023 |
19-Apr-2023 | 17-May-2023 | 3 weeks | 1 |
| 4 | 10 | 8 | 2 |
18-Apr-2023, 22-Apr-2023 26-Apr-2023 |
Not administered | Not applicable | 2nd week ongoing | 0 |
| 5 | 10 | 1 | 9 |
19-Apr-2023, 2,3,5,6,7 May-2023,
|
19-Apr-2023 (prior contact) | 17-May-2023 | Ongoing | 0 |
| 6 (Intl.) | 4 | 0 | 0 | 16-Apr-2023 | Not administered | Not applicable | 2nd week ongoing | 0 |
| 7 (Intl.) | 3 | 0 | 0 | 17-Mar-2023, 23-Mar-2023 | Not applicable | Not applicable | Ongoing | 0 |
References
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