Incubation period of monkeypox: estimates from the Netherlands

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Estimated cumulative density functions, according to different parametric distributions and empirical cumulative density function of reported incubation periods for monkeypox cases in the Netherlands, May 2022 (n=18 cases). Credit: Eurosurveillance

During the current outbreak of monkeypox cases worldwide, 31 cases have been confirmed in the Netherlands up to May 31, 2022. Efforts to stop the spread of the infection are focused on active case finding, contact tracing of close contacts and their isolation or quarantine. Related recommendations from public health agencies on the need for active surveillance and isolation for at least 21 days after the last day of exposure are based on the known incubation period of monkeypox (up to 21 days ).

Miura et al. analyzed data from 18 confirmed cases in the Netherlands who reported the date of symptom onset and the most likely date of exposure. Depending on the route of transmission, the typical duration of incubation period for monkey pox ranges from 9 days after complex and invasive exposure, such as contact with damaged skin, to approximately 13 days after non-invasive exposure such as droplet transmission or contact with intact skin.

In their rapid communication published in Eurosurveillance Today, the authors state that “given the particular types of exposure and differences in the route of transmission, the incubation period for monkeypox in current epidemics may also have a different length.”

All 31 laboratory-confirmed cases of monkeypox detected in the Netherlands up to the end of May 2022 involved men aged 23 to 64 who identified as men who have sex with men. Miura et al. analyzed the distribution of incubation periods based on information on symptom onset and history of exposure to monkeypox among 18 of them. They used a likelihood-based approach, which allows the exposure to be a single moment or time interval.

Estimated average incubation period of 8.5 days

Among the cases analyzed in this outbreak and using this best-fit (log-normal) distribution, the mean incubation period for monkeypox was estimated to be 8.5 days (95% credible intervals: 6.6 to 10, 9 days), the 5e 4.2 day percentile and the 95e percentile of 17.3 days.

This average incubation period is consistent with the typical chronology of so-called complex invasive exposure and “direct contact between broken skin or mucous membranes during sexual activity could be the most likely route of transmission among reported cases” in the Netherlands.

On this basis, Miura et al. estimate that the percentage of people with monkeypox who would not develop symptoms until after 21 days is around 2%, supporting the current use of 21 days for quarantine or other approaches to avoid contact infectious.

The authors note that “more epidemiological information on the details of possible routes of exposure is needed to establish whether the results of the current study are generalizable to other cases of men who have sex with men in the world.” current epidemic, and how the incubation period differs between alternative routes of transmission.”

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More information:
Miura Fuminari et al, Estimated incubation period for confirmed monkeypox cases in the Netherlands, May 2022, Eurosurveillance (2022). DOI: 10.2807/1560-7917.ES.2022.27.24.2200448

Provided by the European Center for Disease Prevention and Control (ECDC)

Quote: Monkeypox incubation period: Netherlands estimates (June 16, 2022) Retrieved June 16, 2022 from

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