Sarah E McFarland, Ulrich Marcus, Lukas Hemmers, Fuminari Miura, Jesús Iñigo Martínez, Fernando Martín Martínez, Elisa Gil Montalbán, Emilie Chazelle, Alexandra Mailles, Yassoungo Silue, Naïma Hammami, Amaryl Lecompte, Nicolas Ledent, Wim Vanden Berghe, Laurens Liesenborghs, Dorien Van den Bossche, Paul R Cleary, Jacco Wallinga, Eve P Robinson, Tone Bjordal Johansen, Antra Bormane, Tanya Melillo, Cornelia Seidl, Liza Coyer, Ronja Boberg, Annette Jurke, Dirk Werber, Alexander Bartel

Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022

  • Virology
  • Public Health, Environmental and Occupational Health
  • Epidemiology
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Background Since May 2022, an mpox outbreak affecting primarily men who have sex with men (MSM) has occurred in numerous non-endemic countries worldwide. As MSM frequently reported multiple sexual encounters in this outbreak, reliably determining the time of infection is difficult; consequently, estimation of the incubation period is challenging. Aim We aimed to provide valid and precise estimates of the incubation period distribution of mpox by using cases associated with early outbreak settings where infection likely occurred. Methods Colleagues in European countries were invited to provide information on exposure intervals and date of symptom onset for mpox cases who attended a fetish festival in Antwerp, Belgium, a gay pride festival in Gran Canaria, Spain or a particular club in Berlin, Germany, where early mpox outbreaks occurred. Cases of these outbreaks were pooled; doubly censored models using the log-normal, Weibull and Gamma distributions were fitted to estimate the incubation period distribution. Results We included data on 122 laboratory-confirmed cases from 10 European countries. Depending on the distribution used, the median incubation period ranged between 8 and 9 days, with 5th and 95th percentiles ranging from 2 to 3 and from 20 to 23 days, respectively. The shortest interval that included 50% of incubation periods spanned 8 days (4–11 days). Conclusion Current public health management of close contacts should consider that in approximately 5% of cases, the incubation period exceeds the commonly used monitoring period of 21 days.

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