Investigation of the third confirmed case of monkeypox in Phuket Province, Thailand, August 2022

Abstract

Background: On 2 August 2022, the joint investigation team of Department of Disease Control was notified of a confirmed case of monkeypox (mpox) who came from Germany in Phuket province. The investigation was conducted to confirm diagnosis, describe epidemiological characteristics of the case, determine risk factors, transmission source and infection among case’s contacts, and recommend appropriate preventive and control measures.
Methods: The investigation included review of the patient’s medical record from the hospital and case report form from Phuket Provincial Health Office, interviewing the case and his girlfriend, physician and health personnel taking care of the case, identifying possible source of infection and active case finding among case’s contacts. Samples from the case and case’s contacts were collected to determine mpox virus by real-time PCR and viral strain by genome sequencing. An environmental investigation was carried out. The mpox surveillance system in Phuket province was surveyed.
Results: One confirmed case of mpox was identified. The case was a 25-year-old German male who took a direct flight to Phuket airport on 18 July 2022. He refused sexual diversity. He developed rashes and papules (and then pustules) first on perineum skin on 24 July 2022 and later throughout his body, with fever, cervical and inguinal lymphadenopathy. Samples from the lesion roof of the pustule at perineum, throat swab and blood were positive for mpox virus. The viral strain was identified to be West African lineage A.2. The case recovered and went back to Germany. All the 10 high-risk and 14 low-risk contacts of this case were negative for mpox infection. He might be an imported case since there was no contact with any infected person in Thailand. Mpox surveillance system in Phuket province was good.
Discussion and Conclusion: The third case of confirmed mpox in Thailand was reported. The viral strain was West African lineage A.2. The patient was a German male who refused sexual diversity. He might be an imported case since there was no contact with any infected person in Thailand.