Fact file

Monkeypox: the symptoms, transmission and the latest cases

Virus could become endemic, EU health chiefs warn

A further 14 cases of monkeypox have been detected in England, bringing the total number of confirmed cases to 71, the UK’s health agency has said.

The UK Health Security Agency (UKHSA) said that the outbreak of the virus in the UK is now “significant and concerning”, adding that the risk to the population “remains low”.

Scotland confirmed its first patient on Monday, while around 100 cases have been confirmed in 15 countries outside Africa. Austria, Switzerland and Israel are the most recent countries to have declared new cases.

The latest

Efforts to “contain the outbreak are continuing”, said The Guardian, with UK patients isolating in hospital or at home. Their closest contacts are also being told to isolate and avoid contact with vulnerable groups for up to three weeks. 

The most at-risk contacts of the infected have been offered the smallpox vaccine, Imvanex, “which offers cross-protection against monkeypox, a far milder disease, and can be effective up to two weeks after exposure to the virus”, the paper added.

On Sunday, Health Secretary Sajid Javid has said that “most cases” of the virus found in the UK are mild and that the UK is stocking up on smallpox vaccines to bolster the country’s protection against the illness, the BBC reported.

The intervention came as an assessment published by the European Centre for Disease Prevention and Control (ECDC) warned that the illness could become endemic in Europe.

“Little is known” about the “suitability” of European animal species “to serve as a host for monkeypox viru”, the report said. But “rodents”, and particularly squirrels, “are likely to be suitable hosts” meaning transmission from humans to pets is “theoretically possible”.

“Such a spill-over event could potentially lead to the virus establishing in European wildlife and the disease becoming an endemic zoonosis”, it added, describing the probability of such an event as “very low”

What is monkeypox?

According to the WHO website: “Monkeypox is a rare viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe.”

The monkeypox virus was discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research, says the UK government website’s infectious diseases portal.

The first human case was recorded in 1970 in the Democratic Republic of Congo.

The illness still mostly occurs in “remote parts of central and west African countries, near tropical rainforests,” said the BBC. There are two main strains of the virus: west African and central African.

The latest cases are believed to be the west African strain of the virus, which is “mild” compared to the central African strain, said the UK Health Security Agency (UKHSA).

Before this outbreak, the UK had only ever seen seven cases of the virus, according to the government’s website.

What are the symptoms?

Initial symptoms include “fever, headache, aching muscles, backache, swollen lymph nodes, chills and exhaustion”, says the i news site. “A rash can also develop, usually starting on the face before spreading to other parts of the body. It eventually forms a scab, which falls off.”

The US Centers for Disease Control and Prevention says that the incubation period (time from infection to symptoms) for monkeypox is usually seven to 14 days, but can range from five to 21 days. The public health institute adds that in Africa, where cases often go untreated, the disease “has been shown to cause death in as many as one in ten persons” who contract it.

The illness “does not spread easily between people”, said the BBC’s digital health editor Michelle Roberts, but it can be spread in the following ways:

  • touching clothing, bedding or towels used by someone with the monkeypox rash 
  • touching monkeypox skin blisters or scabs 
  • coming into contact with the coughs or sneezes of a person with the monkeypox rash 

What do we know about the latest cases?

There are few details about the new confirmed cases. Health officials have only revealed the locations of a few of the new UK infections, with six confirmed in London, two in the southeast, one in the northeast and one in Scotland.

The first case was identified in a person who had “recently travelled to Nigeria, which is where they are believed to have contracted the infection before travelling to the UK”, reported The Guardian

Is it a sexually transmitted infection?

The virus is not a sexually transmitted infection. However, the recent surge in global cases appears to have been spread primarily through men who have sex with other men, according to WHO officials. This is because the illness is spread through close contact. 

“Many diseases can be spread through sexual contact,” Andy Seale, a WHO adviser on HIV, hepatitis and sexually transmitted infections, told CNBC. “You could get a cough or a cold through sexual contact, but it doesn’t mean that it’s a sexually transmitted disease.” 

Dr Susan Hopkins, chief medical adviser at the UKHSA, said that “because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms”. 

A “notable proportion” of cases in the UK and Europe have been found in gay and bisexual men”, she added, “so we are particularly encouraging these men to be alert to the symptoms”.

Anyone with unusual rashes or lesions on any part of their body, especially their genitalia, should immediately contact NHS 111 or their local sexual health service.

Is this the next Covid?

The risk that monkeypox poses to the public is low, according to the UKHSA, and experts do not believe we are on the verge of a national outbreak.

Despite this being the largest outbreak of monkeypox outside Africa for 50 years, the illness does not spread easily, and so the threat is low compared to the Covid pandemic.

Speaking to the BBC, Jonathan Ball, professor of molecular virology at the University of Nottingham, said: “The fact that only one of the 50 contacts of the initial monkeypox-infected patient has been infected shows how poorly infectious the virus is.”

He added: “It is wrong to think that we are on the brink of a nationwide outbreak.”

Dr Michael Head, a senior research fellow in global health at the University of Southampton, told The Independent that more information was needed on the pattern of transmission, currently believed to be mainly through sexual contact, but said that “it would be very unusual to see anything more than a handful of cases in any outbreak, and we won’t be seeing Covid-style levels of transmission.” 

The main reason we shouldn’t worry too much is that monkeypox is also a “known virus” rather than a “completely new coronavirus”, said BBC health correspondent James Gallagher. This means that “we already have tools to help control it”.

The “big challenge” at the moment is identifying the number of cases currently in the UK, he added. The current number is likely to be only “the tip of the iceberg” as “many of the new cases appear unconnected to each other”.

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