Monkeypox

You may have heard about monkeypox in the news recently. But what is it, what are the symptoms and how can you access help and information?

Monkeypox is a rare infectious viral disease usually associated with travel to West Africa. It is generally a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks.

Monkeypox can affect anyone. It can be passed on through close physical contact like kissing, skin-to-skin or sharing things like clothing, bedding and towels. Although there are several cases in the UK, the risk to the UK population remains low; however we ask that people stay alert to any new rashes or lesions on any part of their body. Although this advice applies to everyone, a notable proportion of recent cases have been detected in gay, bisexual and other men who have sex with men. We therefore advise this group in particular to be aware of the symptoms, especially if they have recently had a new sexual partner.

If you have symptoms of monkeypox please phone a sexual health service or call NHS 111. You must call ahead before your visit.

How do you reduce your risk of getting monkeypox?
  • wash your hands with soap and water regularly or use an alcohol-based hand sanitiser
  • only eat meat that has been cooked thoroughly
  • do not go near wild or stray animals, including dead animals
  • do not go near any animals that appear unwell
  • do not eat or touch meat from wild animals (bush meat)
  • do not share bedding or towels with people who are unwell and may have monkeypox
  • do not have close contact with people who are unwell and may have monkeypox
What are the symptoms of monkeypox?

If you test positive for monkeypox, it usually takes between five and 21 days for the first symptoms to appear. These include:

  • Recent unexpected/unusual spots, ulcers or blisters anywhere on your body
  • Fever
  • Muscle aches
  • Chills and exhaustion
  • Headaches
  • Swollen glands/lymph nodes

A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages – similar to chicken pox – before finally forming a scab, which later falls off.

When should I take action?

Please contact a sexual health clinic if you have a rash with blisters and you’ve been either:

  • in close contact, including sexual contact, with someone who has or might have monkeypox (even if they’ve not been tested yet) in the past 3 weeks
  • to West or Central Africa in the past 3 weeks

Make sure you contact the sexual health clinic before your visit. Tell the person you speak to if you’ve had close contact with someone who has or might have monkeypox, or if you’ve recently travelled to Central or West Africa.

Do not go to a sexual health clinic without contacting them first. Stay at home and avoid close contact with other people until you’ve been told what to do.

If you are not able to contact a sexual health clinic you should call NHS 111.

What should people do if they are concerned?

The risk of monkeypox is low to the UK public. Contact a sexual health clinic or NHS 111 if you need urgent advice.

How can the virus be passed on and are we likely to see more cases?

Monkeypox is not usually passed on easily between people and can only be passed on from person to person through direct physical contact or contact with clothing or linens used by someone who has tested positive for monkeypox. As a precaution, the UK Health Security Agency is monitoring all close contacts of the cases to provide advice and monitor their health.

Is monkeypox passed on in coughs and sneezes like Covid-19?

The most likely route of monkeypox transmission is close physical contact, such as through:

  • touching or sharing things like clothing, bedding or towels used by someone with the monkeypox rash
  • touching monkeypox skin blisters or scabs
  • Kissing, skin-to-skin contact or having sex with someone with the monkeypox rash

There is a lesser risk of the virus being passed on by the airborne droplet route (coughs and sneezes). Large respiratory droplets are expelled when someone who has monkeypox breathes, coughs or sneezes. These generally only travel a few feet and fall to the ground quite quickly due to their weight so prolonged face-to-face contact would be required for this route of transmission. This is not one of the main routes of transmission for the monkeypox virus.

This is different to airborne aerosol transmission, which can be a route of transmission for other viruses such as Covid-19. This is when small aerosol particles carrying a virus are exhaled by an infected person and remain suspended in the air for a period of time and can cause infection if a sufficient number are exhaled.

Should people wear a face mask to prevent it being passed on?

Monkeypox remains rare in the UK and the risk to the general public remains low. Where required, individuals who have monkeypox may be advised to wear a face mask to prevent passing it on to others during their infectious period. As monkeypox is a high-consequence infectious disease (HCID), appropriate PPE should be worn by clinicians undertaking clinical assessment of potential cases.

Can monkeypox cases be asymptomatic and if this is possible, can they still pass on the virus?

Previous asymptomatic infection has been in those with low-level exposure to infected animals in Africa. Person to person transmission of monkeypox is rare and there is no known animal reservoir of infection in the UK currently.

What do people who are identified as close contacts need to do?

Anyone identified as a close contact of an infected individual will be contacted by the relevant teams. If anyone is concerned they may have been in contact with someone displaying monkeypox symptoms, they should call NHS 111 if they need urgent advice.

Who will be carrying out the contact tracing?

The UK Health Security Agency is contacting any potential close contacts in the community. They are also working with the NHS to reach any healthcare contacts who have had close contact with the cases prior to confirmation of their infection, to assess them as necessary and provide advice.

What is the incubation period (the time period between exposure to an infection and the appearance of the first symptoms) of monkeypox?

The incubation period for monkeypox is between 5 and 21 days.

Can monkeypox be passed on to pets?

Those diagnosed with monkeypox should inform the UK Health Security Agency or their local health protection team contact if they have pets in the household. The UK Health Security Agency will continue to keep guidance under review as the incident develops.

Is monkeypox treatable?

Treatment for monkeypox is mainly supportive, but newer antivirals may be used. The illness is usually mild and most of those infected will recover within a few weeks without treatment. High-quality medical and nursing supportive care will be provided to individuals to manage symptoms.

Is there a vaccine available for monkeypox and will it be offered it to people?

The smallpox vaccine Imvanex vaccine is shown to offer protective levels of antibodies against monkeypox and is used globally as a preventative vaccine against the virus. It is currently being offered to the following cohorts in England:

 

Healthcare workers:

The vaccine is offered pre-exposure to healthcare workers due to care for patients with suspected or confirmed monkeypox in HCID units and sexual health centres, and for staff regularly undertaking environmental decontamination.

The UK Health Security Agency recently published vaccination strategy also extends the pre-exposure vaccine offer to the following groups at occupational risk of exposure:

  • Staff in additional hospitals outside high consequence infectious disease (HCID) units designated to care for monkeypox patients
  • Workers in laboratories where pox viruses are being handled


Close contacts:

The vaccine is offered to higher category close contacts of confirmed cases following assessment by contact tracing teams. Ideally the vaccine should be offered within four days of exposure, but this can be extended to 14 days for those at higher risk of severe illness.


GBMSM groups:

On June 21, A strategy published by the UK Health Security Agency (UKHSA) recommended that some gay and bisexual men at higher risk of exposure to monkeypox should be offered the smallpox vaccine Imvanex to help control the recent outbreak of the virus.

The offer of the vaccine, which is shown to be effective against monkeypox, will be to gay, bisexual and men who have sex with men considered to be at higher risk of exposure to the virus. An individual’s eligibility would depend on a number of factors but would be similar to the criteria used to assess those eligible for HIV preventative pre-exposure prophylaxis (PrEP) but applied regardless of HIV status.

The strategy states that a clinician may advise vaccination for someone who, for example, has multiple partners, participates in group sex or attends ‘sex on premises’ venues.

NHS England is due to set out details on how eligible people can get vaccinated shortly. People are advised not to come forward for the vaccine until contacted.

Why can’t everyone who wants a vaccine have one?

The NHS will follow UK Health Security Agency guidance on prioritising those at greatest risk.

How many people will be offered the vaccine?

The UK Health Security Agency estimate that the number of those eligible for pre-exposure prophylaxis vaccination is around 100,000 people.

If you’re not in the high-risk category, can you get a vaccination?

No.  The UK Health Security Agency is monitoring the situation very closely but as we are in the early stages of understanding the epidemiology and transmission of the virus, wider vaccination is not advised at this stage.

How will people be able to get a vaccine?

The NHS is working with local partners to make sure current vaccine supply is in the right place for those who need to access it most.  Soon, local services will be contacting people who are eligible for a vaccination as well as offering protection to those at regular clinics and health appointments.

How concerned are the UK Health Security Agency about this? Is the risk to the public really low?

This is a rare and unusual situation. The UK Health Security Agency is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, passed on by close contact. Monkeypox remains rare in the UK and the risk to the general public remains low. The UK Health Security Agency and the NHS have well-established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.

Are children more at risk?

Monkeypox is usually a mild self-limiting illness and most people recover within a few weeks. However, severe illness can occur in some people. As with many infectious diseases, the young, pregnant women, the elderly and those who are immuno compromised can be at increased risk of more severe outcomes.

The World Health Organisation website provides more detail on this, based on reports from countries where monkeypox is endemic. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications.

Should children be going to school? What about if a confirmed case has been in an educational setting?

Monkeypox remains rare in the UK and the risk to the general public remains low.

Local health protection teams are working with individuals who have been identified as a confirmed monkeypox case to advise them on what they should do and are managing close contacts/contact tracing.

During the contact tracing process if any settings of interest are identified, such as education or childcare settings, they will also be contacted and provided with expert advice on any actions that are required.

Schools with concerns should contact their local Health Protection Team in the usual way. ​

 

What are the UK Health Security Agency doing to inform people of the risks of this disease now it appears to be spreading more widely?

We are urging anyone with unusual rashes or lesions on any part of their body, especially their genitalia, to immediately contact their local sexual health service. We are contacting any potential close contacts of the cases to provide health information and advice.

The UK Health Security Agency and the NHS have well-established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.

We continue to engage with partners across the sector to ensure people are aware of the signs and symptoms and what action to take, including working with partners across the sector at pace to deliver training webinars about monkeypox to clinicians to increase knowledge and awareness of this infection, which is unusual in clinical settings in the UK.

For more information please visit nhs.uk or gov.uk for regular updates posted by the UK Health Security Agency.