Monkeypox

Background:

UKHSA is investigating a number of cases of monkeypox in England. Anyone can catch and pass on Monkey Pox. However, recent cases have been detected in gay, bisexual and other men who have sex with men. We advise these people in particular to be aware of the symptoms and ring 111 if unsure.

UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. UKHSA is working closely with the NHS and other stakeholders to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other.

UKHSA is following the epidemiology and the evidence of where transmission is occurring to target messaging to relevant groups in the community, ensuring clear facts are communicated about this outbreak and what people need to do. Our communications are being informed by members of these communities and partners including LGBTQ+ networks and charities like Terrence Higgins Trust and platforms such as Grindr.

UKHSA local Health Protection Teams are contacting all confirmed cases to help identify and trace contacts so that the appropriate public health action can be taken to prevent the spread of infection.

Current national situation

All updates from UKSA will be published via the rolling news story, where you’ll also find the latest case numbers- https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates

Investigations are underway to establish links between cases. Those patients needing medical care are all in specialist infectious disease units.

This communications toolkit is for Local Authority and NHS colleagues to support them with managing local and regional communications and signpost to the latest materials.

Key public health messages

Monkeypox is a rare infectious disease, but there are a number of cases in the UK. That number is rising.

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

The virus can spread if there is close contact between people and the risk to the UK population is low. Anyone can catch and pass on Monkey Pox. However, recent cases have been detected in gay, bisexual and other men who have sex with men. We advise these people in particular to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns.

Symptoms

Unusual rashes or lesions on the body such as the face or genital area
Fever
Muscle aches
Chills and exhaustion
Headaches
Swollen lymph nodes

Call to action

If you think you have monkeypox symptoms – however mild:

Contact NHS 111 or call a sexual health clinic immediately. Your call will be treated sensitively and confidentially.
Avoid close personal or sexual contact with others until you have had a clinical assessment

Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician. Your call or discussion will be treated sensitively and confidentially.

Heard about 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 illness caused by the monkeypox virus and one of the symptoms is a rash that is sometimes confused with chickenpox. It is usually associated with travel to Central or West Africa but cases have been occurring in England with no travel links.

Monkeypox can be spread when someone comes into close contact with an infected person. The virus can enter the body through broken skin, the respiratory tract or through the eyes, nose or mouth.

If you get infected with monkeypox, it usually takes between five and 21 days for the first symptoms to appear. Symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

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 – a bit like chicken pox – before finally forming a scab, which later falls off.

The virus can spread if there is close contact between people through:

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

Anyone with concerns that they could be infected should see a health professional but make contact with the clinic or surgery ahead of a visit. NHS 111 can also give advice.

UKHSA is investigating the recent cases in England. A notable proportion of early cases detected have been in in gay, bisexual and other men who have sex with men. and so UKHSA is urging this community in particular to be alert to any unusual rashes or lesions and to contact a sexual health service without delay.

UKHSA will post regular updates on gov.uk.

A UKHSA blog has been published: https://ukhsa.blog.gov.uk/2022/05/24/information-on-monkeypox-and-our-investigation-into-recent-cases/

Monkeypox Q&A

LATEST: 19/05/2022

What details can you confirm about these latest cases – sex, age group etc?We have published details on all confirmed cases in our rolling news story here: https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates

Are these the first ever confirmed monkeypox cases with no travel history?

In 2018, a case of the monkeypox virus was transmitted from a patient to a healthcare worker in the UK. In May and June 2021, 3 monkeypox cases were reported from within the same family; the index case had recent travel history to Nigeria. Monkeypox can spread if there is close contact between people but the risk of spread of monkeypox to the UK population remains very low.

Wider monkeypox questions

What is monkeypox?

Monkeypox is a rare infectious disease, but there are a number of cases in the UK. That number is rising.

Monkeypox can be caught from infected wild animals in parts of west and central Africa. It’s thought to be spread by rodents, such as rats, mice and squirrels.

You can catch monkeypox from an infected animal if you’re bitten or you touch its blood, body fluids, spots, blisters or scabs.

It may also be possible to catch monkeypox by eating meat from an infected animal that has not been cooked thoroughly, or by touching other products from infected animals (such as animal skin or fur).

Monkeypox can spread if there is close contact between people. through:

touching clothing, bedding or towels used by someone with the monkeypox rash
touching monkeypox skin lesions or scabs, particularly if your own skin has sores or cuts
the coughs or sneezes of a person with the monkeypox rash

What are the symptoms of monkeypox?

If you get infected with monkeypox, it usually takes between 5 and 21 days for the first symptoms to appear.

The first symptoms of monkeypox include:

a high temperature
a headache
muscle aches
backache
swollen glands
shivering (chills)
exhaustion

A rash usually appears 1 to 5 days after the first symptoms. The rash often begins on the face, then spreads to other parts of the body.

The rash is sometimes confused with chickenpox. It starts as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs which later fall off.

The symptoms usually clear up in 2 to 4 weeks.

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 is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.

How is monkeypox spread?

Monkeypox can spread if there is close contact between people

Spread of monkeypox may occur when a person comes into contact with an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth).

Person-to-person spread is very uncommon, but may occur through:

contact with clothing or linens (such as bedding or towels) used by an infected person
direct contact with monkeypox skin lesions or scabs
coughing or sneezing of an individual with a monkeypox rash

Is monkeypox spread by sex?

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

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.

What is the death rate for monkeypox?

The disease caused by monkeypox is usually mild and most of those infected will recover within a few weeks without treatment. However, severe illness can occur in some individuals and those with underlying conditions such as severe immunosuppression.

There are different strains of monkeypox virus in different parts of Africa. The cases confirmed recently in England have been a strain found in West Africa, which is known to be associated with less severe disease. No fatal cases occurred in an outbreak of monkeypox in the USA in 2003 which came from West Africa.

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

There isn’t a specific vaccine for monkeypox, but vaccinia (smallpox) vaccine does offer some protection. Some individuals with higher level of exposures are being offered this smallpox vaccine. We have pro-actively procured further doses of these vaccines.

How concerned are you about this? Is the risk to the public really low?

This is a rare and unusual situation. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. Monkeypox remains very rare in the UK and the risk to the general public remains low. UKHSA 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.

Could you have picked this up sooner?

As soon as the cases presented themselves to healthcare settings they were triaged and clinically assessed by trained healthcare staff. Due to the rare nature of the virus, monkeypox was not an immediate consideration in all cases. However, once monkeypox was suspected, each of the cases was immediately isolated and tested, and the results of those tests very quickly confirmed the diagnoses. As soon as these cases were confirmed, local Health Protection Teams were alerted and contact tracing and isolation of anyone suspected to be in recent close contact with the infected individuals quickly got underway.

Does this mean monkeypox is circulating undetected in the population?

Monkeypox remains very rare in the UK. In the majority of previous cases, there were links to countries where the disease is more common. There are currently no known links to recent travel for these recent cases and so we are rapidly investigating where and when transmission may have taken place. We closely monitor the prevalence of all infectious diseases and the risk of community transmission of monkeypox in the UK remains extremely low. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. Detailed contact tracing is ongoing for follow-up of individuals who have come into contact with these cases.

How many cases do you think could be going undetected – have you done any modelling?

UKHSA and academic partners will be developing an assessment of potential undiagnosed cases, or cases in the community and considering a range of scenarios. We have robust contact tracing procedures in place to ensure we follow up with anyone who has been in close contact with the infected individuals so we can pick up any additional cases as soon as possible.

If someone was to die of monkeypox – would that be the first death of monkeypox in the UK?

Yes.

Gay, bisexual and other men who have sex with men (MSM) questions

Why have you specified the sexuality of the cases?

The most recent cases are predominantly in gay, bisexual, and other men who have sex with men. They have no travel links to a country where monkeypox is endemic, so it is possible they acquired the infection through community transmission. As the virus spreads through close contact, we are asking these groups to be alert to any unusual rashes or lesions on any part of their body and to contact a sexual health service if they have concerns.

What are you doing to inform people of the risks of this disease now it appears to be spreading more widely?

We are urging men in gay, bisexual and other men who have sex with men. to be aware of any unusual rashes or lesions and contact a sexual health service without delay. We are contacting any potential close contacts of the cases to provide health information and advice.

UKHSA 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.

Why are you directing people to sexual health clinics when you say this isn’t sexually transmitted?

Monkeypox isn’t transmitted through sex but can be transmitted through close skin-to-skin contact with infected people. Sexual health clinics are a good option for people with symptoms because they have expertise in infectious diseases, are experienced with infection control, and are regularly accessed by many people. Sexual health clinics can also be accessed anonymously. While they are a good option for people worried about symptoms that could be monkeypox, they can also offer advice and treatment if people don’t have monkeypox but are suspected of having a sexually transmitted infection.

Do condoms prevent you catching or passing on monkeypox?

We always encourage use of condoms to prevent STIs. Monkeypox is not a sexually transmitted infection by nature, though it can be passed on by direct contact during sex. Contagious lesions, through which infections are most likely to be passed on, can appear on any part of the body so condoms will not necessarily prevent transmission of the virus between two people who are in direct contact. The infection can also be passed on through contact with clothing or linens used by an infected person.

Public health advice

What should someone do if they suspect they have monkeypox?

If you think you have monkeypox symptoms – however mild:

Contact NHS 111 or call a sexual health clinic immediately. Your call will be treated sensitively and confidentially.
Avoid close personal or sexual contact with others until you have had a clinical assessment

Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician. Your call or discussion will be treated sensitively and confidentially

How does the virus spread and are we likely to see more cases?

Monkeypox can spread if there is direct contact or contact with clothing or linens used by an infected person. As a precaution, we are monitoring all close contacts of the cases to provide advice and monitor their health.

Can Monkeypox cases be asymptomatic and if this is possible, can they still spread 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 animal reservoir of infection in the UK for this to occur.

What should people do if they are concerned?

The risk of monkeypox is very low to the UK public. Please speak to your local healthcare provider if you have concerns, or NHS 111 if you need urgent advice

Testing, isolation and contact tracing

What’s the testing process? Does it get sent to labs like the COVID tests?

Monkeypox testing is carried out at the UKHSA specialist Rare and Imported Pathogens Laboratory (RIPL).

How many confirmed close contacts are being followed up? How many are self-isolating?

All contacts are in the process of being informed by UKHSA Health Protection Teams and hospital infection prevention and control teams.

How long do close contacts need to isolate for?

Contacts are categorised by tracing teams following verbal assessment based on their level of contact with the infected individual and the likelihood that they may have contracted the infection. The maximum isolation period for the highest category of contact is 21 days from the point they interacted with the infected individual. However, isolation advice is given on a case-by-case basis depending on the specific exposure circumstances of that individual so will differ among different contacts.

How are you ensuring close contacts are isolating?

Individuals who have had significant close contact with a case are followed up by daily phone calls for 21 days following exposure to case to check on their wellbeing.

What do people that 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 their local healthcare provider or NHS 111 if they need urgent advice

Are you recommending extra PPE/ infection control procedures in health settings in response?

As monkeypox is a high consequence infectious disease (HCID), appropriate PPE should be worn by clinicians undertaking clinical assessment of potential cases.

Who will be carrying out the contact tracing?

UKHSA is contacting any potential close contacts in the community. We 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.

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