UKHSA has advised that cases of monkeypox have increased recently but the risk to the UK population remains low.
Advice from UKHSA is that this is because the virus does not usually spread easily between people. It can be passed on through close person-to-person contact or contact with items used by a person who has monkeypox such as clothes, bedding or utensils. Monkeypox is usually a mild illness and most people recover within a few weeks.
The UK clinical and public health response to monkeypox was initially based on the High Consequence Infectious Disease management (HCID) system in line with guidance from the UKHSA. This was highly precautionary and designed for complete containment around single cases. It was also designed prior to the confirmed availability of vaccine and treatment. UKHSA has confirmed that community transmission is occurring in the UK with multiple generations of spread. Illness appears to be generally mild, consistent with other information about the West African clade. Therefore, UKHSA and the NHS will be adopting a more proportionate response as set out in this letter.
Anyone can get monkeypox. Currently most cases have been in men who are gay, bisexual or have sex with men, so it's particularly important for these people to be aware of the symptoms.
Patients should contact a sexual health clinic if they have a rash with blisters and either:
- Have been 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
- Have been to west or central Africa in the past 3 weeks
Patients who meet these criteria should be assessed and tested in line with UKHSA guidance.
If patients are not able to contact a sexual health clinic they should call 111.
Patients should contact the GUM or sexual health clinic by telephone to make an appointment for an assessment in order to ensure appropriate infection control processes are in place. The GUM or sexual health clinic will discuss the case with the patient and in circumstances where it is not appropriate to be seen at the clinic, such as children or pregnant women, alternative arrangements will be made.
Patients that may have an unexplained rash, but do not meet the above criteria should continue to access NHS services as usual. Further public information is available on nhs.uk
Frequently Asked Questions
What details can you confirm about these latest cases – sex, age group etc?
The UK Health Security Agency (UKHSA) 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 UKHSA 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. They have robust contact tracing procedures in place to ensure they follow up with anyone who has been in close contact with the infected individuals so they 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. UKHSA 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.
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?
You can help slow the spread of the outbreak. 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 know that this is not monkeypox.
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.