How does Monkeypox spread and what should you do, if you suspect you've been infected?

·7-min read
Photo credit: Volanthevist - Getty Images
Photo credit: Volanthevist - Getty Images

Hitting a world wearied by over two years of the Covid-19 pandemic with the words 'viral' and 'infection' and 'disease' is sure to spread panic. While undoubtedly concerning, though, experts say the current European Monkeypox outbreak is not a similar situation to that of the Coronavirus.

'It [Monkeypox] is very different from COVID,' said World Health Organisation (WHO) infectious disease epidemiologist Maria Van Kerkhove during a digital Q&A on 23 May. 'Transmission is really happening from close physical contact, skin-to-skin contact.' She noted that there are vaccines and antiviral medications that can be used to stem the flow of infection.

While the risk to the general public is low, some infected people can suffer a serious illness. As such, WHO is responding to the outbreak as high priority.

The UK Health Security Agency (UKHSA) recommends that anyone with 'unusual rashes or lesions' should immediately contact NHS 111 or their local sexual health service.

Is there Monkeypox in the UK?

As of Monday 6 June, over 300 people in the UK have been diagnosed with the illness, with others identified over Europe, including in Spain, the Netherlands, Portugal, France and Germany. The first case was detected here on 7 May.

Prior to this situation, only a small clutch of cases had been noted outside of central and western African countries. WHO notes that the virus is endemic in states including Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Nigeria, Sierra Leone, and South Sudan.

Keen to get a handle on the current state of play with this outbreak? Scroll on.

Is Monkeypox related to Smallpox?

It is. 'Monkeypox is a pox virus of the same family as smallpox. It causes an illness that can look similar to smallpox when the rash develops – though it is less transmissible,' explains Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia.

It's vital to know that Monkeypox does not manifest in one, sole way. 'Virologists recognise two strains of Monkeypox virus,' adds Dr Michael Skinner, Reader in Virology, Imperial College London.

'The Congo strain is more severe (up to 10% mortality) and probably more transmissible in humans than the West African strain.' It's this West African strain that is the source of these latest European cases. With this strain, says Dr Skinner, mortality is estimated at about 1%. 'Most UK cases of Monkeypox are likely to be the West African strain due to the UK receiving more travellers from this region than the Congo.'

'With cases in high-income countries it seems that there is only now a lot of attention on Monkeypox, an infection that regularly causes epidemics in impoverished, neglected communities in Central and West Africa,' says Prof Piero Olliaro, Professor of Infectious Diseases of Poverty, University of Oxford.

'It is with a certain sense of frustration that we see again the same pattern repeating itself: attention is paid only when certain diseases hit high-income countries – an example of our collective failure to properly address "epidemic preparedness" and "global health," though they are nominally on top of our agenda with the COVID-19 pandemic.'

What are the symptoms of Monkeypox?

According to the NHS, the first symptoms of Monkeypox are flu-like. They include:

  • a high temperature

  • a headache

  • muscle aches

  • backache

  • swollen glands

  • shivering (chills)

  • exhaustion

As you'll have seen in the images of infected skin which have been doing the rounds, a raised rash can develop.

Often itchy and sometimes painful, this typically begins on the face, before spreading to other places on your body – particularly the soles of the feet and the palms of the hands. Initially, this rash presents as raised spots, which turn into fluid-filled blisters.

For most people, symptoms tend to clear in 2-4 weeks.

How is Monkeypox treated?

Most cases of Monkeypox are, thankfully, mild. 'There is no effective treatment and most cases will recover by themselves,' says Prof Hunter.

One piece of good news is that we already have vaccines that seem to protect against the infection. 'It does appear that smallpox vaccine is also effective against Monkeypox – though of course, not many of the UK population will have had smallpox vaccine during the past five decades,' he adds.

'The smallpox vaccine can be used pre and post exposure, and is up to 85% effective in preventing Monkeypox,' says official UK guidance.

How is Monkeypox diagnosed?

Given that symptoms could be easily confused with another infection, such as Chickenpox, a definite diagnosis is only reached following an assessment by a medical professional and a test, which is performed in a specialist lab.

How does Monkeypox spread?

'Monkeypox seems to require close contact to spread,' says Dr Skinner. 'We’ve seen infection of close family or household members and carers in hospitals, which might also include intimate contact.'

That's not to say that skin-on-skin contact is necessary, for infection to pass between people. 'Depending on the stage of infection, close range respiratory or droplet transmission can probably occur,' he adds. 'Direct contact with lesions will probably transmit the virus, which might enter by the mouth.'

The scabs which are left as the lesions heal are another potential method of transmission. 'When the lesions have healed, the scabs (which might carry infectious virus) can be shed as dust, which could be inhaled,' Dr Skinner notes.

How do we stem the flow of Monkeypox?

As with any infectious disease, isolation of contacts is a key part of nixing spread. 'It important that potential cases are identified, isolated and their contacts traced,' says Dr Skinner. 'The general public have no need for concern, but clinicians and public health authorities need to be on alert to spot infected cases early to limit transmission.'

Again, the smallpox vaccine can be used pre and post infection, meaning a dose could be given to close contacts of those infected.

'Isolation is one of the most effective measures to contain the spread of a disease, particularly a viral disease, because it limits the number of susceptible individuals that can be exposed to the virus,' adds Dr Carlos Maluquer de Motes, Reader in Molecular Virology, University of Surrey.

'Isolation of confirmed cases and the identification and vaccination of all their close contacts creates a circle of protected people around a positive case that is very effective in breaking chains of transmission. This "ring vaccination" strategy was successfully used to eradicate smallpox, so it is a proven strategy to contain poxvirus disease.'

Can sexual contact spread Monkeypox?

Many identified cases of Monkeypox have occurred in people who identify as men who have sex with men. That is not to say, however, that Monkeypox is sexually transmitted – more that sex is naturally a close contact in situation. As such, it's conducive to spreading an infection.

'The transmission is likely occurring as a result of the close skin to skin contact that occurs during sex rather than being a truly sexually transmitted infection,' says Professor Kate Baker, Chair in Applied Microbial Genomics, University of Liverpool.

Prof Francois Balloux, Professor of Computational Systems Biology and Director of UCL Genetics Institute, University College London (UCL), agrees.

'I would urge some caution at this stage before concluding that Monkeypox has morphed into a Sexually Transmitted Infection (STI). Monkeypox is not particularly transmissible and the number of cases to date where the route of transmission is known remains relatively small.

'What is known is that Monkeypox is transmitted between people in close contact through body fluids, respiratory droplets, lesions or even contaminated materials such as bedding. "Sexual contact" very generally qualifies as "close contact."

'Thus, the recent observations of apparent transmission through sexual contact in the UK do not necessarily imply any recent change in the virus’ route of transmission.'

What should I do, if I think I have Monkeypox?

The NHS recommends that you contact your GP, or call 111, if:

You have a rash with blisters and either:

  • you've been in close contact with someone who has Monkeypox or has symptoms of Monkeypox

  • you've been to west or central Africa in the past 6 weeks

You should stay at home and avoid close contact with others, until a medical professional has told you what to do.

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