Monkeypox virus and symptoms explained as new guidance says must isolate for 21 days

Watch: Monkeypox spreads through 'close physical contact', says WHO health official

Contacts of monkeypox cases at high risk of having caught the virus should now self-isolate for 21 days, according to new government guidance.

But while 'virus' or 'isolation' aren't exactly welcome words after the past couple of years, the good news is that it's a rare infection, hard to catch and often mild.

Nevertheless, people who have had "unprotected direct contact or high-risk environmental contact" should now isolate for three weeks, UK Health Security Agency (UKHSA) guidelines say.

This includes not travelling, providing contact tracing details and avoiding contact with immunosuppressed people, pregnant women and children aged under 12 where possible.

Scenarios that could have caused high risk of exposure include household contact, sexual contact, changing someone's bedding without appropriate personal protective equipment, or bodily fluid in contact with eyes, nose or mouth.

Other recommendations from the UKHSA include those at high risk of developing symptoms being offered a smallpox vaccine, ideally within four days (and up to a maximum of 14 days).

So far, the health agency has confirmed 57 cases of monkeypox in the UK (as of 23 May), increasing from 20. With 56 in England, Scotland also confirmed its first case on Monday.

Meanwhile, Northern Ireland’s Public Health Agency and Public Health Wales said they currently have no confirmed cases of the virus.

This comes after Dr Susan Hopkins, chief medical adviser for UKHSA warned it is "detecting more cases on a daily basis".

What exactly is monkeypox?

Undated handout image issued by the UK Health Security Agency of the stages of Monkeypox. Two more cases of monkeypox have been confirmed in England, health bosses said. One of the two people, who live in the same household, is being treated in hospital, the UK Health Security Agency said. Issue date: Saturday May 14, 2022. (UK Health Security Agency/PA Media)
The stages of Monkeypox. (UK Health Security Agency/PA Media)

The UKHSA says monkeypox is a viral infection usually associated with travel to West Africa. It is typically a mild self-limiting illness – so resolves on its own with no long-term harmful effect – and is spread by very close contact with someone with monkeypox, with most people recovering within a few weeks.

"It is important to emphasise it does not spread easily between people and requires close personal contact with an infected symptomatic person. The overall risk to the general public remains very low," said Dr Colin Brown, director of clinical and emerging infections at UKHSA, earlier in May.

However, as a notable proportion of early cases detected have been in gay and bisexual men, the UKSHA is urging this community 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."

Dr Hopkins said on BBC One's Sunday Morning, "We are detecting more cases on a daily basis and I’d like to thank all of those people who are coming forward for testing to sexual health clinics, to the GPs and emergency department.”

Speaking on the community transmission occurring in the UK, Dr Hopkins added, "We are finding cases that have no identified contact with an individual from west Africa, which is what we’ve seen previously in this country. The community transmission is largely centred in urban areas and we are predominantly seeing it in individuals who self-identify as gay or bisexual, or other men who have sex with men.”

Despite this, it is important to note that monkeypox "can affect anyone", with the Joint United Nations Programme on HIV/AIDS (UNAIDS) condemning some prejudicial reporting around the virus that reinforces homophobic and racist stereotypes, and exacerbates potential stigma.

UNAIDS said the "WHO notes that available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, and that risk is not limited to men who have sex with men."

"Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” said Matthew Kavanagh, UNAIDS Deputy Executive Director a.i. “Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures.

"We appreciate the LGBTI community for having led the way on raising awareness – and we reiterate that this disease can affect anyone.”

Dr Hopkins said she "would recommend to anyone who is having changes in sex partners regularly, or having close contact with individuals that they don’t know, to come forward if they develop a rash".

UKHSA experts are working closely with the individuals affected and NHS colleagues, and will be contacting people who might have been in close contact to provide information and health advice.

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The NHS website says you can catch monkeypox from an infected animal – thought to be spread by rodents (not so much monkeys, oddly) – if you're bitten or you touch its blood, body fluids, spots, blisters or scabs. It's also possible to catch it by eating undercooked meat from an infected animal or by touching other products from infected animals, like skin or fur.

The health service reiterates it is uncommon to catch it from a person with the infection. However, if it was to spread, it could be through touching clothing, bedding or towels used by someone with symptoms, touching monkeypox on skin blisters or scabs or the coughs or sneezes of a person who has it.

Pox virus, illustration. Pox viruses are oval shaped and have double-strand DNA. There are many types of Pox virus including Chickenpox, Monkeypox and Smallpox. Smallpox was eradicated in the 1970's. Infection occurs because of contact with contaminated animals or people and results in a rash or small bumps on the skin.
There are many types of poxvirus including chickenpox, monkeypox and smallpox. (Getty Images)

“The name ‘monkeypox’ is a misnomer," said Dr Michael Skinner, reader in virology at Imperial College London, commenting on the misleading name.

"It’s primarily a disease (mostly sub-clinical) of small African animals including rodents (there are two different strains, in the Congo Basin & West Africa). Like humans, monkeys sometimes acquire infection from the small animals.

"It’s a poxvirus [typically affects the skin], in the same family as variola virus, which caused smallpox before it was eradicated globally in 1980. Vaccinia virus, used as the vaccine to eradicate smallpox, is also in the same family and vaccination against smallpox protects against monkeypox too."

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“Two factors probably contribute to the cases we have seen over recent years," added Dr Skinner, with those in the UK likely to be imported occasionally by travel.

The first reason, he said, is that the ending of smallpox vaccination (after the eradication of variola virus) means that levels of cross-reactive immunity to monkeypox have now weakened or disappeared, so more people can now be infected with monkeypox virus.

The second, he said, is the possibility that the distribution of the virus in West African wildlife has altered in some way, possibly increasing or broadening, so that humans are more likely to be infected.

"Investigating this possibility would require extensive testing of wildlife in the field (something that field virologists in China have sadly been criticised for by some quarters)," he added.

What are the symptoms of monkeypox?

Woman with flu virus lying in bed, she is measuring her temperature with a thermometer and touching her forehead
A high temperature might be one of the first signs of monkeypox. (Getty Images)

There are seven key initial symptoms of monkeypox:

  • Fever

  • Headache

  • Muscle aches

  • Backache

  • Swollen lymph nodes

  • Chills and exhaustion

  • A rash, often beginning on the face, then spreading to other parts of the body including the genitals

The rash also changes and goes through different stages – it can look like chickenpox or syphilis, before eventually forming a scab, which then falls off.

People without symptoms are not considered infectious, but out of precaution, those who have been in close proximity to individuals affected are being contacted to ensure, if they do become unwell, they can be treated quickly.

If you do get infected with monkeypox, it usually takes between five and 21 days for the first symptoms to appear, with the rash usually appearing one to five days after this, the NHS outlines.

"Cases need to be identified, isolated and treated, either in hospital or at home, depending on severity and circumstances. Close contacts need to be identified and monitored for signs of infection," said Prof Jimmy Whitworth, professor of international public health at the London School of Hygiene & Tropical Medicine (LSHTM).

"Monkeypox is not very transmissible and with these measures the outbreak can be quickly brought under control."

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How is monkeypox treated?

General view of the Royal Free Hospital, in Hampstead, north west London. PRESS ASSOCIATION photo. Picture Date: Thursday April 30th, 2009. 

Photo credit should read: Dominic Lipinski/PA Wire
Patients have been treated in specialist infectious disease units at the Royal Free Hospital, pictured, as well as at Royal Victoria Infirmary in Newcastle upon Tyne and Guys’ and St Thomas’ in London. (PA Wire)

Treatment for monkeypox aims to relieve symptoms, according to the NHS, with people recovering in two to four weeks. Those infected need to stay in a specialist hospital, to ensure it does not spread to other people and symptoms can be treated.

The UKHSA is working closely with NHS partners to identify if there may have been more cases in recent weeks, as well as international partners to understand if similar rises have been seen in other countries.

Investigations are also underway to establish exactly where and how individuals got their infections, including how they may be linked to each other.

The first patient (reported on 7 May) had a recent travel history from Nigeria, where they are believed to have contracted the infection, before travelling to the UK.

"We continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals," said Dr Hopkins. "We are contacting any identified close contacts of the cases to provide health information and advice.

"Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact NHS 111 or a sexual health service if they have any concerns.

"Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician."

The UKSHA said these individuals "can be assured their call or discussion will be treated sensitively and confidentially".

Additional reporting PA.