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20th August 2024
Monkeypox (Mpox)
The World Health Organisation (WHO) have declared the recent monkeypox outbreak in the Democratic Republic of Congo (DRC) a public health emergency of international concern. There's been an upsurge of cases of a new strain called clade 1b, not only in the DRC but also in some of the neighbouring countries of East Africa [see risk map]. Should everyone be offered the monkeypox vaccination? Before we answer that question, let’s explore the disease in more detail.
Image: WHO
In this article, we’ll try and answer the following:
What is monkeypox (Mpox)?
Monkeypox is a virus that’s closely related to the smallpox virus and is a similar but much milder disease. Although, smallpox was thankfully eradicated in the 1980s, monkeypox is very much alive and kicking not only in parts of Africa but also around the world including the UK.
There are two main strains, clade 1 and 2. The UK had a very large outbreak of monkeypox in 2022 with the strain - clade 2b. Although, it’s not strictly a sexually transmitted disease as such, it was mainly transmitted through sexual networks and therefore gay men, and men who have sex with men were particularly affected.
The 2022 outbreak was largely controlled with effective targeted monkey pox vaccination although there are still up to 40 monkeypox cases reported every month in the UK.
Why is monkeypox back in the news?
Clade 2b monkeypox virus is not severe and usually gets better by itself but the new monkeypox outbreak involving clade 1b in the DRC, is much more severe and this has caused deaths. It's also much easier to pass on both sexually and through social contact. Clade 1b has also spread rapidly to other countries in East Africa like Rwanda, Burundi, Uganda and Kenya (see map below).
The WHO main concern now is that this new aggressive strain can spread more easily to other parts of the world and have therefore released $1.4 million of emergency contingency funding for a rapid vaccination programme.
Source: UKHSA
How do I get monkeypox?
We haven’t had any cases of the new strain of monkeypox in the UK yet, so the UK Health Security Agency(UKHSA) states that the risk of you getting monkeypox is still quite low.
You're most likely to catch monkeypox if you’ve been in close contact with somebody who has monkeypox or monkeypox symptoms.
You can get monkeypox in the following ways:
Close contact (within 1 metre) of someone with monkeypox symptoms. It can be spread by droplets from coughing, sneezing, etc
Touching clothing, bedding or towels used by someone with monkeypox
If you've been bitten or touched animals such as rats, mice and squirrels in West, Central and East Africa.
What symptoms of monkeypox should I be looking out for?
Your symptoms are likely to begin 5 to 21 days after you've being infected and can include:
A high fever
Headache
Joint and muscle aches
Backache
Chills and shivers
Exhaustion
Swollen glands
The monkeypox rash itself usually starts 1 to 5 days after the other symptoms. It usually starts on the face and moves outwards and can even spread to your anus and genital areas. It’s usually red and flat at the beginning but eventually turns into pus-filled blisters.
How long is monkeypox infectious for?
Symptoms of monkeypox usually last a few weeks and you’re no longer infectious once the symptoms have gone, there are no new crops of rash, and all the existing rash has scabbed over.
Is there any monkeypox treatment?
Monkeypox usually gets better by itself even though there’s no specific treatment available.
Can I get the monkeypox vaccination?
The risk of you getting the more serious form of monkey pox (clade 1B from DRC) is still low as there haven’t been any cases so far in the UK. Therefore, monkey pox vaccination is not yet routinely available in the UK except for specific high-risk groups.
Since 2022, more than 120,000 individuals have been vaccinated at sexual health clinics around the country. That vaccination programme was mainly targeted towards high-risk individuals (gay men) and has been very effective in controlling the number of cases.
Currently monkey pox vaccination programme in the UK is only offered to:
Men who have sex with men in the Greater London and Greater Manchester area
Staff who work at sex-on-premises venues
Healthcare workers who look after people with monkeypox
Individuals who have been in contact with someone who has had monkeypox. They should be vaccinated within 4 days but can be vaccinated until 14 days after contact
If you think you maybe eligible you can find an monkeypox vaccination site that's currently offering it through the NHS.
What should I do if I think I have monkeypox?
This will depend on the type of symptoms;
Call a sexual health clinic:
If you have blisters around your genital area or are bleeding from the back passage, and in the last 3 weeks, have either:
Had sexual contact with someone who might have or known to have monkeypox
Had one or more new sexual partners
Travelled to West, Central and East Africa (See risk map)
Call a GP or 111:
If you or your child has a rash with blisters, and in the last 3 weeks, have either:
Been in contact with someone who might have had or known to have monkeypox
Travelled to West, Central and East Africa
It’s best to stay at home and isolate yourself, until you’re told what to do next. The Terence Higgins Trust has good practical advice on how to self-isolate.
Summary
We know this can be a worrying time, particularly if you have children or travelling to affected areas. So here are the key points you should take away:
Clade 2b is a mild disease and there are only a few cases per month in the UK
The newer, more aggressive form of monkeypox , Clade 1B from Central Africa, has not been detected in the UK and the UKHSA have stated it’s low risk
Although some cases of Clade 1B can be serious, most cases are still mild
If you’re at high risk (see above) you may be eligible for monkeypox vaccination
The UKHSA are constantly monitoring the situation and we’ll update you on a regular basis of any changes on vaccination policy
References:
Reviewed and approved by:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
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