Monkeypox in the UK

Julia - Over the past week, over a hundred cases of monkeypox have been reported worldwide, including 20 cases, so far, picked up in the UK. This is a virus endemic to parts of central and west Africa. It’s naturally carried by rodents, like mice, but can occasionally jump the species barrier and infect humans and monkeys.

Cases periodically crop up here when people travelling to the UK bring the infection with them. The incubation period is a week or two, and most people have a mild illness that lasts about a week which is characterised by a fever, muscle aches, and blistering rash, although in a small percentage of cases the infection can be lethal. People are infectious while they are symptomatic and the disease spreads through close contact with cases.

One of the UK patients had a travel history to Africa, but the remaining cases do not, suggesting that transmission is occurring in the community. One notable observation is that most of the documented cases in western countries are occurring among men who have sex with men, suggesting that these people may be at particular risk of catching the infection and need to be on the look out.

Here to bring us up to speed with the measures that are being taken to investigate and halt the outbreak is public health expert Linda Bauld. Linda…

Linda - Well, Julia, as you were saying, normally these cases are travel linked, but we picked up a case on the 7th of May. That was an individual who had a recent travel history to Nigeria. But then, on the 14th of May, two further cases with no known links to the case that was picked up on the 7th of May were reported. Those two cases were individuals from the same household. After that, we've seen several more and it's increased since then up to 20. That means we've got a cluster of cases in the community, primarily in England, where they're not linked necessarily, and it means there is community transmission. There's now 15 countries that have identified cases. This is very unusual given the pattern of this disease in the past. It suggests that there may be more cases out there and we're going to pick them up through contact tracing?

Julia - How is this being investigated? Is it similar to the sort of ways we look for Covid 19 in the population?

Linda - There's two main methods that we use in public health. The first one is, we need to investigate. That's lab based studies once we've identified people who have a virus. Secondly, through then trying to trace their contacts -which everybody's now familiar with, the phenomenon of contact tracing, we all know about that from Covid. Essentially, the investigations are happening when you are able to take samples from those who have the infection, that's through biochemistry, haematology and also microbiology. There's a lab which we normally use for this at Porton Down, that's a designated diagnostic lab or two. They'll be looking at that and they'll also be doing, I think, as we've already seen from Portugal, genetic sequencing to see if is this the same as the virus we've normally picked up in Africa, or is it different?

Linda - The Portuguese have already released some data on that suggesting it doesn't look like the virus has changed. The second part is contact tracing. The UK health security agency has already published their standard protocol. They've got people who go from highest risks - that might be very close bodily contact or the same household - to those who are at less risk. Less risk might be people who, for example, have been in the same place as someone who's infected or, alternatively, colleagues in the lab or who are doing investigations, who are fully protected through PPE. But if, for example, they have droplet exposure you may be wearing a glove and there's a small hole in the glove and you're then concerned about exposure, they would be a risk as well. We'll be using that for the next little while.

Julia - And what is the management plan for this type of virus?

Linda - Monkeypox infection is usually a self-limiting illness and most people recover within several weeks. That's a really important point to emphasise. As you were saying, severe illness can occur. What we're doing at the moment, my colleagues, is supporting the people who do have symptoms. That might begin with a fever, a headache, muscle aches and then, as people know now, as seen reported in the media, what normally happens is you then have a rash and these pustules emerge. What we're doing in terms of treatment is mainly supportive. People can be treated for the symptoms and then there's another really important arm of this and that's vaccination. We have a vaccine that is originally created for smallpox, and it can be used both pre and post exposure, so even if people already are infected, they may actually be offered this vaccine. More importantly, the contacts for doing something called ring vaccination, which means that you give the vaccine to the people who are close contacts and that may prevent them from developing severe symptoms. And then finally, of course, tried and tested public health, again in settings or groups where we might have people who are at risk, hand hygiene is really important because this is not the same as COVID, it's not an airborne virus, it's a virus that transfers to close contacts or through droplets.

Julia - As you mentioned, this has been in the news a lot. I think at the minute, we're all very sensitive to hearing this is a new virus and it's potentially in the community. Is this situation going to escalate or have we caught it in time?

Linda - Well, the whole international community working on this is very alert. I think we really need to recognise that because it's normally symptomatic transmission, we can be reassured. We will pick up the cases. And, in fact, the populations as you were discussing, men ages 20 to 50 who are coming forward, they're a group who are good at picking up if they have a rash or symptoms and at seeking support. don't know how many cases we'll find. Just to give you one example, from contact tracing that's happened, out of 50 contacts, only one of them might have picked up the virus. So, we're really looking at something that is A) more easily identifiable than the asymptomatic transmission from COVID and B) that we know how to manage it, and we have an effective vaccine. We're all looking at this with great interest, but I don't think we should be panicking. I think we should be reassured. And certainly in the UK, the UK health security agency is releasing very good information on a regular basis.