Monkeypox – how serious is it?

How serious is Monkeypox occupational health news

Monkeypox – just how serious is it?

There are now reportedly 20 cases of Monkeypox in the UK and a handful of cases have been identified in Spain, Portugal, Canada and the USA. Cases have reportedly also been found in Australia, Sweden and Italy, although have not been confirmed at the time of publishing (16:00 19th May 2022)

Three of the UK cases were amongst the same family. Four cases have been reported amongst men who have sex with men. Beyond the initial case, who had recently travelled to West Africa, there is no confirmed source of infection as yet.

Based on the information made public so far, infection in the UK cases seems to have been locally acquired. It is not clear whether the disease is continuing to transmit locally. It is possible further cases may be identified in the coming days.

Although the disease can make people very ill and causes an unpleasant rash, in a similar way to chickenpox, it is a cause for concern but not a cause for alarm.

How dangerous is Monkeypox?

Based on all the cases recorded by the WHO to date, up to 11% of patients may die from the disease. However, this fatality rate may be higher because most cases to date have appeared in countries with far less developed health infrastructure than the UK.

There are two strains of Monkeypox. One called “Congo” strain has the mortality rate of up to 11%, the second called “West African” has a mortality rate of 1%. The cases reported in the UK are the West African strain.

The risk of contracting Monkeypox in the UK is very low. You are more likely to be killed or injured by lightning (which kills 2 people on average every year) than you are to contract the disease, or die from it, in the UK.

What are the main Monkeypox symptoms?

Monkeypox presents with a fever, headache, a rash with liquid filled bumps which become blistered and usually also with swollen lymph nodes.

The disease presents in a very similar way to chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. 

The incubation period ranges from 5 to 21 days. The febrile stage (when illness presents most strongly) usually lasts 1 to 3 days with symptoms including fever, intense headache, swelling of the lymph nodes, back pain, myalgia (muscle ache), and lethargy.

The skin usually erupts after the febrile stage, with the resulting rash lasting for 2 to 4 weeks. Lesions are usually followed by scabs or crusts, in a similar way to Chickenpox.

How does Monkeypox spread?

It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.

How far has it spread worldwide?

To date 5 cases have been reported in Portugal, 7 in Spain, 1 has been confirmed in the USA and 13 in Canada. Unconfirmed cases have been reported in Sweden and Italy. The unconfirmed case reported in Australia has been linked with travel from the UK.

In the last 51 years Monkeypox has only been found in 15 countries, the majority in Central and Western Africa. Outside Africa, the disease has only ever been found in the UK, Israel, the USA and Singapore. Every previous case was imported from Africa.

Human-to-human transmission is rare and limited. The longest documented chain of transmission was six generations, which means the last person to be infected was six links away from the original carrier. Until now, locally acquired infection has only ever been found in Africa.

Why is it spreading now?

Not enough information is available to provide a definitive answer, although the hypothesis is that the underlying transmission mechanism of the virus may somehow have changed, possibly to become more transmissible between people.

Levels of natural immunity to the virus have been falling for years too, since the cessation of smallpox vaccination programmes, which also delivered some protection from Monkeypox.

There are a number of conspiracy theories being reported online and even by some mainstream media (“NATO is under attack from virus” is our current favourite) which are without much merit.

How is it treated? Is there a vaccine?

Treatment of monkeypox is focussed on relieving the symptoms. Patients will only be treated in specialist hospitals.

Smallpox vaccine, cidofovir (an injectable antiviral), and tecovirimat (another antiviral medicine) can be used to control outbreaks of monkeypox.

Vaccination against smallpox can be used for both pre and post exposure and is up to 85% effective in preventing monkeypox. People vaccinated against smallpox in childhood may experience a milder disease.

What should I do to protect my business?

Although the infection appears to be transmitting locally in the UK, there is no cause for alarm. The same control measures against COVID-19 are helpful in preventing infection or transmission of Monkeypox.

Prevention of transmission of infection by respiratory and contact routes is required (carry on with masks and elbow bumps, for example). The scabs are also infectious and care must be taken to avoid infection through handling bedding, clothing, and so on.

The main reasons not to be alarmed

Although the virus is unpleasant, it has never transmitted easily between humans. That could change, although it is likely the
increase in cases would have been much more rapid if a substantive change in transmission rates had occurred (cases have been slowly increasing for a long time). 

The strain of the cases identified in the UK have a much lower fatality rate than the “Congo” strain. It is possible, yet the virus is unlikely to kill anybody in the UK. 

There is also a relatively long period between symptoms presenting and people becoming infectious to others, which suggests isolation and contact tracing should be highly effective in preventing the virus spreading.

Furthermore, it is also possible to deploy “ring” vaccination to contain outbreaks, in which the contacts of any confirmed cases will be offered the smallpox vaccine. 

Despite the alarming headlines, all the indicators currently suggest that the virus is unlikely to become as troubling to everyone as SARS-CoV-2. If you are concerned or would like to speak to a member of our team, please feel free to contact us at any time. 

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