Monkeypox is spreading fast

Monkeypox was rarely reported outside Africa until this April year. Cases have spread to 75 countries and the rate of transmission is increasing in some parts of the world.

Last week, the World Health Organisation (WHO) declared the outbreak a Public Health Emergency of International Concern. The WHO has issued recommendations to countries that have not had any cases yet to prepare their readiness to act to stop transmission.

19,178 laboratory confirmed cases have now been reported by the WHO across 75 countries, with 5 fatalities – an increase in cases of 218% in less than three weeks. Case numbers are currently increasing at around 60% a week. The majority of reported cases are in the European region (67%).

The WHO advises countries where there have been cases (including the UK) to increase protection and surveillance measures.

The WHO now also advise that anyone with signs and symptoms compatible with monkeypox virus infection; or being considered a suspect, probable, or confirmed case or contacts of cases are subject to health monitoring. Those affected should not travel until they are determined as no longer constituting a public health risk.

What you need to know about Monkeypox

Monkeypox is a viral zoonotic infectious disease. Person-to-person transmission can occur through direct contact with an infected person or shared contaminated objects. The possibility and extent of respiratory transmission is currently unclear.

Historically, Monkeypox has presented with a characteristic rash, which could be preceded by other symptoms such as fever. A swelling of lymph nodes is a feature that helps to differentiate Monkeypox from other diseases with a similar rash (such as chickenpox).

Presentation of cases during the current outbreak has not always been typical. However, generally, severity has been low, with few reported hospitalisations and deaths.

What symptoms may be present?

During the current outbreak, not all cases are presenting with traditional symptoms. Some people may present with exclusively oral, genital or perianal lesions, which may sometimes be accompanied by an inflammation of the lining of the rectum.

A detailed review of 528 cases published last week in the New England Journal of Medicine showed that the range of presenting symptoms can be wide, although 95% had a rash (often with less than 10 lesions).

Amongst those with a clear exposure the median time from exposure to symptoms presenting (the incubation period) was 7 days. However, cases have been reported with incubation periods ranging from 5 to 21 days.

How does the virus spread?

Infection is thought to occur when the virus enters the body through skin, the respiratory tract, or mucous membranes. To date, 99% of cases have been amongst males, with 98% reported as being amongst men who have sex with men (MSM). 322 cases are reported to be health workers, although most were infected in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.

Historically, sustained and rapid outbreaks with very large numbers of affected persons have not been reported. However, human-to-human transmission does occur, sometimes leading to outbreaks in endemic areas.

It is unclear whether the virus spreads via respiratory transmission. The extent to which asymptomatic infection may occur is currently unknown.

At this time, it is not known with certainty if a person can transmit the infection before they develop a fever or rash. However, it is believed that contagiousness may begin with the onset of symptoms. Individuals remain contagious until the scabs have fallen off on their own and the lesions are healed.

How long are people sick?

Monkeypox is usually self-resolving within a period of 2 to 4 weeks. However, severe cases can occur and may be fatal.

Case fatality rates (CFR) depend on the viral type, the health of the infected person and factors such as availability of health infrastructure. There are two types of Monkeypox virus – the Congo strain which has a CFR of around 10% and West African strain (which is responsible for the current outbreak) has historically had a CFR of approximately 1 to 3%.

How is Monkeypox treated?

Supportive care is a central part of Monkeypox management. There is limited data on the clinical effectiveness of specific treatments for Monkeypox infections in humans.

Some existing treatments for smallpox may have a role to play in select instances.

A smallpox vaccine, IMVAMUNE®, is indicated for active immunization against smallpox, Monkeypox and related Orthopoxvirus infection in adults 18 years of age and older determined to be at high risk for exposure.

What do I need to do to protect my business?

At the moment there are no special steps to consider to protect your business. Testing for Monkeypox is restricted and is currently only processed by the Rare and Imported Pathogens Laboratory.

Sensible hygiene and cleanliness is encouraged, continuing the COVID themes with which we are all familiar. Social distancing does not need to be enforced due to Monkeypox, aside from close contacts with symptoms who will be advised to self-isolate for 21 days.

Vaccination may be offered to close contacts via the UK Health Security Agency. There is no vaccine for Monkeypox available privately.

Anyone with suspected symptoms is advised to contact their local Health Protection teams.

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