Monkeypox

Monkeypox poster
What is Monkeypox ?
Signs and symptoms
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If you have symptoms

If you have symptoms of monkeypox, phone NHS 111 or your usual sexual health clinic (do not visit your clinic without calling them first) and take a break from close physical contact – including sex – until you’ve sought medical advice and know you are well.

• Tell the person you speak to if you've had close contact with someone who has or might have monkeypox, or if you've recently travelled to central or west Africa.

• Do not go to a sexual health clinic without contacting them first. Stay at home and call 111 for advice if you're not able to contact a sexual health clinic. Stay at home and avoid close contact with other people until you've been told what to do.

• If you have recently been diagnosed with monkeypox or think you have suspected symptoms, you should isolate – you can pass monkeypox on to people around you through kissing, cuddling and sharing towels or bedding

 

Call a Sexual Health Clinic – If you have a rash with blisters and:

You've been in close contact with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks

• You've been to west or central Africa in the past 3 weeks

• You have had new sexual partner in the past 3 weeks

 

Call NHS 111 – they can tell you what to do if you have a rash but:

• you have not been in close contact with someone who has or might have monkeypox

• you have not been to west or central Africa recently You should call your GP if a child has a rash with blisters and has either:

• been in close contact with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks

• been to west or central Africa in the past 3 weeks They should stay at home and avoid close contact with other people, including sharing towels or bedding, until you've been told what to do.

 

Terrence Higgins Trust (THT) Monkeypox page

Brighton and Hove Sexual Health Services - Monkeypox page

UK Health Security Agency (UKHSA) Advice - 26th July 2022

What is Monkeypox?

Monkeypox is a rare infectious disease, usually associated with travel to west and central Africa. But the UK now has cases

But we are now seeing an unusual number of cases spreading within the UK.

That number is rising. However, the overall risk to the UK population remains low

And this is how it can spread

Monkeypox is a viral infection, spread by close contact with someone with the virus. Monkeypox can be passed on from person to person through:

• any close physical contact with monkeypox blisters or scabs (including during sexual contact, kissing, cuddling or holding hands)

• touching clothing, bedding or towels used by someone with monkeypox

• the coughs or sneezes of a person with monkeypox when they're close to you

Where are most of the cases?

Anyone can get monkeypox, but currently most cases are in men who are gay, bisexual or have sex with men.

So be aware of the symptoms

As the virus spreads through close contact, we are advising these groups to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia.

There is a vaccine to protect people

Monkeypox is caused by a similar virus to smallpox. The smallpox (MVA) vaccine should give a good level of protection against monkeypox. The NHS is offering smallpox (MVA) vaccination to people who are most likely to be exposed to monkeypox, including gay, bi and other men who have sex with men considered to be at higher risk of exposure. UKHSA has recently announced the procurement of over 100,000 extra doses to be delivered in July and September.

And we are vaccinating

Local NHS or sexual health services will invite eligible people when it’s their turn to get vaccinated against monkeypox. Once invited, people should get vaccinated at the earliest opportunity. The vaccine is being offered only to those who are at a higher risk of having very close or frequent contact with someone with monkeypox. Eligibility for gay, bi and other men who have sex with men depends on a number of factors but is similar to the criteria used to assess those eligible for HIV pre-exposure prophylaxis (PrEP) – even if someone is already living with HIV. These criteria would include a recent history of multiple partners, participating in group sex, attending sex on premises venues or a proxy marker such as recent bacterial STI (in the past year)

 How and when?

The vaccine is being delivered through sexual health clinics. For now, you should wait to be contacted by your local sexual health clinic. To make the best use of current supply, and to help stop the spread of the virus, the NHS is prioritising vaccination in line with UKHSA advice. As most cases are currently in London, the majority of vaccines are also being given out in London. Over the coming weeks, we expect the speed of vaccinations to increase and more vaccines to be given across the country.

We are also vaccinating

We are also offering the vaccine to some healthcare workers and people who have been in close contact with someone who has monkeypox.

But some cases are in

But we have seen a small number of cases or potential close contacts identified as women

Everyone needs to be aware of symptoms

So, everyone needs to be aware of the symptoms. If you get monkeypox, it usually takes between 5 and 21 days for the first symptoms to appear. The symptoms of monkeypox include:

• Unusual rashes or blisters on the body, including mouth, genitals and anus. Some get just one spot.

• a high temperature

• a headache

• muscle aches

• backache

• swollen glands

• shivering (chills)

• Exhaustion

• Proctitis (anal or rectal pain or bleeding) 

If you have symptoms you should 

You should call a sexual health clinic if you have a rash with blisters and have either:

• been in close contact, including sexual contact, with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks

• been to west or central Africa in the past 3 weeks

You should stay at home and avoid close contact with other people, including sharing towels or bedding, until you've been told what to do.

If your child has symptoms you should

 You should call your GP if a child has a rash with blisters and has either:

• been in close contact with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks

• been to west or central Africa in the past 3 weeks

They should stay at home and avoid close contact with other people, including sharing towels or bedding, until you've been told what to do. Stay at home and call 111 for advice if you're not able to contact a GP

If a child is a close contact

Children who are a close contact of a monkeypox case should avoid being close to young children, pregnant women, and people with a weakened immune system, with conditions such as cancer or kidney disease as they may be at higher risk of serious illness.

The rash is sometimes confused with chickenpox. It starts as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs which later fall off.

A vaccine is offered to children who have been identified as a close contact of a confirmed monkeypox case, although siblings of a contact are not offered the vaccine.

If you are positive you should

If you test positive for monkeypox, you should isolate at home. Monkeypox is usually mild and most people recover within a few weeks without treatment. You should self-isolate at home until:

• you have not had a high temperature for at least 72 hours

• you have had no new lesions in the previous 48 hours • all your lesions have scabbed over

• you have no lesions in your mouth

• any lesions on your face, arms and hands have scabbed over, all the scabs have fallen off and a fresh layer of skin has formed underneath

• If you meet all of the points above, you may be able to stop self-isolating and you should contact the medical team for further advice.

Some people need to go to hospital

But, if your symptoms are more severe and you become unwell, you may need treatment in hospital. The risk of needing treatment in hospital is higher for:

• older people

• young children

• people with a condition or who are taking a medicine that affects their immune system

You can also do things to stay safe and reduce the chances of getting or passing on monkeypox

There are some things you can do to help keep you and others safer:

Do

• wash your hands with soap and water regularly or use an alcohol-based hand sanitiser

• talk to sexual partners about their sexual health and any symptoms they may have

• be aware of the signs and symptoms of monkeypox if you are sexually active, especially if you have new sexual partners

• take a break from sex and intimate contact if you have symptoms of monkeypox until you get seen by a doctor and told you are no longer at risk of passing it on

 

This information was copied from: 

https://int.sussex.ics.nhs.uk/wp-content/uploads/2022/07/220728-MPX-stakeholder-pack-.pdf

 

Monkeypox vaccine leaflets

Click this link for Vaccine leaflet:

 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1095496/UKHSA-12370-monkeypox-vaccination-leaflet.pdf
 

Click this link for: Why do I have to wait leaflet:

 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1088160/UKHSA-12370-MKP-why-do-I-have-to-wait-flyer.pdf

 

Click these links for Leaflets in other languages and other formats:

EnglishAlbanianArabicBengaliEstonianFrenchGermanHindiLatvianLithuanianPanjabiPolishPortugueseRomanianRussianSpanishSwahiliTigrinyaUkrainianUrdu Xhosa and Yoruba.

An English large print version is available to order.

braille version of this leaflet is available to order.

A British Sign Language video of this leaflet is available to view or download.
An audio version is available to download.
 

UK Health Security Agency (HSA) - Links

Rolling news with latest updates: 

https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates

 

Epidemiological overview

https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview

 

Monkeypox technical briefing (published every other Friday)

These briefings share useful data from UKHSA’s investigation into the monkeypox outbreak including early evidence, epidemiological data and preliminary analyses. 

https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings 

 

Latest Case definition (Possible, Probable, Highly Probable, Confirmed)

https://www.gov.uk/guidance/monkeypox-case-definitions

 

Semen testing for viral DNA (likely to be updated shortly)

https://www.gov.uk/guidance/monkeypox-semen-testing-for-viral-dna

 

UKHSA twitter thread:

https://twitter.com/UKHSA/status/1526255175828127746

 

More Questions and Answers from UKHSA (26th July)

What is the incubation period

The incubation period is the duration/time between contact with the affected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.

How is monkeypox spread?

Monkeypox can spread if there is close contact between people Spread of monkeypox may occur when a person comes into contact with an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth).

How can monkeypox spread between people?

Person-to-person spread may occur through:

•contact with clothing or linens (such as bedding or towels) used by someone with monkeypox

•direct contact with monkeypox skin lesions or scabs

•coughing or sneezing of an individual with a monkeypox rash

Is monkeypox passed on during sex?

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during

It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

Is monkeypox treatable?

Treatment for monkeypox is mainly supportive, but newer antivirals may be used. The illness is usually mild and most of those infected will recover within a few weeks without treatment. High quality medical and nursing supportive care will be provided to individuals to manage symptoms. What is the death rate for monkeypox? The disease caused by monkeypox is usually mild and most of those with Monkeypox will recover within a few weeks without treatment. However, severe illness can occur in some individuals and those with underlying conditions such as severe immunosuppression. There are different strains of monkeypox virus in different parts of Africa. The cases confirmed recently in England have been a strain found in west Africa, which is known to be associated with less severe disease. No fatal cases occurred in an outbreak of monkeypox in the USA in 2003 which came from west Africa.

How concerned are you about this? Is the risk to the public really low?

This is a rare and unusual situation. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there is transmission of the monkeypox virus in the community, spread by close contact. Monkeypox remains very rare in the UK and the risk to the wider public remains low. UKHSA and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed. 

Does this mean monkeypox is circulating undetected in the population?

Monkeypox remains rare in the UK. In the majority of previous cases, there were links to countries where the disease is more common. There are currently no known links to recent travel for these recent cases and so we are rapidly investigating where and when transmission may have taken place.. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there is transmission of the monkeypox virus in the community, spread by close contact. Detailed contact tracing is ongoing for follow-up of individuals who have come into contact with these cases.

How many cases do you think could be going undetected - have you done any modelling?

UKHSA and academic partners will be developing an assessment of potential undiagnosed cases, or cases in the community and considering a range of scenarios. We have robust contact tracing procedures in place to ensure we follow up with anyone who has been in close contact with the infected individuals so we can pick up any additional cases as soon as possible.

If someone was to die of monkeypox – would that be the first death of monkeypox in the UK?

Yes. 

What should I do if my child has monkeypox symptoms?

Parents of children with suspected monkeypox should call their GP or health professional (alerting the clinic to their suspicion first and avoiding other contacts until they've seen a clinician). Stay at home and call 111 for advice if you're not able to contact a GP.

What should I do if my child gets monkeypox?

Local health protection teams are working with individuals who have been identified as a confirmed monkeypox case to advise them on what they should do and are managing close contacts/contact tracing.

What should schools do if they suspect a student has monkeypox?

Schools with concerns should contact their local Health Protection Team in the usual way. The UKHSA ‘Health protection in education and childcare settings guidance’ provides a practical guide for staff in education and childcare settings to manage a range of infections

What if a school identifies a case of monkeypox? During the contact tracing process if any settings of interest are identified, such as education or childcare settings, they will also be contacted and provided with expert advice on any actions that are required.

Is monkeypox the same as chickenpox?

Chickenpox and monkeypox are two different and unrelated diseases. Chickenpox is a mild and common illness that most children catch and there are a number of cases in the UK at the moment.

 

This information was copied from: 

https://int.sussex.ics.nhs.uk/wp-content/uploads/2022/07/220728-MPX-stakeholder-pack-.pdf

 

Guidance for people isolating at home

Case histories / Research papers

British Medical Journal

BMJ 2022;378:e072410 (Published 28 July 2022)

WARNING - this paper contains graphic images of genitalia

 

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

Results The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

Conclusions These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.