Mpox (monkeypox) - what do we know so far?
In May 2022, an outbreak of mpox (formerly known as monkeypox) spread across the UK, wider Europe, Australia, and the Americas. As the UK mpox vaccine rollout winds down, we explore the recent rise in cases and whether the threat is over in 2023.
What is mpox?
Is mpox in the UK?
In July 2022, the World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC), after May 2022 figures confirmed 219 cases worldwide1. At that time, the UK Health Security Agency (UKHSA) placed the total number of reported UK cases at 90 - and this rose to 3,732 confirmed and highly probable cases by the end of 20222.
Since 2022, people infected with mpox have been found in all six WHO regions - Europe, Africa, South-East Asia, the Americas, the Mediterranean, and the Western Pacific. 2023 saw a decline in cases in the UK, but the threat of mpox isn't eradicated:
2023 UK stats - the latest data 1 June 2023
- 21 new mpox cases this year.
- Of these, 20 were in England and 1 in Scotland.
- Of the England cases, 10 are thought to have been spread by other infected people within the UK, while at least 8 others are believed to have been spread to people when they've been abroad.
Has the UK mpox vaccine rollout worked?
The UK was quick to respond to the new threat, introducing an mpox vaccine for those most at risk of exposure to the infection, which includes gay, bisexual, and/or men who have sex with men (GBMSM), as well as hospital staff who have come in close contact with someone who has mpox.
This vaccine programme is no longer open for people who haven't had there first dose. Those who need their second dose must have it by the end of July 2023.
However, while health experts believe the vaccine has reduced the spread significantly, it hasn't completely eradicated mpox. In light of the 10 new infections confirmed in London between April and May 2023, many worry that while cases still exist, there is always the chance of another wave.
Mpox factsheet - FAQs
Q1. What happens if you get mpox?
The symptoms of mpox tend to develop between 5-21 days after you contract the virus. Usually, symptoms will then clear up of their own accord in 2-4 weeks.
First mpox symptoms:
- A high temperature (fever).
- Shivering (chills).
- Swollen glands (called lymph nodes - these are the lumps you sometimes feel in the neck, armpits, and groin).
- Excessive tiredness (exhaustion).
- Muscle aches and pains.
These symptoms are often followed by a rash, which usually forms on your face then spreads to other parts of the body. This rash is made of raised spots on your skin which turn into pus-filled blisters. These blisters gradually form scabs which later fall off.
Q2. Does mpox leave scarring?
While severe scarring from these scabs is rare, pitted scars (hollow indents on the skin) or patches of darker or lighter colour (hyperpigmentation or hypopigmentation) may remain for some time after scabs disappear. It is thought that these scars could be visible for up to two years in roughly half of all cases.
Q3. Is mpox like chickenpox?
Chickenpox is another infectious disease that causes skin rash and often leaves scarring. This illness actually belongs to a completely different family of viruses to mpox, but it can be easy to confuse the symptoms. Dr Krishna Vakharia describes the main differences to look out for:
Chickenpox: "The rash tends to start around the tummy area and spreads. Uncommonly, the rash spreads to genitals, palms of hands, and soles of feet."
Mpox: "The rash mainly develops on the face and works its way downwards, commonly appearing on genitals, palms of hands, and soles of feet. Unlike chickenpox, the rash also forms blisters that have pus in them. Another key difference is that at the beginning, mpox causes swollen lymph glands but chickenpox doesn't."
Q4. Does mpox spread easily?
The virus is mainly spread by rodents - such as mice, squirrels, and rats - in parts of west and central Africa. You would need to come into close contact with an infected animal to catch the virus yourself - for example, eating or being bitten by an infected animal, or coming into contact with its blisters or body fluids.
According to Dr Rohde, the virus "typically enters the body through broken skin, inhalation, or the mucous membranes in the eyes, nose, or mouth".
Unlike COVID-19, the virus does not spread easily between people: "Mpox is hard to catch," says Dr Vakharia. "The infected person needs to be very close to you - often through skin-to-skin contact, or touching infected linen, clothes or towels, or by coughing or sneezing directly on you.
"Of course, good hand hygiene is important. Avoiding skin-to-skin contact, not touching the rash, or handling any of their clothes or bed linen is key to minimising the spread."
Q5. Does mpox hurt?
For most people, the illness is classed as mild. This being said, symptoms can be uncomfortable and irritating, and the rash may be particularly itchy and painful3. However, severe illness from the virus is rare and symptoms usually clear up within a few weeks.
Q6. Can you die from mpox?
There are two main strains of mpox virus. The one seen in the UK in 2023 is the West African version, which has a death rate in the order of 1%. The other, found predominantly in central Africa (Congo Basin), has a much higher death rate, possibly as high as 10%3.
Factors such as malnutrition, which increase the likelihood of severe illness and death, may mean that worldwide death rates are not directly relevant to the UK. So far, there have been no deaths from mpox reported in the UK.
If you are pregnant, there's also a risk that mpox can lead to complications and occasionally stillbirth. Children also have a higher risk of becoming more severely ill than adults.
Is mpox likely to cause another pandemic?
Following COVID-19, fear of another pandemic is understandable. But mpox does not travel from person to person as easily as COVID-19. As such, experts such as Dr Rohde believe an mpox pandemic is "unlikely".
You're extremely unlikely to become infected with mpox if:
- You haven't recently been to central or west Africa.
- You haven't been in close contact with an infected person (eg, touching their skin or sharing their clothes or bed).
What to do if you come into contact with mpox
UK Chief Medical Advisor guidance
This is continually being updated - you can check the most up-to-date advice here.
- If you notice unusual rashes or skin abnormalities (lesions), particularly if you have recently had a new sexual partner:
- Limit your contact with others.
- Contact a sexual health service or NHS 111 as soon as possible.
- Phone ahead before attending a clinic in person.
- A notable proportion of recent cases have been found in gay and bisexual men, so this group is encouraged to be alert to symptoms.
- UKHSA health protection teams are contacting people considered to be high-risk contacts of confirmed cases:
- These people are advised to isolate at home for up to 21 days.
There is no treatment that cures mpox, but the illness typically clears up on its own. The most effective method for both pre and post exposure to mpox is the smallpox vaccine. This is up to 85% effective4.
Mpox research and knowledge gaps
This outbreak is still very new, and while research teams have been set up, there are some knowledge gaps at this stage:
- We don't yet know exactly how the infection entered the UK.
- It's possible that the number of actual people infected could be higher than the confirmed mpox cases or suspected cases.
- Experts are concerned the virus may be spreading through an unidentified mechanism.
- We may not know all the animals that are able to carry the virus5.
- Our understanding is that you are no longer infectious once your scabs drop off. However, the infectious period may last longer.
- There are currently no treatments to cure mpox. Instead, treatment is focused on easing and managing symptoms.
- European Centre for Disease Prevention and Control: Epidemiological update: monkeypox multi-country outbreak.
- GOV.UK: Mpox (monkeypox) outbreak epidemiological overview 1 June 2023.
- World Health Organization: Monkeypox United Kingdom of Great Britain and northern Ireland.
- World Health Organization: Mpox (monkeypox).
- Moore et al: Mpox (monkeypox).