Monkeypox: what do we know so far?

Cases of monkeypox continue to rise across the UK as well as in wider Europe, Australia, and the Americas. How much do we know about this infectious disease, and should we be worried about the possibility of another pandemic?

What is monkeypox?

There's a high chance that monkeypox has only recently entered your vocabulary. However, you may be surprised to learn that this rare disease isn't new. Monkeypox was first discovered in 1958 when a group of monkeys kept for research became infected - this is the disease's namesake.

Rodney E. Rohde, a professor of clinical laboratory science and an infectious disease specialist at Texas State University, explains: "Monkeypox is caused by infection with the monkeypox virus, which belongs to a subset of the Poxviridae family of viruses called Orthopoxvirus. This subset includes the smallpox, vaccinia, and cowpox viruses."

Monkeypox is mainly spread by wild animals in parts of central and west Africa. This isn't limited to monkeys - rodents are also thought to be carriers of the disease. Historically, transmission to humans has been relatively rare and well contained within central and western African countries.

Is monkeypox in the UK?

Since May 2022, over 100 cases of the virus have been confirmed in Europe, in addition to cases in Australia, and the Americas. In the UK as of 25th May, the UK Health Security Agency (UKHSA) placed the total number of reported cases at 90 since the first case of monkeypox at the beginning of the month. The latest official government figures can be found here.

Monkeypox factsheet - FAQs

As numbers grow, you may be wondering how much we know about this latest outbreak of infectious disease. Here are the most frequently asked questions regarding monkeypox:

Q1. What happens if you get monkeypox?

The symptoms of monkeypox 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 monkeypox symptoms:

These monkeypox 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 monkeypox 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 monkeypox 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 monkeypox, 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."

Monkeypox: "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, monkeypox causes swollen lymph glands but chickenpox doesn't."

Q4. Does monkeypox spread easily?

Monkeypox 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, monkeypox "typically enters the body through broken skin, inhalation, or the mucous membranes in the eyes, nose, or mouth".

Unlike COVID-19, monkeypox does not spread easily between people: "Monkeypox 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."

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Q5. Does monkeypox hurt?

For most people, the monkeypox illness is classed as mild. This being said, symptoms can be uncomfortable and irritating, and the rash may be particularly itchy and painful. However, severe illness from monkeypox is rare and symptoms usually clear up within a few weeks.

Q6. Can you die from monkeypox?

There are two main strains of monkeypox virus. The one seen in the last few weeks in the UK is the West African version, which has a fatality rate in the order of 1%. The other, found predominantly in central Africa (Congo Basin), has a much higher mortality rate, possibly as high as 10%.

It is important to remember that 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. Thus far, there have been no deaths from monkeypox reported in the UK.

If you are pregnant, there's also a risk that monkeypox can lead to complications and occasionally stillbirth. Children also have a higher risk of becoming more severely ill than adults.

Is monkeypox likely to cause another pandemic?

Following COVID-19, fear of another pandemic is understandable. It's important to understand that monkeypox does not travel from person to person as easily as COVID-19. As such, experts such as Dr Rohde believe a monkeypox pandemic is "unlikely".

You're extremely unlikely to become infected with monkeypox 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 monkeypox

The UK has been quick to respond to this new threat and has established an incident team, set up contact tracing, and is offering the smallpox vaccine to people who have come into close contact with infected people. As smallpox and monkeypox are closely related, the smallpox vaccine can also protect people against monkeypox.

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 monkeypox, but the illness typically clears up on its own. The most effective method for both pre and post exposure to monkeypox is the smallpox vaccine. This is up to 85% effective.

What we don't know about monkeypox

This outbreak is still very new, and while research teams have been set up, there are some knowledge gaps at this stage:

  1. We don't yet know exactly how the infection entered the UK.
  2. It's possible that the number of actual people infected could be higher than the confirmed monkeypox cases or suspected cases.
  3. Experts are concerned the virus may be spreading "through an unidentified mechanism".
  4. We may not know all the animals that are able to carry the monkeypox virus.
  5. Our current understanding is that you are no longer infectious once your scabs drop off. However, new data suggest that the infectious period may last longer.
  6. There are currently no treatments to cure monkeypox. Instead, treatment is focused on easing and managing symptoms.
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