‘Now we have to deal with it’: what’s going on in the UK with monkeypox?

The person was sick when they boarded the plane. They noticed a rash five days before leaving Nigeria for Britain. The plane touched down on May 4th. The person went to the hospital because the doctors suspected monkeypox. The doctor took a sample from the patient's skin and was dressed in full PPE.

The situation moved quickly because monkeypox is listed as a high-consequence infectious disease. The sample was quickly sent to the UK Health Security Agency's rare and imported pathogens laboratory in Porton Down. On 7 May, the agency announced that the infection had been confirmed.

There are rare cases of monkeypox in Britain. Seven cases have been recorded in the last three years, all of them linked to travel to Nigeria where monkeypox is endemic.

This year was going to be different. For the first time, doctors have found transmission in the community among people with no known links to travel. More than 100 known or suspected cases are under investigation in the US, Canada, France, Germany, Belgium, Spain, Portugal, Italy, Sweden and Australia, despite the UK's 20 confirmed cases.

Prof David Heymann said that it came into the UK and now we have to figure out what is going on.

Most people don't bother with Monkeypox. There are two forms. The central African strain is more serious. The milder west Africa strain is involved in the latest cases. About 1% of people with cases die. The concern is not about the impact on healthy people, but on the vulnerable, such as those with weakened immune systems, and the virus spreading in healthcare settings.

Most human cases of monkeypox are believed to come from contact with other animals, such as rodents. In the past, transmission between humans has been limited.

The virus can be spread through large respiratory droplets, calling for face-to-face contact or contact with body fluids such as saliva or skin, either directly or through contaminated sheets, towels and other items.

The first patient was confirmed a week after the UKHSA reported two more in a family in London. According to one doctor, the announcement on Saturday 14 May wascrucial because it carried images of monkeypox. These were seen by specialists trying to diagnose patients with unexplained rash. The cases were confirmed as monkeypox by sending the samples to Porton Down. The health agency confirmed four more cases on Monday, all men who have sex with men, and who appeared to have caught the virus in London.

The increase in mostly unrelated cases prompted the UK's chief medical officers to send immediate advice to healthcare workers. It called on providers to make sure they had enough PPE to assess and treat patients and noted that the vaccine Imvanex offered some protection against monkeypox if given soon after exposure. The vaccine is already being offered to healthcare workers and contacts of cases at high risk of infection, and the Department of Health has secured thousands of doses in case the outbreak grows.

A flurry of cases have been confirmed since the alert was put out. The public health experts warn against focusing on any group.

Sir Ali Zumla, professor of infectious diseases and international health at University College London, said that focusing on men who have sex with men was unfair and stigmatising. It was highly unlikely that the clusters were due to a change in the virus, he said.

Everyone should be alert to monkeypox symptoms, said Dr Meera Chand, director of clinical and emerging infections at the UKHSA. Gay and bisexual men in the UK and Europe have been found to have a lot of recent cases, so we are encouraging them to be alert to the symptoms. We are working to trace contacts of cases and offer vaccine where appropriate, while we investigate how the virus is spreading to understand why we are seeing this outbreak.