Health chiefs brace for ‘MORE monkeypox cases in the coming days’

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Covid-weary Britons were today warned that the worst of monkeypox is still to come as the country’s outbreak doubled in size.

Health bosses tasked with containing the tropical virus have admitted they ‘expect this increase will continue in the coming days’. 

Sajid Javid confirmed another 11 cases today, taking the total number of infected Britons to 20. No details about the new patients have been released yet.

But six of the previous nine confirmed cases were in men who have sex with men — which officials say is ‘highly suggestive of spread in sexual networks’. A similar pattern is emerging in Europe.

Leading experts are adamant monkeypox won’t spiral out of control like Covid, which forced the nation into two years of economically-crippling restrictions. However, they have called the UK’s escalating situation ‘undoubtedly worrying’ and ‘unprecedented’.

Fears are also growing internationally, with the World Health Organization convening an emergency meeting later today to discuss containment strategies. Twelve countries have now detected cases of the virus, which is usually only spotted within Africa. Germany today became the latest nations to spot monkeypox, while the Netherlands is probing several suspected patients.

Dr Susan Hopkins, the UK Health Security Agency’s chief medical adviser, claimed authorities ‘anticipated further cases would be detected’.

Yet, in a stark warning, she added: ‘We expect this increase to continue in the coming days and for more cases to be identified in the wider community.’

MailOnline yesterday revealed health chiefs were stockpiling vaccines amid growing fears about the virus’ spread. Ministers were already sitting on 5,000 doses but have now ordered an extra 20,000, sources say.

Close contacts of the UK’s known cases, including NHS workers, are already being offered the jab.

But experts today told this website how it was possible gay men could be offered monkeypox vaccines as part of a focused roll-out, if cases continue to disproportionally be in homosexual and bisexual males.

Announcing the new cases today, Mr Javid tweeted: ‘UKHSA have confirmed 11 new cases of monkeypox in the UK. This morning I updated G7 health ministers on what we know so far.’

The Health Secretary insisted that most cases were ‘mild’ and acknowledged No10 had ‘procured further doses of vaccines that are effective against monkeypox’.

Britain’s 20 cases — which have all been spotted since May 6 — don’t all stem from the same cluster, with separate infections springing up that are unconnected.

The first patient had returned from Nigeria, where the smallpox-like virus is endemic. None of the other cases are related to travel, suggesting there is community transmission.

The UKHSA said anyone with unusual rashes or lesions on any part of their body, especially their genitalia, should contact NHS 111 or a sexual health service.

It is delivering training webinars about monkeypox ‘at pace’ to medics across the UK.

Medical authorities are also probing gay bars, clubs and spas visited by British cases as they scramble to contain the outbreak.

Dr Hopkins added: ‘We continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals. 

‘We are contacting any identified close contacts of the cases to provide health information and advice.

The UKHSA is now ‘urging everyone to be aware of any unusual rashes or lesions and contact NHS 111 or a sexual health service if they have any concerns’.

Dr Hopkins said: ‘Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician.

‘A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men, so we are particularly encouraging them to be alert to the symptoms and seek help if concerned.

‘Clinicians should be alert to any individual presenting with unusual rashes without a clear alternative diagnosis and should contact specialist services for advice.’

Dr Michael Head, senior research fellow in global health at the University of Southampton, said: ‘The monkeypox outbreak continues to escalate, and is undoubtedly worrying. 

‘The extent of the community transmission of monkeypox, being observed here in the UK and now in several other countries around the world, is concerning.

‘However, whilst it is understandable to compare monkeypox with Covid, it’s important to remember they are two different viruses with their own characteristics. A big monkeypox outbreak like this is still a very different situation to a Covid pandemic.’

He also warned that there are ‘likely’ to be more cases to come.  

Dr Simon Clarke, a microbiologist at the University of Reading, told MailOnline he suspects UK case numbers are already ‘in the tens’.

Professor Jimmy Whitworth, an expert in international public health at the London School of Hygiene and Tropical Medicine (LSHTM), said the outbreak in the UK was ‘unprecedented’.

He said: ‘There is a need to engage with the at-risk community of gay and bisexual men to ensure they know about the presence of this infection and report any sign and symptoms to health facilities.

‘Cases need to be identified, isolated and treated, either in hospital or at home, depending on severity and circumstances.’

Before May, the UK had only ever seen seven cases of the virus, which is endemic in West Africa.

It is usually spread through handling infected animals, either through their lesions, blood, bodily fluids or eating poorly cooked meat.

But it was known that it could be passed on between humans through close contact with the likes of body fluids, respiratory droplets and lesions.

This is why scientists now think the virus is passing through skin-to-skin contact sex, even though this has never been described in medical literature before.

Initial monkeypox symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.

The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.

Monkeypox has an incubation period of up to 21 days, meaning it can take three weeks after an infection for symptoms to appear.

MailOnline this week revealed close contacts of monkeypox cases — including NHS workers — are already being offered the Imvanex smallpox vaccine.

The strategy, known as ring vaccination, involves jabbing and monitoring those around an infected person to form a buffer of immune people to limit the spread of a disease.

A spokesman for the UKHSA did not disclose how many have been vaccinated, but said: ‘Those who have required the vaccine have been offered it.’

Professor Geoffrey Smith, from the University of Cambridge, who advises the World Health Organization on virus research, said the strategy was ‘sensible’.

‘This outbreak of monkeypox is highly unusual, but it is very likely the precautions being taken will mean it comes to an end quickly,’ he added.

Although designed for smallpox, Imvanex offers recipients cross-protection because monkeypox stems from the same orthopoxvirus family.

Data shows the jab, manufactured by Danish-based Bavarian Nordic, prevents around 85 per cent of cases. It has been used ‘off-label’ in the UK since 2018.

The vaccine, thought to cost £20 per dose, contains a modified vaccinia virus, which is similar to both smallpox and monkeypox, but does not cause disease in people.

The US is already stockpiling the jabs for future, ordering 13million for a reported $299million (£240million).

Smallpox has been eradicated worldwide through vaccination and British children have not routinely been offered the jab since 1971.

But experts believe young people are most at risk of catching or falling ill with the disease because they are less likely to have been vaccinated against smallpox.

Professor Ian Jones, a virologist at Reading University, told MailOnline that the current vaccination policy would be enough.

‘You would need much more evidence of community spread before it [targeted rollout] could be considered,’ he said.

He added: ‘Monkeypox doesn’t spread easily and is generally a mild infection so my view would be that the current policy is enough.

‘Very few people have been infected overall and a general vaccine rollout needs the community to agree to take it up and a willingness to fight off any negative anti-vax nonsense.

‘I doubt numbers will climb much more and think the current outbreak is controllable.’

But Professor Paul Hunter, an infectious disease expert at the University of East Anglia, said he ‘could see a role’ for a targeted jab rollout ‘if this isn’t brought under control quickly’.

He said: ‘I presume if the UKHSA come to the conclusion that [targeted jab rollout] is what needs to be done then it’ll be done quite quickly.’

A public health source said if the outbreak spirals, ‘there would be a number of strategies we’d look at, but at the moment there are no plans in place for that’.

The UK’s drug watchdog yesterday told MailOnline it was monitoring the outbreak and ‘working with companies to speedily bring forward suitable treatments’.

There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox, including the drug tecovirimat, which was approved for monkeypox in the EU in January.

Monkeypox is usually mild, with most patients recovering within a few weeks without treatment. Yet, the disease can prove fatal.

It can kill up to 10 per cent of people it infects. The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit.

It comes as it was revealed today that World Health Organization bosses will hold an emergency monkeypox amid growing fears about the international outbreak.

Experts on the UN agency are set to discuss the unusually high rates among gay and bisexual men, it was claimed today.

The panelists, reported to include one of the WHO’s most senior Covid advisers, will also deliberate how vaccines should be dished out to control spiralling cases.

Since the monkeypox outbreak began, the WHO has hosted daily meetings with experts from affected countries, its regional offices, as well as the European Centre for Disease Prevention and Control and US Centers for Disease Control and Prevention.

Its Strategic and Technical Advisory Group on Infectious Hazards with Pandemic and Endemic Potential (STAG IH), is meeting today.

Dr Mike Ryan, the WHO’s executive director of health emergencies, is set to be in at the gathering of experts, the Telegraph claimed.

One UKHSA epidemiologist speculated that health chiefs would consider escalating the crisis to a public health emergency of international concern (PHEIC).

Dr Meaghan Kall said the meeting confirms the WHO is ‘taking the situation seriously’. Only six PHEICs have been declared in the past, with the most recent being Covid.

Spain today reported another 14 cases, bringing the nation’s total to 21. And Belgium detected two cases, one in Antwerp and the other in Flemish Brabant.

Germany subsequently confirmed its first ever monkeypox case in a patient who had ‘characteristic skin lesions’ — a tell-tale sign of the illness.

Meanwhile, France last night confirmed a 29-year-old man in Paris had contracted the virus. He had not recently travelled, suggesting the virus is spreading in the community.

And Australia last night confirmed two cases, including one man in his thirties who had travelled from Britain to Melbourne with symptoms earlier this week.

Elsewhere, Portuguese researchers today published a draft genome sequence of the virus.

The data, obtained from a male patient whose infection was confirmed on May 4 after he spotted skin lesions, will help scientists determine the origin and international spread of the currently circulating virus.

How DO you catch monkeypox and what are the symptoms? EVERYTHING you need to know about tropical virus

Twenty cases in UK could be tip of iceberg as health chiefs hunt for common linkFirst time ever spreading in community and appears to be transmitting via sexCan kill one in 10 but milder strain is transmitting in UK, which kills one in 100

By Stephen Matthews Health Editor and Emily Craig Health Reporter For Mailonline

Published: 09:40 EDT, 20 May 2022 | Updated: 12:18 EDT, 20 May 2022

Monkeypox is spreading globally for the first time, in an outbreak that has caught health officials off-guard.

The UK’s case count today doubled to 20 but the majority of them are not linked — which suggests more are going undetected.

Eleven countries have now detected the tropical virus, which is usually only spotted within Africa.

Germany and Belgium today became the latest nations to declare monkeypox cases, while France and Australia announced patients had tested positive overnight.

A disproportionate number of cases are in gay and bisexual men, authorities have said. Health chiefs say the pattern of transmission is ‘highly suggestive of spread in sexual networks’.

Here is everything we know about the monkeypox outbreak so far: 

How do you catch monkeypox?

Until this worldwide outbreak, monkeypox was usually caught from infected animals in west and central Africa.

The tropical virus is thought to be spread by rodents, including rats, mice and even squirrels. 

Humans can catch the illness — which comes from the same family as smallpox — if they’re bitten by infected animals, or touch their blood, bodily fluids, or scabs. 

Consuming contaminated wild game or bush meat can also spread the virus.

The orthopoxvirus can enter the body through broken skin — even if it’s not visible, as well as the eyes, nose and mouth.

Despite being mainly spread by wild animals, it was known that monkeypox could be passed on between people.

However, health chiefs insist it is very rare.

Human-to-human spread can occur if someone touches clothing or bedding used by an infected person, or through direct contact with the virus’ tell-tale scabs. 

The virus can also spread through coughs and sneezes. 

In the ongoing surge in cases, experts think the virus is passing through skin-to-skin contact during sex — even though this exact mechanism has never been seen until now.

How is it tested for? 

It can be difficult to diagnose monkeypox as it is often confused with other infections such as chickenpox.

Monkeypox is confirmed by a clinical assessment by a health professional and a test in the UK’s specialist lab – the UKHSA’s Rare and Imported Pathogens Laboratory.

The test involves taking samples from skin lesions, such as part of the scab, fluid from the lesions or pieces of dry crusts. 

What are the symptoms?

It can take up to three weeks for monkeypox-infected patients to develop any of its tell-tale symptoms.

Early signs of the virus include a fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion — meaning it could, theoretically, be mistaken for other common illnesses.

But its most unusual feature is a rash that often begins on the face, then spreads to other parts of the body, commonly the hands and feet.

The rash changes and goes through different stages before finally forming a scab, which later falls off.

How long is someone contagious?

An individual is contagious from the point their rash appears until all the scabs have fallen off and there is intact skin underneath.

The scabs may also contain infectious virus material.

The infectious period is thought to last for three weeks but may vary between individuals.

What do I do if I have symptoms?

Anyone with an unusual rash or lesions on any part of their body, especially their genitalia, should contact NHS 111 or call a sexual health service.

Britons are asked to contact clinics ahead of their visit and avoid close contact with others until they have been seen by a medic.

Gay and bisexual men have been asked to be especially alert to the symptoms as most of the cases have been detected in men who have sex with men. 

What even is monkeypox?

Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research in 1958.

The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.

Only a handful of cases have been reported outside of Africa and they were confined to people with travel links to the continent. 

The UK, US, Israel and Singapore are the only countries which had detected the virus before May 2022.

Is it related to chickenpox?

Despite causing a similar rash, chickenpox is not related to monkeypox.

The infection, which usually strikes children, is caused by the varicella-zoster virus. 

For comparison, monkeypox — like smallpox — is an orthopoxvirus. Because of this link, smallpox vaccines also provide protection against monkeypox.  

Are young people more vulnerable?

Britons aged under 50 may be more susceptible to monkeypox, according to the World Health Organization.

This is because children in the UK were routinely offered the smallpox jab, which protects against monkeypox, until 1971.

The WHO also warns that the fatality rate has been higher among young children. 

Does it spread as easily as Covid?

Leading experts insist we won’t be seeing Covid-style levels of transmission in the monkeypox outbreak.

A World Health Organization report last year suggested the natural R rate of the virus – the number of people each patient would infect if they lived normally while sick – is two. 

This is lower than the original Wuhan variant of Covid and about a third of the R rate of the Indian ‘Delta’ strain. 

But the real rate is likely much lower because ‘distinctive symptoms greatly aid in its early detection and containment,’ the team said, meaning it’s easy to spot cases and isolate them.

Covid is mainly spread through droplets an infected person releases whenever they breathe, speak, cough or sneeze. 

How is the UK managing the outbreak?

MailOnline this week revealed close contacts of monkeypox cases, including NHS workers, are already being offered the Imvanex smallpox vaccine. 

The strategy, known as ring vaccination, involves jabbing and monitoring anyone around an infected person to form a buffer of immune people to limit the spread of a disease.

A spokesman for the UKHSA did not disclose how many have been vaccinated, but said: ‘Those who have required the vaccine have been offered it.’

Health chiefs are also contacting all close contacts of those who have been infected.

What if it continues to spread? 

Experts told MailOnline they ‘could see a role’ for a targeted jab rollout to gay men in the UK ‘if this isn’t brought under control quickly’.

Close contacts of the UK’s known cases are already being offered the jab, which was originally designed for smallpox. The two rash-causing viruses are very similar.

A health source told MailOnline ‘there would be a number of strategies we’d look at’ if cases continued to rise.

Professor Kevin Fenton, London’s public health regional director, said if the outbreak in the capital continues to grow then the rollout of vaccines and treatments could be broadened to more groups.

He said there are ‘plans in place’ to have more antivirals if the outbreak keeps growing. 

What other countries have spotted cases?

Twelve countries — including the US, Spain and Italy — have now detected cases of monkeypox.

Spain this morning reported 14 new confirmed cases, bringing the nation’s total to 21.

And Belgium detected two cases, one in Antwerp and the other in Flemish Brabant.

Germany subsequently confirmed its first ever monkeypox case in a patient who had ‘characteristic skin lesions’ — a tell-tale sign of the illness.

France last night confirmed a 29-year-old man in Paris had contracted the virus. He had not recently travelled, suggesting the virus is spreading in the community. 

Meanwhile, Australia last night confirmed two cases, including one man in his thirties who had travelled from Britain to Melbourne with symptoms earlier this week. 

The Netherlands Portugal, Sweden and Canada have also detected cases.

The World Health Organization said it has received reports of 37 confirmed cases and 71 suspected infections. 

How deadly is it?

Monkeypox is usually mild, with most patients recovering within a few weeks without treatment. 

Yet, the disease kills up to 10 per cent of people it infects.

However, with milder strains the fatality rate is closer to one in 100 — similar to when Covid first hit.

The UK cases all had the West African version of the virus, which is mild compared to the Central African strain. 

It is thought that cases in Portugal and Spain also have the milder version, though tests are underway.

Is there a vaccine for it? 

The smallpox vaccine, called Imvanex in the UK and Jynneos in the US, can protect against monkeypox because the viruses causing the illnesses are related. 

 

Data shows it prevents around 85 per cent of cases, and has been used ‘off-label’ in the UK since 2018. 

The jab, thought to cost £20 per dose, contains a modified vaccinia virus, which is similar to both smallpox and monkeypox, but does not cause disease in people. 

Because of its similarity to the pox viruses, antibodies produced against this virus offer cross protection.

Are thre any drugs? 

There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox.

This includes the drug tecovirimat, which was approved for monkeypox in the EU in January.

Tecovirimat prevents the virus from leaving an infected cell, hindering the spread of the virus within the body. 

An injectable antiviral used to treat AIDS called cidofovir can be used to manage the infection, according to the US Centers for Disease Control and Prevention (CDC).

It also works by stopping the growth of the virus.

What is the situation with the UK outbreak?

Twenty cases were confirmed in the UK between May 6 and 20.

No details about the eleven confirmed on May 20 have been released yet. 

But six of the previous nine confirmed cases were in men who have sex with men — which officials say is ‘highly suggestive of spread in sexual networks’.

How worrying is it?

UK health chiefs say the risk of a major outbreak is low.

But experts not that the outbreak is ‘concerning’ and that it is ‘very unusual’ to see community transmission in Europe.  

Dr Michael Head, a global health expert at the University of Southampton, said the rise in cases is ‘undoubtedly worrying’.

But he noted that ‘a big monkeypox outbreak like this is still a very different situation to a Covid pandemic’.

Dr Head added: ‘Given 11 further cases have been announced today, it’s likely there will be more cases to come in the UK. 

‘There certainly will be further cases confirmed in other countries. The contact tracing efforts by public health teams will be crucial in containing the outbreak.’

Dr Charlotte Hammer, an infectious diseases expert at the University of Cambridge, said: ‘It is very unusual to see community transmission in Europe, previous monkeypox cases have been in returning travellers with limited ongoing spread.

‘Based on the number of cases that were already discovered across Europe and the UK in the previous days, it is not unexpected that additional cases are now being and will be found, especially with the contact tracing that is now happening.’

What is the situation in the US?

The US has confirmed one case and is investigating more.

A Massachusetts man on May 18 became the first confirmed US case for this outbreak.

On May 19, officials in New York City announced they were probing a suspected monkeypox case as well.

And what about Australia?

Australia last night confirmed two cases, its first every monkeypox infections.

One is a man in his thirties who travelled from Britain to Melbourne with symptoms earlier this week.

The second case is a man in his forties who became mildly unwell days after returning to New South Wales from Europe. Both he and the person he lives with are isolating at home.

What do I do if I have symptoms? 

Anyone worried that they could be infected with monkeypox is advised to make contact with clinics ahead of their visit. 

Health chiefs say their call or discussion will be treated sensitively and confidentially.