Dr Yakup Kilic is taking the reins on the blog this week, talking about a concerning disease hot on the tail of the recent pandemic. But is monkeypox a real concern for the UK?
What?
There is currently an outbreak of monkeypox in the UK and a handful of other nations worldwide. The disease is caused by the monkeypox virus, a double-stranded virus that affects humans and other animals. It’s a species in the orthopoxvirus genus.
According to the European Centre for Disease Prevention and Control (ECDC), the virus initially causes symptoms of tiredness, muscle aches and headaches, before progressing to swollen lymph nodes and a characteristic rash across the hands, feet, face or genitals.
This rash appears as small, flat spots that progress to fluid-filled, then pus-filled lumps. These lumps will then burst and scab over. On average, patients remain unwell for 2-4 weeks. It is spread by direct contact or respiratory droplets, though only within a few feet. Novel reports of sexual transmission have been noted, with men who have sex with men being a key risk group.
Monkeypox rash
At the time of writing, there is no cure or effective treatment for monkeypox, and care is focused on alleviating symptoms. The death rate for monkeypox ranges from 1-15% according to age and health at time of infection. But, in one study of 300 patients in the Democratic Republic of Congo, the mortality was approximately 10%. For perspective, COVID-19 has an average death rate of less than 1%, although these figures vary widely depending on patient age or pre-existing health conditions.
Why?
Occasionally, infectious diseases that are usually uncommon in the UK arrive in a host. The disease is transmitted to other hosts in the destination country for a brief period, but then the spread dies out. Highly transmissible diseases will experience rapid growth in case numbers (e.g. COVID-19), whereas other diseases will peter out more quickly. This may be due to visible symptoms preventing social mixing or the virus killing the host more quickly (e.g. Ebola). Highly transmissible diseases and social mixing often will cause one person to be able to spread the disease to more people. This is the concept of the R number that we became familiar with during the COVID-19 pandemic.
The current UK outbreak may be related to an infected British resident who travelled to the UK from Nigeria, where the disease is common. A small number of cases related to this patient have been subsequently noted, and there has been extensive contact tracing in an effort to stem the spread of infection. There have been some cases with no link to this individual, perhaps indicating more than one initial infection.
In England currently, there are fewer than 20 cases reported. However across Europe small pockets of transmission have been reported, with at least 11 countries affected. While this is concerning as it indicates the rise of human-to-human spread, affected patients are largely being isolated and treated at specialist infectious disease units, and relatively little community transmission has been noted thus far.
But monkeypox is not a new disease. The monkeypox virus has been known about and studied for at least the past 50 years. Its name derives from when it was first identified in crab-eating macaque monkeys in 1958. The virus can infect many different species of mammal, with the first human case being reported in 1970. There have been sporadic outbreaks in recent decades, but none that gained a significant foothold (in the manner of COVID-19 or swine flu, for example). Small outbreaks in the UK have been reported in 2018 and 2021, and these were linked to single patients travelling from endemic (i.e. where a disease is commonly found) areas in Africa.
How (does it affect you)?
Broadly, monkeypox should not be a cause for concern for most UK citizens. Early patients have been identified as contact tracing has been effectively established from the outset, and whilst there is no specific treatment or cure, the smallpox vaccine is effective at preventing disease in close contacts.
The elderly and very young are at more significant risk of severe infection, and people in these age groups should be particularly vigilant about new, unexplained symptoms. Similarly, men who have sex with men should be aware of symptoms in potential partners, as the disease has currently been disproportionately identified in this group of people. Here is a useful guide from the NHS explaining what to do if you think you have been in contact with someone who has monkeypox.
Readers may be concerned that chickenpox, a disease that causes a similar group of symptoms, could mimic monkeypox. Chickenpox is a common and low severity disease of childhood – even in adults, death rates are low. A chickenpox rash is far more likely to affect the torso, and typically forms small, clear fluid-filled lumps that do not fill with pus. Here is a helpful explanation on how to differentiate between the two.
For those concerned about the birth of a new pandemic similar to COVID-19, be reassured that many of the factors that made COVID so virulent, namely asymptomatic spread and far-reaching respiratory transmission, are less present with monkeypox.
Monkeypox is a concerning threat for those at risk, but currently the risk is low.
As always, best wishes from myHSN!
References:
https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates.
