Monkeypox cases in the UK.
This is a story that’s been bubbling away in the background of the news since the beginning of May with reports of one UK case. Shortly afterwards, two people from the same household were also diagnosed. These two people had had no contact with the first case, and no recent travel abroad. So where did they catch it from?
What is Monkey Pox?
Monekypox was first discovered in 1958 when some poor research monkeys developed a pox-like disease. However, it is thought to originate from rodents rather than monkeys.
The first human case documented was in 1970, when a 9-year-old boy who lived in the Democratic Republic of Congo was found to have smallpox like pustules. Since then, there have been further cases in 11 African countries.
Monkeypox is a viral zoonosis illness, meaning it originated from animals and is most likely to effect children. It is transmitted through close contact with an infected animal or human, or by contact with contaminated material. Monkeypox enters the body through broken areas in the skin, or via the respiratory system or mucous membranes (eyes, mouth, nose). Animal to human spread occurs by being bitten, scratched or eating a poorly cooked infected animal.
It is thought that the smallpox vaccination, also offers protection against monkeypox. However, people are no longer getting vaccinated from smallpox since it was eradicated in the 70’s, hence why cases of monkeypox may well be increasing.
There are two different clades of monkeypox (strains). The most severe originating from the Congo Basin and the lesser West African strain. It is thought the cases discovered in the UK this month are the West African strain, which causes sufferers to exhibit more minor symptoms and is less contagious.
What are the symptoms?
Monkeypox has an incubation period usually between 6-13 days after exposure but can be as long as 21 days.
Early symptoms of monkeypox include fever, chills muscle aches, headaches, fatigue, and swollen lymph nodes. Similar symptoms to every other viral illness, however the swollen lymph nodes appear to be unique to monkeypox, and not present in other pox viruses. After one to three days, a raised bumpy rash will start to develop. Unlike chickenpox which usually starts on the trunk (stomach or back) of an infected person, monkeypox usually starts on the face before spreading to other parts of your body and can go everywhere. Commonly present on the hands and soles of the feet and in the mouth, amongst other places. Initially the rash starts as small red bumps, which then turn into pustules (blisters) which fill with pus. Like chickenpox, they then dry out, and fall off. It is possible to only get a few spots, or to have huge areas completely covered so there is no unaffected skin visible in those areas.
Symptoms usually last between 2 to 4 weeks with more severe cases occurring amongst children, particularly if they have existing health problems/immune deficiencies.
Complications of monkeypox, include secondary infection – most likely to the skin. Pneumonia, sepsis, encephalitis, and loss of vision due to the infection spreading to the corneas. It is believed the fatality ratio is around 3-6%. (I believe it is important to consider the areas of the world where most cases occur i.e, Africa, and their lack of access to adequate medical facilities before panicking and locking your children in a sterile room)
Treatment options
As with most viral illnesses, treatment options remain limited to symptom relief rather than treatment of the virus itself. Paracetamol for fever and muscle aches, topical creams for itching, and ensuring adequate fluid intake. Any secondary infections can be treated with antibiotics, however this will not help with curing the viral illness itself.
Vaccination
The smallpox vaccination is thought to have roughly an 80% success rate against monkeypox, however is no longer routinely given now smallpox is eradicated. This smallpox vaccine was created after witnessing milkmaids seemingly being immune to the smallpox virus after contracting the milder strain of cowpox from the cows they milked. I have always found this really interesting. And on a side note, there is also such a thing as buffalo pox.
However, even with a known vaccination with a very high success rate, I believe it is unlikely to be made available routinely in the UK. Chickenpox has a vaccination too, but unlike the US and other countries such as Germany, it is not part of the routine childhood immunisations. Without wanting to sound too cynical, I believe this is because the cost of rolling out a vaccination to every UK child, greatly outweighs the financial burden caused by chickenpox regarding healthcare access and time missed off work. Basically, chickenpox just isn’t severe enough to warrant vaccination. However, it is difficult to find the exact mortality rate figures for chickenpox (varicella) in the UK, with many different figures popping up depending on the source, but it is thought to be around 0.2 deaths per 100,000 cases. It is far too early to speculate as to whether a vaccination will be rolled out for monkeypox, and I think it will be very much a watch and wait approach, meanwhile only vaccinating known close contacts of confirmed cases.
This is not the first time that cases of monkeypox have been discovered outside of Africa. In 2003, over 70 Americans were infected with monkeypox after being in contact with pet prairie dogs which had been housed with Gambian dormice and rats. The UK also had cases in 2018, 2019, 2021.
The UK now has 20 diagnosed cases this month, thankfully all with reportedly minor symptoms. Australia, Italy, Spain, Sweden, France, Belgium, Portugal and the US and Canada have all reported cases, and there are many more suspected cases being investigated worldwide. Monkeypox is now featuring heavily in the news with case numbers varying dramatically depending on where you look.
I am sure many people out there will be concerned, and particularly with recent events and the world slowly moving out of the last pandemic. The media is always very good at playing on our insecurities and I think it’s important to not lose focus and perspective. Don’t get your information from Facebook, or dodgy websites. Read only reputable sources, such as the World Health Organisation (WHO) or NHS website.
Despite many cases having popped up throughout Europe and further afield, there have not been any serious side effects reported and no fatalities. Monkeypox seems to require a lot more exposure to the virus than Covid19, and most cases seem to have been transmitted through sexual partners – it doesn’t get much closer than that. I don’t think we need to start panicking about who we’re sitting next to on the bus, or who our kids are mixing with in soft play.
I was going to make a joke about isolation in a pandemic..
But you might not get it..