'Now we have to deal with it': what is the status of Monkeypox in the United Kingdom?

It's not the first time the virus has been discovered in the UK, but there are now transmission links.

When they boarded the plane, he got unwell. They discovered a rash that grew into a scattering of fluid-filled lumps five days before leaving Nigeria for Britain. They wasted no time when the jet landed on May 4th. The victim went to the hospital, where doctors suspected monkeypox because of their recent travel. A doctor wearing full PPE isolated the patient and obtained a swab from a blister on their skin.

The crisis escalated quickly since monkeypox is classified as a "high-consequence infectious illness." The sample was transferred to the UK Health Security Agency's uncommon and imported diseases laboratory in Porton Down, Wiltshire, where a PCR test was performed quickly. The illness was confirmed the next day, on May 7, when the agency revealed it.

Monkeypox is uncommon in the United Kingdom, but it is not unknown. Seven instances have been reported in 2018, 2019, and 2021, all of which have been connected to travel to Nigeria, where monkeypox is endemic.

This year, however, was to be different, as public health experts soon discovered. Doctors have discovered chains of transmission in the community – not just in Britain – among people who have no known links to travel for the first time. The UK has confirmed 20 instances, while the US, Portugal, France, Germany, Belgium, Canada, Spain, Italy, Sweden, and Australia are all investigating more than 100 known or suspected cases.

"It's entered the UK, it's entered other countries, and now we have to deal with it and figure out what's going on," said Prof David Heymann, a distinguished associate at Chatham House and former executive director of the World Health Organization's infectious diseases cluster.

Monkeypox is a contagious virus that most people ignore. There are two distinct types. The central African and Congo strain is the most dangerous. The milder west African strain is involved in the most recent instances. According to African data, around 1% of those with cases die. The focus is on the vulnerable — individuals with impaired immune systems, for example – and the virus spreading in healthcare settings, rather than on the impact on healthy people.

Despite the fact that the virus was first discovered in macaques, most human cases of monkeypox are thought to be caused by contact with infected animals such as rats. In the past, human-to-human transmission was limited; illnesses spread in houses but quickly fizzle out.

The virus spreads through large respiratory droplets, necessitating lengthy or frequent face-to-face contact, contact with body fluids such as saliva, or contact with skin lesions, either directly or through infected sheets, towels, and other items.

The UKHSA reported two further patients in a London family a week after the first case was confirmed, with no ties to the initial case. According to one expert, the release on Saturday, May 14th, was "crucial" because it included photographs of monkeypox lesions. At sexual health clinics, these were viewed by professionals struggling to diagnose patients with unexplained rashes.

They submitted swabs to Porton Down right away, and the cases were confirmed as monkeypox. The health department confirmed four further cases on Monday, all of which were guys who had intercourse with men and looked to have contracted the infection in London.

The rise in mostly unrelated instances prompted the UK's chief medical officers to provide urgent advise to healthcare professionals through the NHS central alerting system. It urged physicians to make sure they had enough personal protective equipment (PPE) to diagnose and treat patients, noting that the smallpox vaccine shot, Imvanex, provided some protection against monkeypox if given promptly after exposure.

Healthcare professionals and contacts of individuals at high risk of infection have already been administered the vaccine, and the Department of Health has secured thousands of doses in case the outbreak spreads.

Men who have sex with men (MSM) were highlighted in the alert, and a flurry of cases have since been confirmed, indicating that MSM is spreading through sexual networks. While public health officials strive to contain the outbreak, they caution against focusing on any one group in particular. "This could have easily come out in a different setting," said one prominent sexual health professional. "The MSM phenomenon could have been a very quick approach to attract our attention to the community's skin-to-skin transmission."

Sir Ali Zumla, professor of infectious diseases and international health at University College London, urged publics to avoid any "prejudicial, biased, and stigmatising" focus on the group when asked why the majority of cases are in males who have sex with men. Monkeypox clusters, he noted, could emerge in any group that comes into close touch with infected persons. He said that the clusters were "very unlikely" to be caused by a viral modification.

"Everyone" should be aware of monkeypox symptoms, according to Dr Meera Chand, director of clinical and emerging infections at the UKHSA. "If you detect any strange rashes or lesions that could be caused by monkeypox, phone NHS 111 or a sexual health clinic ahead of time."

A significant number of recent cases in the UK and Europe have been discovered among gay and bisexual males, which is why we are urging them to be especially aware of the symptoms. We're attempting to track down case contacts and provide vaccinations where necessary, while also examining how the virus spreads to figure out why we're experiencing this unique outbreak."