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Monkeypox

There has recently been an increase in monkeypox cases within the UK, however the risk of catching it remains low. Monkeypox can affect anyone; however the majority of monkeypox cases in the UK continue to be in gay, bisexual and other men who have sex with men (MSM), with the infection being passed on mainly through close contact between people in interconnected sexual networks. Therefore, these groups in particular are advised to be aware of the symptoms, especially any new rashes or lesions on any part of their body. If you have symptoms of monkeypox please contact a sexual health service or call NHS 111. For more information, please visit nhs.uk.

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Monkeypox FAQs

Monkeypox is a rare disease that is caused by infection with monkeypox virus. It is not usually passed on easily between people.

The most likely route of monkeypox transmission is close physical contact, such as through:

  • touching or sharing things like clothing, bedding or towels used by someone who has the monkeypox rash
  • touching monkeypox skin blisters or scabs
  • Kissing, skin-to-skin contact or having sex with someone who has monkeypox rash

It may also be possible to catch monkeypox by eating meat from an infected animal that has not been cooked thoroughly, or by touching other products from infected animals (such as animal skin or fur).

If you get infected with monkeypox, it usually takes between 5 and 21 days for the first symptoms to appear.

The first symptoms of monkeypox include:

  • unusual rashes or blisters on the body, including mouth, genitals and anus. Some get just one spot.
  • a high temperature
  • a headache
  • muscle aches
  • backache
  • swollen glands
  • shivering (chills)
  • exhaustion
  • proctitis (anal or rectal pain or bleeding) 

If you have a rash with blisters and have either:

  • been in close contact, including sexual contact, with someone who has or might have monkeypox (even if they've not been tested yet) in the past 3 weeks
  • been to west or central Africa in the past 3 weeks

Call your local sexual health service, stay at home and avoid close contact with other people, including sharing towels or bedding, until you've been told what to do. Please call the clinic before visiting.

Tell the person you speak to if you've had close contact with someone who has or might have monkeypox, or if you've recently travelled to central or west Africa.

If you have any concerns at all about any symptoms, or you are unable to contact a sexual health clinic, call 111 for advice. You can be assured that all calls or discussions will be treated sensitively and confidentially.

The risk of monkeypox is low to the UK public. Contact a sexual health clinic or NHS 111 if you need urgent advice.

Spread of monkeypox

Monkeypox is not usually passed on easily between people and can only be passed on from person to person through direct physical contact. The spread of monkeypox may also occur when a person comes into contact with an animal, human, or materials contaminated with the virus. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth).

The most likely route of monkeypox transmission between people is through close physical contact, such as:

  • contact with clothing or linens (such as bedding or towels) used by someone with monkeypox
  • direct contact with monkeypox skin lesions or scabs
  • coughing or sneezing of an individual with a monkeypox rash 

 

Anyone identified as a close contact of an infected individual will be contacted by the relevant teams. If anyone is concerned they may have been in contact with someone displaying monkeypox symptoms, they should call NHS 111 if they need urgent advice.

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close physical contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

Treatment and vaccines

Treatment for monkeypox is mainly supportive, but newer antivirals may be used.  The illness is usually mild and most of those infected will recover within a few weeks without treatment. High-quality medical and nursing supportive care will be provided to individuals to manage symptoms.

A vaccine strategy has been launched to vaccinate and protect those who are more likely to get monkeypox.

At this time, a vaccine is being offered only to those who are at a higher risk of having very close or frequent contact with someone with monkeypox. 

Although anyone can get monkeypox, the large majority of cases in the UK at the moment are in gay, bisexual and other men who have sex with men, with the infection being passed on through close contact between people in interconnected networks. By offering the vaccine to individuals who are more likely to get the infection, we will help prevent infection and limit transmission of the virus. 

A smallpox (Modified Vaccinia Ankara (MVA)) vaccination, as recommended by the Joint Committee on Vaccination (JCVI), is being offered to people who are at higher risk of getting monkeypox to help protect them and their close contacts.

As monkeypox is caused by a virus like smallpox, vaccines against smallpox prevent or reduce the severity of a monkeypox infection. The MVA vaccination is only available through the NHS to eligible groups and is a free vaccination. If you're at risk of exposure, your local NHS services may contact you and offer you a vaccine. You can check the website of your local sexual health service for more information. 

The vaccine contains a virus which has been modified so that it cannot grow in the human body, but which triggers the immune system (the body’s natural defence system) to produce antibodies to protect against the smallpox virus. These same antibodies should also protect against the monkeypox virus which is similar. The vaccine does not contain live smallpox virus and cannot spread or cause smallpox.
The UK Health Security Agency currently recommends that the vaccine is offered to:

  • healthcare workers who are caring for and who are due to start caring for a patient with confirmed monkeypox. This includes some staff in sexual health clinics who are assessing any suspected cases.
  • Some GBMSM who are more likely to get the infection, using criteria similar to those used to assess eligibility for HIV pre-exposure prophylaxis (PrEP), even if someone is already living with HIV. These criteria would include a recent history of multiple partners, participating in group sex, attending sex on premises venues or a proxy marker such as recent bacterial STI (in the past year).
  • People who have already had close contact with a confirmed monkeypox case. Vaccination with a single dose of vaccine should be offered as soon as possible, ideally within 4 days of contact but may be offered up to 14 days in those at ongoing risk, or those who are at higher risk of the complications of monkeypox.

The smallpox (MVA) vaccines are not made to be routinely used in any country, so global supplies are limited. The UK has procured more than 100,000 doses to cover this outbreak and the vaccine batches will become available as each batch is manufactured and supplied. Every dose is needed to protect those who are most likely to get the infection and to help curtail the outbreak.

Some sexual health services will be contacting those people who are likely to be at increased risk of getting monkeypox, for example those who have had a recent sexually transmitted infection, to come in first. Other services will offer vaccine alongside other appointments, for example for HIV PrEP. 

First doses will be prioritised during this outbreak. The offer of a second dose will be considered if the outbreak continues. Local NHS services are identifying and contacting people who are a priority for vaccination and will continue to work with local partners to make sure those who may be eligible know how and where to get jabbed. People should not come forward and should instead wait to be contacted.

While monkeypox will be mild for many, some of the symptoms can be painful and uncomfortable. Some people can become more seriously unwell and require hospitalisation. In addition to protecting yourself, the vaccine may also help limit the transmission of the virus to your close contacts.

The vaccine hasn’t been used at such a large scale before so vaccine effectiveness data is limited at this stage of the outbreak – we will be monitoring this just as with all vaccines used in this country. However, based on available data we would expect the vaccine to provide some protection against symptoms. This means that you still need to be aware of monkeypox symptoms as the vaccine won’t provide complete protection.

One dose of MVA vaccine is offered to help modify or reduce the symptoms of disease and should also help to kick-start your protection for the future. In this outbreak we are prioritising giving the first dose to as many eligible people as possible and then a second dose will be considered.

The vaccine has a very good safety profile. Like all vaccines it can cause side effects, but most of these are mild and short-lived and not everyone gets them.

Side effects may be more common in people who have previously received a dose of live smallpox vaccine. These people only need a single dose of MVA to boost their existing protection.

The vaccine has a good safety profile in those living with HIV. However, the immune response to the vaccine could be reduced in severely immunosuppressed individuals.

Common side effects
Like all medicines, this vaccine can cause side effects, although not everybody gets them. Common side effects include pain and itching at the injection site and headache, muscle ache, sickness and tiredness. About 1 in 10 people will have chills and fever, but these should not last more than a few days. 

If you experience any of the side effects listed above, you should rest and you can take the correct dose of paracetamol to help relieve the symptoms. If you already have atopic dermatitis (a form of eczema), you may experience more intense local skin reactions (such as redness, swelling and itching) and other general symptoms (such as headache, muscle pain, feeling sick or tired), as well as a flare-up or worsening of your skin condition.

Serious side effects
Some other conditions have been more rarely reported in people who received the vaccine. In the spirit of openness, the vaccine product insert mentions all these conditions – even those reported from single cases – but this does not mean that the vaccine was responsible. If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this guide.

If you have the following symptoms shortly after vaccination, ring 999 (or ask someone to do this for you):
  • difficult or noisy breathing or wheezing
  • swollen tongue
  • prolonged fainting or unconsciousness
  • confusion
These symptoms may be a sign of a rare but serious allergic reaction and typically happen within 15 minutes of vaccination. Simple faints are much more common after vaccination. If you do faint, stay flat on your back with your legs raised. If this doesn’t make you feel better, then call for help. 

For other symptoms, contact 111 or your health professional.

GBMSM and sexual health questions

The most recent cases are predominantly in gay, bisexual, and other men who have sex with men. They have no travel links to a country where monkeypox is endemic, so it is possible they acquired
the virus through community transmission. As the virus spreads through close contact, we are asking these groups to be alert to any unusual rashes or lesions on any part of their body and to
contact a sexual health service if they have concerns. 

The UK Health Security Agency are urging gay, bisexual and other men who have sex with men to be aware of any unusual rashes or lesions and contact a sexual health service without delay. We are contacting any potential close contacts of the cases to provide health information and advice. The UK Health Security Agency and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.

The UK Health Security Agency takes any concerns about hate crimes or discrimination seriously. The monkeypox virus is passed on through close contact and a notable proportion of the cases identified to date have been among gay and bisexual men and other men who have sex with men.

We have asked these groups in particular to be aware of the symptoms so people are informed and able to manage their own health.  We have worked closely with many partners, including third sector organisations that work closely with gay and bisexual men and other men who have sex with men, to develop messaging. This work has included advising healthcare professionals on how to discuss this topic sensitively and we are developing best practice guidance and targeted communications to reach groups who may be at higher risk. We are proactively sharing advice to the public as well as information to health professionals to try and tackle disinformation, both in the media and within local communities.

Monkeypox isn’t transmitted through sex but can be transmitted through close skin-to-skin contact with someone carrying the virus. Sexual health clinics are a good option for people with symptoms because they have expertise in infectious diseases, are experienced with infection control, and are regularly accessed by many people. While they are a good option for people worried about symptoms that could be monkeypox, they can also offer advice and treatment if people don’t have monkeypox but are suspected of having a sexually transmitted infection.

We always encourage use of condoms to prevent STIs. Monkeypox is not a sexually transmitted infection by nature, though it can be passed on by direct contact during sex. Contagious lesions, through which infections are most likely to be passed on, can appear on any part of the body so condoms will not necessarily prevent transmission of the virus between two people who are in direct contact. The infection can also be passed on through contact with clothing or linens used by a person who has monkeypox. 

Risk and detection

This is a rare and unusual situation. The UK Health Security Agency is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, passed on by close contact. Monkeypox remains rare in the UK and the risk to the general public remains low. The UK Health Security Agency and the NHS have well-established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.

The UK Health Security Agency are urging anyone with unusual rashes or lesions on any part of their body, especially their genitalia, to immediately contact their local sexual health service. We are contacting any potential close contacts of the cases to provide health information and advice.

The UK Health Security Agency and the NHS have well-established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.

We continue to engage with partners across the sector to ensure people are aware of the signs and symptoms and what action to take, including working with partners across the sector at pace to deliver training webinars about monkeypox to clinicians to increase knowledge and awareness of this infection, which is unusual in clinical settings in the UK.

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