Several people in the UK have been diagnosed with a rare infection called monkeypox. While monkeypox can affect anyone, the risk to the UK population remains low. People are advised to stay alert to new rashes or lesions on any part of their body. Most recent cases have been in gay, bisexual and other men who have sex with men. These groups in particular are advised to be aware of the symptoms. If you have symptoms of monkepox please contact a sexual health service or call NHS 111. For more information, please visit nhs.uk.
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:
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:
A rash usually appears 1 to 5 days after the first symptoms. The rash often begins on the face, then spreads to other parts of the body.
The rash is sometimes confused with chickenpox. It starts as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs which later fall off.
The symptoms usually clear up in 2 to 4 weeks.
A notable proportion of the cases identified to date have been among people who are gay, bisexual and men who have sex with men, so these groups in particular are being asked to be aware of the symptoms.Anyone with recent unexpected/unusual spots, ulcers or blisters on any part of their body, especially their genitalia, should immediately contact NHS 111 or their local sexual health service.
People should notify clinics ahead of their visit and avoid close contact with others until they have been seen by a clinician. People can be assured their call or discussion 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.
Monkeypox is not usually passed on easily between people and can only be passed on from person to person through direct physical contact or contact with clothing or linens used by someone who has tested positive for monkeypox. As a precaution, the UK Health Security Agency is monitoring all close contacts of the cases to provide advice and monitor their health.
The most likely route of monkeypox transmission is close physical contact, such as through:
There is a lesser risk of the virus being passed on by the airborne droplet route (coughs and sneezes). Large respiratory droplets are expelled when someone who has monkeypox breathes, coughs or sneezes. These generally only travel a few feet and fall to the ground quite quickly due to their weight so prolonged face-to-face contact would be required for this route of transmission. This is not one of the main routes of transmission for the monkeypox virus.
This is different to airborne aerosol transmission, which can be a route of transmission for other viruses such as Covid-19. This is when small aerosol particles carrying a virus are exhaled by an infected person and remain suspended in the air for a period of time and can cause infection if a sufficient number are exhaled.
Monkeypox remains rare in the UK and the risk to the general public remains low. Where required, individuals who have monkeypox may be advised to wear a face mask to prevent passing it on to others during their infectious period. As monkeypox is a high-consequence infectious disease (HCID), appropriate PPE should be worn by clinicians undertaking clinical assessment of potential cases.
Previous asymptomatic infection has been in those with low-level exposure to infected animals in Africa. Person to person transmission of monkeypox is rare and there is no known animal reservoir of infection in the UK currently.
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.
The incubation period for monkeypox is between 5 and 21 days.
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.
Those diagnosed with monkeypox should inform UK Health Security Agency or their local health protection team contact if they have pets in the household. The UK Health Security Agency will continue to keep guidance under review as the incident develops.
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.
The smallpox vaccine Imvanex vaccine is shown to offer protective levels of antibodies against monkeypox and is used globally as a preventative vaccine against the virus. It is currently being offered to the following cohorts in England:
Healthcare workers:
The vaccine is offered pre-exposure to healthcare workers due to care for patients with suspected or confirmed monkeypox in HCID units and sexual health centres, and for staff regularly undertaking environmental decontamination.
The UK Health Security Agency recently published vaccination strategy also extends the pre-exposure vaccine offer to the following groups at occupational risk of exposure:
Close contacts:
The vaccine is offered to higher category close contacts of confirmed cases following assessment by contact tracing teams. Ideally the vaccine should be offered within four days of exposure, but this can be extended to 14 days for those at higher risk of severe illness.
GBMSM groups:
On June 21, A strategy published by the UK Health Security Agency (UKHSA) recommended that some gay and bisexual men at higher risk of exposure to monkeypox should be offered the smallpox vaccine Imvanex to help control the recent outbreak of the virus.
The offer of the vaccine, which is shown to be effective against monkeypox, will be to gay, bisexual and men who have sex with men considered to be at higher risk of exposure to the virus. An individual’s eligibility would depend on a number of factors but would be similar to the criteria used to assess those eligible for HIV preventative pre-exposure prophylaxis (PrEP) but applied regardless of HIV status.
The strategy states that a clinician may advise vaccination for someone who, for example, has multiple partners, participates in group sex or attends ‘sex on premises’ venues.
NHS England is due to set out details on how eligible people can get vaccinated shortly. People are advised not to come forward for the vaccine until contacted.
There is no data to show that Imvanex is effective as post-exposure prophylaxis (PEP) for monkeypox. It is offered to prevent or reduce the severity of monkeypox and is likely to be most effective if administered early, and ideally within 4 days. Vaccination may still be offered up to 14 days post-exposure for those at high risk of complications, or to those at on-going risk where the vaccine may protect against later exposures.
Studies show that Imvanex is likely to provide high levels of protection against monkeypox when given pre-exposure. Because of this, UK Health Security Agency is now recommending the prioritisation of pre-exposure vaccination for occupations at high risk of exposure and vaccination strategy to reduce transmission in the group most affected, based on JCVI considerations.
No, the vaccine is only offered to high-risk contacts, not to confirmed cases.
The UK Health Security Agency estimate that the number of those eligible for pre-exposure prophylaxis vaccination is around 100,000 people.
The NHS will follow UK Health Security Agency guidance on prioritising those at greatest risk.
No. The UK Health Security Agency is monitoring the situation very closely but as we are in the early stages of understanding the epidemiology and transmission of the virus, wider vaccination is not advised at this stage.
The NHS is working with local partners to make sure current vaccine supply is in the right place for those who need to access it most. Soon, local services will be contacting people who are eligible for a vaccination as well as offering protection to those at regular clinics and health appointments.
A notable proportion of the cases identified to date have been among people who are gay, bisexual and men who have sex with men, so these groups in particular are being asked to be aware of the symptoms. They have no travel links to a country where monkeypox is endemic, so it is possible they acquired the infection 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 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 infected people. 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 an infected person.
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.
