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expert reaction to latest number of monkeypox cases identified in the UK, the current situation and advice, as published by UKHSA

The UK Health Security Agency (UKHSA) has detected an additional 36 cases of monkeypox in England, bringing the total number of confirmed cases in England since 7th May to 56.


Dr Carlos Maluquer de Motes, Reader in Molecular Virology, University of Surrey, said:

“The increase in the number of cases is to be expected, because we are now actively looking for patients that have symptoms compatible with monkeypox virus infection. The chains of transmission behind these remain unclear, but most seem unconnected to outbound travellers from endemic countries, so are not imported cases. This scenario indicates that community transmission has been occurring for a period of time inadvertently. It is therefore likely that more cases will appear over the next days and even weeks.

“Isolation is one of the most effective measures to contain the spread of a disease, particularly a viral disease, because it limits the number of susceptible individuals that can be exposed to the virus. Isolation of confirmed cases and the identification and vaccination of all their close contacts creates a circle of protected people around a positive case that is very effective in breaking chains of transmission. This ‘ring vaccination’ strategy was successfully used to eradicate smallpox, so it is a proven strategy to contain poxvirus disease.”  


Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia, said:

“The document from UKHSA on classification of contacts and advice for vaccination and follow-up of contacts of confirmed monkeypox cases, published on 20 May, ( is sound and based on current science. The categorisation of risk is valid with the highest risk being sexual or household contact, certain medical activities without protective equipment and even changing bed linen without wearing PPE. There was an outbreak in England in 2018 when a healthcare worker was infected whilst changing bedlinen of a case. As the rash heals it leaves scabs which can still be infectious especially as they flake off.  

“The most effective way this epidemic will be controlled is the early and complete diagnosis of cases, thorough identification of contacts and rapid vaccination of all contacts, preferably within 4 days. A concern with contact tracing of infections spread through sexual contact is often getting cases to report on sexual contacts. We have a very good contact tracing service within Genitourinary (STD) Clinics in the UK. Although isolation for up to 21 days after a contact makes good sense, my concern with enforced isolation of cases is whether this will prevent people from coming forward for diagnosis or for giving full contact histories. If this is the case then that could make control somewhat more difficult, especially where contacts may be sexual and associated with significant stigma. This aspect of the control needs to be managed well.

“Outside of the highest risks exposures person to person transmission is not particularly effective and in the West African context chains of transmission of Monkeypox tend to be short. I guess the most concern relates to risk group 2, especially “ Driver and passengers in shared car or taxi with case, or sitting next to case on plane”. This group are not being asked to isolated but will be offered the vaccine. This group is likely to be the most difficult to contact.”



Declared interests

None received.



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