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expert reaction to news that two cases of monkeypox have been identified in Wales

There have been several news reports stating that two cases of monkeypox have been identified in north Wales.


Dr Jake Dunning, Senior Clinical Researcher and Consultant in Infectious Diseases, University of Oxford, said:

“Monkeypox is not an infection that is caught from animals present in the UK. Almost all cases have been acquired in countries in West and Central Africa, where the virus circulates in animals, particularly rodents, and may pass from animals to humans and then sometimes from infected people to other humans. The cases that were detected in the UK in 2018 and 2019 were in people who had acquired their infections in West Africa, with the exception of one healthcare worker who caught it when looking after a patient, before the diagnosis of monkeypox had been made.

“These pox viruses usually spread through direct contact, and they do not appear to spread very easily compared to other, more common infections. In the case of monkeypox, how people become infected is not completely understood, but close and direct contact – with an infected person with active skin lesions, or an infected animal (live or dead) – seems to be most important. Infectious virus shed by humans or animals can contaminate an environment and this can lead to infection; for example, by handling the bed linen or clothes of a case without the use of appropriate protective equipment, or before virus in shed skin or scabs has been inactivated by washing the fabrics.

“Monkeypox is a travel-associated infection in the UK; it is not something that’s present in our own human or animal populations. The risk to people living in the UK is very low and we have never been ‘hit’ by a big outbreak of monkeypox. Monkeypox outbreaks appear to be more common now in countries where the infection occurs naturally, possibly as immunity against the related smallpox virus wanes, following eradication of smallpox in 1980 and smallpox vaccination stopping subsequently, leading to waning in immunity against smallpox, which may also be cross-protective against other pox viruses, including monkeypox. Changes in animal reservoirs and how people interact with animals and their environments in endemic countries may also explain why we have seen more outbreaks and cases recently. Better awareness and surveillance may also increase case counts in endemic countries. If there are more cases in an endemic country and many people travel to and from that country, we will inevitably see some cases – but very low numbers currently.

“The fact that we have seen a small number of cases of monkeypox in recent years in the UK is probably down to large numbers of travellers, and also increased awareness of travel-associated monkeypox following news about the initial UK cases. It is quite possible that there have been travel-associated cases in Europe prior to 2018, but because many cases are mild and resolve without specific treatment or medical care, they may have gone unrecognised, or perhaps were diagnosed as another type of common rash illness. Also, because close contact with an infected person or their contaminated environment is required, and transmission is not as efficient as many other infections, this is not a disease that spreads easily in the UK. However, there is still a risk of human-to-human transmission (already seen in the UK), and some people can get severe illness or complications, which is why monkeypox is classified as a High Consequence Infectious Disease in the UK and why we take it seriously. Because monkeypox virus can be detected in throat swab samples from patients with monkeypox, we also take precautions to protect against exposure to respiratory droplets and secretions that may contain infectious virus when caring for suspected or confirmed cases.

“Most people with monkeypox have a mild to moderate illness that resolves spontaneously after a few weeks, although some people can get serious complications. Studies suggest that infection with the Central African type of monkeypox virus is associated with a higher risk of death than the West African type.

“For monkeypox, people really should not worry about acquiring it in the UK; almost all cases are travel-associated, rather than being acquired in the UK. Any cases diagnosed in the UK are managed by specialist HCID treatment centres, to offer expert treatment and also minimise the risk of infection spreading to other people. Travellers visiting African countries where monkeypox occurs naturally should follow advice from WHO on how to reduce the risk of exposure to monkeypox virus: Anyone returning from these countries who develops a rash illness, with or without fever, within 3 weeks of arriving in the UK should seek medical advice and make sure they declare their travel history. UK clinicians should be aware of rash illnesses in travellers and the possibility of monkeypox in people who have recently arrived from a country with recent or current outbreaks, which includes Nigeria and the Democratic Republic of the Congo. Because this is a rare disease in the UK, guidance with photos of the skin lesions is available to assist healthcare professionals: Any clinician who thinks they may have a case of monkeypox should contact the National Imported Fever Service (this service is not available to the general public).”






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