An outbreak of the rare tropical disease monkeypox has global health authorities concerned and UK health chiefs, where the first case was diagnosed, considering that the disease might be spread during sexual contact.
Although it is known to disseminate via close contact, it has previously never been linked to sexual intercourse.
Daily Mail reports that so far seven Britons have been diagnosed with the virus and six are thought to have been infected in the country itself, in a sign it is spreading in the community for the first time.
Four of the cases are in gay or bisexual men, who are now being urged to be extra vigilant for new lesions or rashes. The first patient, who was diagnosed nearly two weeks ago, had brought the virus back from Nigeria, where the disease is endemic.
Experts at the UK Health Security Agency say the pattern of spread is “highly suggestive of spread in sexual networks”. Because of this, British sexual health clinics have reintroduced social distancing amid fears about the outbreak.
Independent scientists are split on the theory, with some saying it is still too early to say either way.
“This may be the first time transmission of monkeypox via sexual contact has been documented, although it has not been confirmed to be the case,” said Dr Michael Head, a public health expert from the University of Southampton.
Monkeypox can be mistaken for syphilis or other common rash illnesses, making it difficult to diagnose early.
There are no specific treatments or widely-available vaccines for monkeypox infection, according to the World Health Organization (WHO). However, a jab used to vaccinate against smallpox has been shown to protect against monkeypox.
The virus can kill up to one in 10 people it infects, but all seven UK cases have the West African form of it, which is less deadly, killing about one in 100
Head added: 'While part of a different family of viruses, a pragmatic comparison might be to suggest that this virus behaves in a similar fashion to Lassa Fever, where we saw a few cases here in the UK earlier in 2022, tragically with an associated death; however, the outbreak did not spread more widely.”
Professor Jimmy Whitworth, a public health expert at the London School of Hygiene & Tropical Medicine (LSHTM), said: “This outbreak of monkeypox is unprecedented in the UK and has provoked urgent public health action.
“Cases need to be identified, isolated and treated, either in hospital or at home, depending on severity and circumstances.
“Close contacts need to be identified and monitored for signs of infection. It is not very transmissible and the outbreak can be quickly brought under control. It will have been brought to the UK recently by a traveller from west or central Africa who was incubating the infection. It spreads by close contact, either through touching the person, or items such as bedding or shared utensils.
“However a vaccine is available that can be given to prevent the development of disease.”
While there are no reported cases outside the UK, the US Centers for Disease Control and Prevention (CDC) has expressed concern about the outbreak and warned about the possibility of it spreading beyond Britain’s borders.
“We are concerned that this is very different from what we typically think of as monkeypox, and we have some concern that there could be spread outside the UK associated with this,” Jennifer McQuiston, a senior CDC official, told STAT News.
A 2003 outbreak in the United States, which was traced back to imported exotic animals, saw 71 people in six states contracting monkeypox.
The WHO said that while one of the British cases had recently travelled to Nigeria, the other cases appeared to have contracted the virus in the UK: none of the people infected domestically has any known connections with the traveller and the timing of the onset of the cases suggests he was not the source of those infections.
Complicating the situation was that the cases have no discernible links to one other. Two of the confirmed cases and the single probable case are a family unit, said Maria Van Kerkhove, a WHO expert, at a press conference on Tuesday (17 May). The other four confirmed cases were identified as gay, bisexual, or other men who have sex with men – three from London and a fourth from Newcastle, nearly 480km to the north. All four were probably infected in London, the agency said.
When a case of monkeypox was diagnosed in Britain in 2018, experts noted at the time that “despite its relation to the notoriously deadly smallpox, monkeypox is actually a very mild illness, and it doesn’t spread easily between people”.
“It’s not spread readily at all. In fact, it’s rather hard to spread,” said Dr William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Centre in Nashville, Tennessee, who was not involved with the UK case, at the time.
BMJ article – Seven monkeypox cases are confirmed in England (Restricted access)
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UK reports first case of monkeypox, probably from Nigeria