The report of two apparently unconnected cases of monkeypox in the UK within one week was a surprise for public health officials. No cases of the virus had been reported previously in the UK, or even more widely in Europe.
The two cases had both travelled to the UK from Nigeria, where they would have contracted their infections. There have been reports of an increase in cases of monkeypox in Nigeria and elsewhere in west Africa in the past few months, and this is likely to explain why we have seen these infections for the first time in the UK.
A third case has now been reported, this time in a healthcare worker who was infected in the UK while caring for one of the imported cases. Public Health England has said that the transmission occurred before the diagnosis was made. This is often a risky period as stringent infection control procedures may not be in place before a diagnosis is made or even suspected. Whether this transmission was bad luck or due to a lapse in basic standard precautions is not clear.
Monkeypox emerged in west and central Africa in the 1980s. It is thought that this is related to stopping routine smallpox vaccination once that disease had been eradicated, leaving the population exposed to the closely related but much milder monkeypox. Over 100 cases of monkeypox were reported in Nigeria in 2017.
The infection is usually contracted from small rodents in the African forest and is not easily transmitted from human to human. It causes a typical acute viral illness with fever, pains and malaise, with a typical rash of pox lesions, as seen in chickenpox or smallpox.
Most cases recover with careful nursing in a few weeks, although it can be fatal in around one to 10 per cent of cases. Why there has been a rise in cases in Nigeria is not clear but increases in rodent populations or more contact with humans are possible reasons.
Public health measures include isolation of cases and strict infection control. If the authorities actively identify the contacts of the cases and can keep them under observation there is very little risk of any sustained transmission in the UK.
Since the cases arrived, contacts have been offered smallpox vaccination which will reduce the risk of transmission still further. It is possible more cases will be identified in travellers to the UK, and health authorities will need to be vigilant and consider the possibility of monkeypox in patients with a consistent medical and travel history.
We of course wish those affected a full, speedy recovery but isolated monkeypox cases pose no great cause for concern in the UK. However these cases are another reminder that our modern, mobile, interconnected world, which enables us to travel quickly from continent to continent, does make countries across the globe more vulnerable to occasional imported infections – many of which are more dangerous to humans than monkeypox.
This year we have seen bigger than normal outbreaks of Lassa fever (Nigeria), Nipah virus in (India), and of course the Democratic Republic of Congo, supported by various global organisations, is still tackling its second Ebola virus outbreak of 2018.
The UK’s expertise, experience and robust health system means we are well prepared to handle these isolated cases and offer excellent care to those affected. Other countries, however are not so fortunate.
It’s imperative that the UK continues its strong support to help low-income countries stop disease outbreaks in their tracks. This will save lives “on the ground”, and will also help prevent dangerous infections reaching our shores.
Jimmy Whitworth is a professor of international public health at the London School of Hygiene and Tropical Medicine
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