Monkeypox Outbreak in the United Kingdom : Signs, Symptoms, Diagnosis, Vaccine

Monkeypox Outbreak in the United Kingdom :

Two instances of monkeypox have been discovered in north Wales, according to health experts.

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The first case was obtained overseas, according to Public Health Wales, and both instances were found in two people from the same family.

Monitoring and contact tracing are already underway, according to PHW, and the risk to the general population is very low.

But what exactly is monkeypox, and what are the symptoms and signs?

Here’s everything you need to know about it.

Monkeypox

What exactly is Monkeypox and how is it transmitted?

Monkeypox is an uncommon disease caused by a monkeypox virus infection.

The majority of instances have occurred in Africa, and the risk of contracting monkeypox in the UK is extremely low, according to the NHS.

Monkeypox is often a benign infection that improves on its own without treatment, but because some people develop more serious symptoms, individuals with monkeypox in the United Kingdom are treated in specialist facilities.

However, there have only been a few occurrences of monkeypox in the UK, and if one occurs, health officials will attempt to contact anyone who has had intimate contact with the sick person.

“If you have not been notified, be assured that you are extremely unlikely to contract monkeypox,” according to the NHS website.

Monkeypox is not easily transmitted between individuals, although it can be contracted from the following sources:

– coming into contact with an infected person’s clothing, bedding, or towels

– touching the patches or scabs of monkeypox

– a person who coughs or sneezes near you and has a monkeypox rash

Key facts

  • Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.
  • Monkeypox is a viral zoonotic disease that occurs primarily in tropical rainforest areas of Central and West Africa and is occasionally exported to other regions.
  • Monkeypox typically presents clinically with fever, rash and swollen lymph nodes.
  • Monkeypox virus is mostly transmitted to people from wild animals such as rodents and primates, but human-to-human transmission also occurs.
  • Monkeypox virus is transmitted from one person to another by contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.
  • Typically, up to a tenth of persons ill with monkeypox may die, with most deaths occurring in younger age groups.
  • The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980.
  • Vaccinia vaccine used during the smallpox eradication programme was also protective against monkeypox. A new third generation vaccinia vaccine has now been approved for prevention of smallpox and monkeypox. Antiviral agents are also being developed.

What are some of the main signs and symptoms of monkeypox?

The disease starts with:

– excessive heat

– a migraine

– Muscle pain

– back pain

– glands that are enlarged

– shivers

– tiredness

After the first symptoms develop, a rash usually appears one to five days later. The spots usually begin on the face and then migrate to other parts of the body.

Outbreaks

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo (then known as Zaire) in a 9-year-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo, where it is considered to be endemic.

Since 1970, human cases of monkeypox have been reported from 11 African countries – Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan. In 2017 Nigeria experienced the largest documented outbreak, 40 years after the last confirmed case. The true burden of monkeypox is not known. For example, in 1996–97, a major monkeypox outbreak was suspected in the Democratic Republic of Congo with, however, a lower case fatality and a higher attack rate than usual. Some patient samples tested positive for varicella virus and some contained both varicella and monkeypox viruses. Concurrent outbreaks of chickenpox and monkeypox could explain a change in transmission dynamics in this case.

The virus has been exported from Africa a few times. In the spring of 2003, monkeypox cases were confirmed in the United States of America. Most patients were reported to have had close contact with pet prairie dogs that were infected by African rodents that had been imported into the country from Ghana. Recently, monkeypox was carried to Israel in September 2018, to the United Kingdom in September 2018 and December 2019 and to Singapore in May 2019 by travelers from Nigeria who fell ill with monkeypox after arrival. A health worker was infected and became ill.

Two distinct genetic clades of the virus have been identified – the Congo Basin and the West African clades – with the former found to be more virulent and transmissible. The geographical division between the two clades is thought to be in Cameroon as this is the only country where both monkeypox virus clades were detected.

Transmission

Infection of index cases results from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys and others. The natural reservoir of monkeypox has not yet been identified, though rodents are the most likely. Eating inadequately cooked meat and other animal products of infected animals is a possible risk factor.

Secondary, or human-to-human, transmission is relatively limited. Infection can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Transmission via droplet respiratory particles usually requires prolonged face-to-face contact, which puts health workers and household members of active cases at greater risk. The longest documented chain of transmission in a community was six successive person-to-person infections. Transmission can also occur via the placenta from mother to fetus (congenital monkeypox).

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Signs and Symptoms

The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days.

The infection can be divided into two periods:

  • the invasion period (lasts between 0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle aches) and an intense asthenia (lack of energy). Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox).
  • the skin eruption usually begins within 1-3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of the lesions varies from a few to several thousand. In severe cases, lesions can coalesce until large sections of skin slough off.

During the disease, the rash transforms from raised red bumps to fluid-filled patches, which finally turn into scabs that fall off.

Monkeypox is a contagious disease that can be identified and treated in a variety of ways. “It’s difficult to know if the infection is monkeypox because it can easily be confused with other viruses like chickenpox,” the NHS notes.

Monkeypox is identified following a specialist examination, and treatment seeks to alleviate symptoms and takes place at specialised facilities.

Diagnosis

The clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox. If monkeypox is suspected, health workers should collect an appropriate sample and transport it safely to a laboratory with appropriate capability.

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Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Thus, specimens should be packaged and shipped in accordance with national and international requirements. Polymerase chain reaction (PCR) is the preferred laboratory test given its accuracy and sensitivity. For this, optimal diagnostic samples for monkeypox are from skin lesions – the roof or fluid from vesicles and pustules, and dry crusts. Where feasible, biopsy is an option.

Lesion samples must be stored in a dry, sterile tube (no viral transport media) and kept cold. PCR blood tests are usually inconclusive because of the short duration of viremia relative to the timing of specimen collection after symptoms begin and should not be routinely collected from patients.

Treatment and Vaccine

There is currently no specific treatment recommended for monkeypox. Vaccination against smallpox with vaccinia vaccine was demonstrated through several observational studies to be about 85% effective in preventing monkeypox. Thus, prior childhood smallpox vaccination may result in a milder disease course.

However at the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. A newer vaccinia-based vaccine was approved for the prevention of smallpox and monkeypox in 2019 and is also not yet widely available in the public sector.

Prevention

Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus is the main prevention strategy for monkeypox. Scientific studies are now underway to assess the feasibility and appropriateness of using vaccinia vaccine for the prevention and control of monkeypox. Some countries have, or are developing, policies for use of vaccinia vaccine to prevent infection, for example in laboratory staff and health workers who may be at risk of exposure.

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