Close contacts of monkeypox cases will no longer need to self-isolate unless they develop tell-tale symptoms, UK health chiefs announced today.
Only those who develop ailments such as a fever, headache and rash after being in contact with someone infected will now need to stay at home.
UK Health Security Agency (UKHSA) bosses said the change, which includes people who have had sex with the infected, is because only a ‘relatively small number’ of contacts develop monkeypox.
Officials said there is a ‘lack of evidence’ the rash-causing virus — usually only spotted in west and central Africa before the current global outbreak took off in gay and bisexual men — is spreading outside of sexual contact.
Dr Merav Kliner, deputy incident director at UKHSA, said that while self-isolation is easing, monkeypox still poses a ‘serious public health challenge’.
Contacts should still ‘take a break’ from skin to skin contact, including sex, hugging and kissing ‘to reduce the risk of the virus being passed on unknowingly’, she said.
Meanwhile, the UKHSA today confirmed cases had surpassed the 2,000 barrier.
It has bought 100,000 extra doses of the smallpox vaccine, which works against its milder cousin monkeypox and is offered to close contacts and some gay and bisexual men as part of efforts to thwart the ever-growing outbreak.
As part of efforts to thwart the ever-growing outbreak, both confirmed cases and close contacts are offered the Imvanex jab. The strategy, known as ring vaccination, has been used in the past and is proven to work. The US today entered a new deal to buy half a million more doses of the vaccine, which is 85 per cent effective against the virus. Its extra supply will be delivered this year. For comparison, the UK is understood to have just 25,000 doses — 20 times fewer than America’s order
Officials are urging gay and bisexual men to be aware of new lesions, rashes or scabs and get in contact with a sexual health clinic
The infection often starts with small bumps that scab over and are contagious
Timeline of monkeypox
1958: Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research.
1970: The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.
2003: A Monkeypox outbreak occurred in the US after rodents were imported from Africa. Cases were reported in both humans and pet prairie dogs. All the human infections followed contact with an infected pet and all patients recovered.
SEPTEMBER 8, 2018: Monkeypox appeared in the UK for the first time in a Nigerian naval officer who was visiting Cornwall for training. They were treated at the Royal Free Hospital in London.
SEPTEMBER 11, 2018: A second UK monkeypox case is confirmed in Blackpool. There is no link with the first case in Cornwall. Instead, the patient is though to have picked up the infection when travelling in Nigeria. They were treated at Blackpool Victoria Hospital and Royal Liverpool University Hospital.
SEPTEMBER 26, 2018: A third person is diagnosed with monkeypox. The individual worked at Blackpool Victoria Hospital and treated the second Monkeypox case. They received treatment at the Royal Victoria Infirmary in Newcastle.
DECEMBER 3, 2019: A patient was diagnosed with monkeypox in England, marking the fourth ever case.
MAY 25, 2021: Two cases of monkeypox were identified in north Wales. Both patients had travel links to Nigeria.
A third person living with one of the cases was diagnosed and admitted to hospital, bringing the total number ever to seven.
MAY 7, 2022: A person was diagnosed with Monkeypox in England after recently travelling to Nigeria. The person received care at the expert infectious disease unit at Guy’s and St Thomas’ NHS Foundation Trust in London. Experts have suggested the virus was spreading in the UK for months before this case was spotted.
MAY 14, 2022: Two more cases were confirmed in London. The infected pair lived in the same household but had not been in contact with the case announced one week earlier.
One of these individuals received care at the expert infectious disease unit at St Mary’s Hospital in London. The other isolated at home and did not need hospital treatment.
MAY 16, 2022: Four more cases were announced, bringing the UK total to seven. Three of these cases are in London, while one of their contacts is infected in the north east of England.
The UKHSA first confirms that the spate of cases, described as ‘unusual’ and ‘surprising’, are mainly among gay and bisexual men and advises them to look out for new rashes.
MAY 19, 2022: Two more cases were revealed, with no travel links or connections to other cases. The cases were based in the South East and London. Fears began to grow that infections are going undetected.
MAY 20, 2022: Eleven more cases are announced, meaning Britain’s monkeypox outbreak have doubled to 20. Minsters discuss the possibility of a public health campaign to warn gay men the disease may be more prevalent for them
MAY 23-26, 2022: Scotland, Wales and Northern Ireland log their first ever monkeypox cases.
MAY 29, 2022: World Health Organization (WHO) says risk of monkeypox is ‘moderate’, citing concerns about virus infecting children and immunosuppressed people if it becomes more widespread.
JUNE 7, 2022: The UKHSA declares monkeypox a notifiable disease. It means all medics must alert local health authorities to suspected cases. The tropical virus now carries the same legal status as the plague, rabies and measles.
The UKHSA guidance sets out new steps for high-risk monkeypox contacts — including sexual contacts who did not use a condom, household contacts and medics who treated an infected person without PPE.
Until now, contacts had to isolate for 21 days.
As well as not having to isolate, these groups now should only contact NHS 111 or a sexual health clinic if they develop symptoms.
A fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion are the initial monkeypox symptoms, which are followed by a rash that looks like chickenpox or syphilis.
However, high-risk contacts are told to avoid skin-to-skin contact with others, refrain from sexual contact, avoid international travel and let dentists know you are infected.
People who have physical contact with a monkeypox case or touched their bedding are told to avoid contact with under-fives, pregnant women and the immunosuppressed.
If they work with anyone from these groups, the UKHSA or their employer may inform them to take time off after a clinical assessment.
Health teams are offering smallpox vaccines, which are 85 per cent effective against monkeypox, to close contacts who had a high-risk exposure to an infected person.
The strategy, known as ring vaccination, has been proven to work in other outbreaks.
And gay and bisexual men who are at a ‘high risk’ of catching monkeypox were offered the jab from last month.
But latest UKHSA data shows the outbreak is continuing to grow.
Since the first case was detected on May 6, there has been 2,137 confirmed monkeypox infections. And the figure for July 18 is up by 272 since July 14.
Of these, 2,050 are in England, 51 are in Scotland, while 23 are in Wales and 13 in Northern Ireland.
Within England, the vast majority (1,492) are in London. Hotspots also include the South East (172), North West (115) and East of England (82).
Almost all of cases so far have been identified in the gay, bisexual and men who have sex with other men community.
But anyone can get monkeypox if they have had close contact with an infected person.
Monkeypox is not normally a sexually-transmitted infection, but it can be passed on by direct contact during sex. It can also be spread through touching clothing, bedding or towels used by someone with the monkeypox rash.
Almost all of the cases are mild and no deaths have been recorded.
Dr Kliner said: ‘We have now passed over 2,000 confirmed cases of monkeypox in the UK, and the outbreak continues to grow.
‘Based on the growing evidence of how the monkeypox virus is being passed on in this outbreak, close contacts will no longer have to isolate for 21 days unless they develop symptoms.
‘While our advice on isolation is changing, monkeypox is still a serious public health challenge, and we urge contacts to take a break from any activities or events involving skin to skin contact, including sex, hugging and kissing to reduce the risk of the virus being passed on unknowingly.
‘Stay alert to symptoms and call a sexual health clinic if you become unwell.
‘Thank you to all contacts who have isolated already in response to this outbreak. We understand that isolation can be difficult but this was a necessary precaution whilst our knowledge of the outbreak was limited.’
It comes as health chiefs today bought another 100,000 smallpox vaccines from Denmark-based Bavarian Nordic. The doses will arrive between July and September.
The UK had already ordered 30,000 doses of the vaccine to rollout to infected people and their contacts.
Studies have shown Imvanex — known as Jynneos in the US — is around 85 per cent effective at preventing a monkeypox infection.
The vaccine was developed for use against smallpox but offers cross-protection against monkeypox because the viruses are so similar.
Health and Social Care Secretary Steve Barclay said: ‘Monkeypox is a rare and usually mild disease that does not spread easily between people.
‘But we are taking action to help further manage the outbreak in the UK by procuring over 100,000 additional doses of vaccine.
‘The NHS is already contacting those eligible for the vaccine, and I would urge people to take up the offer as soon as they are contacted.
‘In the meantime, please contact a sexual health clinic if you notice any unusual rashes or lesions.
‘I am hugely grateful to the fantastic sexual health staff and 111 call handlers for working hard to keep the current outbreak under control.’
Dr Gayatri Amirthalingam, head of immunisation at UKHSA said the additional doses mean the UK is ‘in an even stronger position to bring the current monkeypox outbreak under control’.
She said: ‘Although most cases of monkeypox in the current outbreak are mild, severe illness can occur in some people.
‘So it is important we use the available vaccine to reach groups where transmission is occurring.
‘Anyone can get monkeypox and we continue to urge anyone with a rash with blisters, or any other monkeypox symptoms, to take a break from events, meeting with friends or having sexual contact.
‘Instead, stay at home and contact 111 or your local sexual health service for advice.’
How DO you catch monkeypox and what are the symptoms? EVERYTHING you need to know about tropical virus
How do you catch monkeypox?
Until this worldwide outbreak, monkeypox was usually spread by infected rodents — including rats, mice and even squirrels — in west and central Africa.
Humans can catch the illness — which comes from the same family as smallpox — if they’re bitten by infected animals, touch their blood, bodily fluids, or scabs, or eat wild game or bush meat.
The orthopoxvirus, which causes monkeypox, can enter the body through broken skin — even if it’s not visible, as well as the eyes, nose and mouth.
Despite being mainly spread by wild animals, it was known that monkeypox could be passed on between people. However, health chiefs insist it was very rare until the current outbreak.
Human-to-human spread can occur if someone touches clothing or bedding used by an infected person, or through direct contact with the virus’ tell-tale scabs. The virus can also spread through coughs and sneezes.
In the ongoing surge in cases, experts think the virus is passing through skin-to-skin contact during sex — even though this exact mechanism has never been seen until now.
How deadly is it?
Monkeypox is usually mild, with most patients recovering within a few weeks without treatment.
Yet, the disease kills up to 10 per cent of cases. But this high rate is thought to be in part due to a historic lack of testing meaning that a tenth of known cases have died rather than a tenth of all infections.
However, with milder strains the fatality rate is closer to one in 100 — similar to when Covid first hit.
The West African version of the virus, which is mild compared to the Central African strain, is behind the current spread. No deaths have been reported as part of the ongoing outbreak.
How is it tested for?
It can be difficult to diagnose monkeypox as it is often confused with other infections such as chickenpox.
Monkeypox is confirmed by a clinical assessment by a health professional and a test in the UK’s specialist lab — the UKHSA’s Rare and Imported Pathogens Laboratory.
The test involves taking samples from skin lesions, such as part of the scab, fluid from the lesions or pieces of dry crusts.
What are the symptoms?
It can take up to three weeks for monkeypox-infected patients to develop any of its tell-tale symptoms.
Early signs of the virus include a fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion — meaning it could, theoretically, be mistaken for other common illnesses.
But its most unusual feature is a rash that often begins on the face, then spreads to other parts of the body, commonly the hands and feet.
The rash changes and goes through different stages before finally forming a scab, which later falls off.
How long is someone contagious?
An individual is contagious from the point their rash appears until all the scabs have fallen off and there is intact skin underneath.
The scabs may also contain infectious virus material.
The infectious period is thought to last for three weeks but may vary between individuals.
What do I do if I have symptoms?
The UK Health Security Agency advises Britons to contact their sexual health clinic if they have a rash with blisters and have been in close contact with a suspected or confirmed monkeypox case or have been in West or Central Africa in the last three weeks.
Britons are asked to contact clinics ahead of their visit and avoid contact with others until they have been seen by a medic.
Gay and bisexual men have been asked to be especially alert to the symptoms as most of the cases have been detected in men who have sex with men.
What even is monkeypox?
Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research in 1958.
The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.
Only a handful of cases have been reported outside of Africa and they were confined to people with travel links to the continent.
The UK, US, Israel and Singapore are the only countries which had detected the virus before May 2022.
Monkeypox is a rare viral infection which kills up to one in ten of those infected but does not spread easily between people. The tropical disease is endemic in parts of Africa and is known for its rare and unusual rashes, bumps and lesions (file photo)
Nurses and doctors are being advised to stay ‘alert’ to patients who present with a new rash or scabby lesions (like above)
Is it related to chickenpox?
Despite causing a similar rash, chickenpox is not related to monkeypox.
The infection, which usually strikes children, is caused by the varicella-zoster virus.
For comparison, monkeypox — like smallpox — is an orthopoxvirus. Because of this link, smallpox vaccines also provide protection against monkeypox.
Are young people more vulnerable?
Britons aged under 50 may be more susceptible to monkeypox, according to the World Health Organization.
This is because children in the UK were routinely offered the smallpox jab, which protects against monkeypox, until 1971.
The WHO also warns that the fatality rate has been higher among young children.
Does it spread as easily as Covid?
Leading experts insist we won’t be seeing Covid-style levels of transmission in the monkeypox outbreak.
A World Health Organization report last year suggested the natural R rate of the virus – the number of people each patient would infect if they lived normally while sick – is two.
This is lower than the original Wuhan variant of Covid and about a third of the R rate of the Indian ‘Delta’ strain.
But the real rate is likely much lower because ‘distinctive symptoms greatly aid in its early detection and containment,’ the team said, meaning it’s easy to spot cases and isolate them.
Covid is mainly spread through droplets an infected person releases whenever they breathe, speak, cough or sneeze.
How is the UK managing the outbreak?
MailOnline revealed monkeypox patients and their close contacts, including NHS workers, are being offered the Imvanex smallpox vaccine.
The strategy, known as ring vaccination, involves jabbing and monitoring anyone around an infected person to form a buffer of immune people to limit the spread of a disease.
Additionally, close contacts of those with a confirmed monkeypox infection who have symptoms are being told to stay at home. And those without symptoms are told to avoid contact under-12s, immunosuppressed people and pregnant women.
The Government said unprotected direct contact or high risk environmental contact includes living in the same house as someone with monkeypox, having sexual contact with them or even just changing their bedding ‘without appropriate PPE’.
As with Covid, someone who has come within one metre of an infected person is classed as a monkeypox contact.
What if it continues to spread?
Experts told MailOnline they ‘could see a role’ for a wider targeted jab rollout to more NHS staff and female sex workers in the UK ‘if this isn’t brought under control quickly’.
Close contacts of the UK’s known cases and some gay and bisexual men are already being offered the jab, which was originally designed for smallpox. The two rash-causing viruses are very similar.
A health source told MailOnline ‘there would be a number of strategies we’d look at’ if cases continued to rise.
Professor Kevin Fenton, London’s public health regional director, said if the outbreak in the capital continues to grow then the rollout of vaccines and treatments could be broadened to more groups.
He said there are ‘plans in place’ to have more antivirals if the outbreak keeps growing.
What other countries have spotted cases?
More than 70 countries — including the US, Spain and Italy — have detected cases of monkeypox.
Most cases have been detected in the UK, Spain, Germany, US and France.
There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox, including the drug tecovirimat, which was approved for monkeypox in the EU in January
Is there a vaccine for it?
The smallpox vaccine, called Imvanex in the UK and Jynneos in the US, can protect against monkeypox because the viruses behind the illnesses are closely related.
Data shows it prevents around 85 per cent of cases, and has been used ‘off-label’ in the UK since 2018.
The jab, thought to cost £20 per dose, contains a modified vaccinia virus, which is similar to both smallpox and monkeypox, but does not cause disease in people.
Because of its similarity to the pox viruses, antibodies produced against this virus offer cross protection.
Are there any drugs to treat it?
There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox.
This includes the drug tecovirimat, which was approved for monkeypox in the EU in January.
Tecovirimat prevents the virus from leaving an infected cell, hindering the spread of the virus within the body.
An injectable antiviral used to treat AIDS called cidofovir can be used to manage the infection, according to the US Centers for Disease Control and Prevention (CDC).
It also works by stopping the growth of the virus.