Mpox (Monkeypox)
Mpox (Monkeypox) is an infectious disease caused by the mpox virus. Other diseases in the same family include variola virus (which causes smallpox), vaccinia virus and cowpox virus.
In November 2022, the World Health Organization (WHO) announced a new preferred term for monkeypox as mpox.
Prior to 2022, mpox occurred in tropical rainforest areas of Central and West Africa and was occasionally exported to other regions. Whilst the natural reservoir of mpox virus remains unknown, it was mainly spread by African rodents, such as rats, mice, and squirrels. The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC). Since then, according to the WHO, cases were reported in 11 African countries with DRC and Nigeria reporting the largest number of mpox cases annually. The true burden of mpox in this region is not known.
Travel-related mpox cases have been reported in the United Kingdom (UK) in previous years, including in 2021, when a case of mpox was identified in an individual who previously travelled from Nigeria. Two family members were subsequently identified as having mpox.
Since May 2022, cases of mpox have been identified in many countries where the disease is not regularly found, including the UK. A notable portion of cases in this international outbreak have been detected in gay, bisexual and other men who have sex with men (GBMSM), though not exclusively.
Mpox can be transmitted when a person comes into close contact with an infected animal (rodents are believed to be the primary animal reservoir for human transmission), human or with contaminated material. The virus enters the body through broken skin (even if not visible), the respiratory tract or the mucous membranes (eyes, nose, or mouth). The virus does not usually spread easily between people, but it can be passed on through close person-to-person contact or contact with items used by a person who has mpox, such as clothes, bedding, towels or utensils. Person-to-person contact can also occur through direct contact with mpox skin lesions or scabs or coughing/sneezing of an individual with a mpox rash.
The incubation period for mpox is between five and 21 days. Symptoms usually begin with fever, headache, muscle/backache, joint pain, swollen lymph nodes, chills and exhaustion. Within one to five days after the appearance of fever, a rash develops, often on the face and spreading to other parts of the body. The rash goes through different stages and ends with a scab that later falls off. An individual is contagious until all the scabs fall off and the skin underneath is intact. Scabs may also be infectious.
Mpox is usually a self-limiting illness with mild symptoms; most people recover, within several weeks, without treatment. However, severe illness, which can be fatal, can occur in some individuals. Treatment for mpox is mainly supportive. Antiviral drugs can be used to treat severe disease or those who are at high risk of severe disease.
Prevention
The risk of mpox is very low for most travellers. The risk can be reduced by taking the following steps:
- Avoid contact (including sexual contact) with anyone who is unwell or has an unusual rash and practise good hygiene before and after sex. Talk to sexual partners about their sexual health and any symptoms they may have.
- Before you have sex, go to a party or event, check yourself for mpox symptoms, including rashes and blisters. If you have mpox symptoms, take a break from attending events or sex until you've been assessed by a clinician.
- It can take up to 3 weeks for symptoms to appear after being in contact with someone with mpox, so stay alert for symptoms after you have skin to skin or sexual contact with someone new.
- Everyone is encouraged to exchange contact details with sexual partners, to help limit further transmission where cases occur.
- Avoid touching contaminated items such as bedding/clothing or sharing eating utensils/cups, food or drink with a person who has, or may have, mpox.
- Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol. Keep your hands away from your eyes, nose, and mouth. If you need to touch your face, make sure your hands are clean.
- Avoid contact with animals, especially rodents.
- Do not eat, cook or prepare any type of raw or wild meat (bushmeat) or any meat from unknown sources.
Aid workers and health professionals planning to undertake humanitarian work in areas where outbreaks or isolated mpox cases are reported should seek advice and training from their employer/organisation, prior to travel.
Advice for people with HIV is available from the British HIV Association.
UK travellers experiencing symptoms abroad should:
- limit their contact with other people.
- get medical advice locally, calling ahead before going to a healthcare facility. If they are not able to call ahead, they should inform a staff member as soon as they arrive that they are concerned about mpox.
- check with a health professional that they are fit to travel.
- those who are diagnosed with mpox should not have sex while symptomatic and while lesions are present and use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
Travellers should follow local public health advice. They may be required to self-isolate, be hospitalised or put into a quarantine facility until they are no longer considered to be infectious to other people. Travel to a mpox affected area may affect travel health insurance options. Travellers should discuss their plans with their travel insurance provider before they go.
Travellers who become unwell after returning to the UK should seek medical advice by telephone, see current NHS guidance.
More detailed information is available from the UKHSA Mpox webpages.
Vaccine
The NHS previously offered a countrywide vaccination schedule to people most likely to be exposed to mpox. This included some healthcare workers, some men who are gay, bisexual or have sex with other men and people who had close contact with someone with mpox. This nationwide vaccine programme ended in July 2023.
Vaccination is still currently available in London: find an mpox vaccination site.
Resources
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