TThe person was ill when he got on the plane. Five days before leaving Nigeria for Britain, they noticed a rash spreading into fluid-filled bumps. When the plane landed on May 4th, they wasted no time. The person went to the hospital where doctors immediately suspected monkeypox, after being alerted of their recent travel. The patient was isolated and a doctor, wearing full PPE, took a swab from a blister on their skin.
Because monkeypox is listed as a “highly sequential infectious disease,” the situation moved quickly. The sample was sent to Porton Down Science Park in Wiltshire where the UK’s Health Security Agency’s Rare and Imported Pathogens Laboratory performed a rapid PCR test. This confirms the infection, which the agency announced the next day, May 7.
Sporadic monkeypox cases are rare but not new in Britain. In total, seven cases were recorded in 2018, 2019 and 2021, all linked to travel to Nigeria where monkeypox is endemic.
But as public health officials soon found out, this year was different. For the first time, doctors have discovered chains of transmission in society – not just in Britain – between people with no known travel links. The UK has confirmed 20 cases, but more than 100 known or suspected cases are under investigation in the US, Canada, France, Germany, Belgium, Spain, Portugal, Italy, Sweden and Australia.
Professor David Heymann, Distinguished Fellow at the Global Health Program Chatham House and former CEO of the World Health Organization’s Staph Infectious Communications Company, said:
Monkeypox is a viral infection that most people ignore. There are two forms. The most dangerous is the Central African or Congolese breed. Recent cases include a milder strain in West Africa. Data from Africa indicates the death of about 1% of those infected. The concern is less about the impact on healthy people, but on the vulnerable — those with weakened immune systems, for example — and the spread of the virus in healthcare settings.
Despite its name—the virus was first discovered in macaques—most human cases of monkeypox virus are thought to come from contact with other infected animals, such as ferrets. Historically, human-to-human transmission has been limited – the infection sometimes spreads in homes but quickly subsides.
The virus spreads through large respiratory droplets, necessitating prolonged or repeated face-to-face contact, or contact with body fluids such as saliva, or skin lesions, either directly or through sheets, towels, and other contaminated objects.
A week after the first patient was confirmed, the UKHSA reported two more people in a family in London, with no connection to the first case. Saturday’s May 14 announcement was “crucial” according to one doctor, because it bore images of monkeypox lesions. These have been seen by professionals struggling to diagnose patients with unexplained rashes in sexual health clinics. They immediately sent swabs to Porton Down, which confirmed the cases were monkeypox. On Monday, the health agency confirmed four more cases, all of them men who had sex with men who appeared to have contracted the virus in London.
The surge in most unrelated cases has prompted UK medical chiefs to send immediate advice to healthcare workers via the NHS’s central alert system. She called on caregivers to ensure they had adequate personal protective equipment to assess and treat patients, and noted that the smallpox vaccine, Imvanex, offers some protection against monkeypox if given soon after exposure. The vaccine is already being offered to health care workers and contacts of cases at high risk of infection, and the Ministry of Health has secured thousands of doses in the event of an outbreak.
The alert highlighted men who have sex with men (MSM), and a series of cases have since been confirmed, indicating a prevalence in sexual networks. As public health experts rush to contain the outbreak, they caution against focusing on any particular group. “This could easily have come up in a different context,” said one senior sexual health professional. “Maybe the MSM phenomenon was a very quick way to get our attention that there is a skin-to-skin transmission in society.”
The focus on MSM was “biased, unfair and stigmatizing”, said Sir Ali Zumla, professor of infectious diseases and international health at University College London, adding that monkeypox groups can occur in any group in close contact with infected people. . He added that it was “highly unlikely” that the gatherings were caused by any change in the virus.
Dr Mira Chand, director of clinical and emerging infections at UKHSA, said “everyone” should be vigilant for monkeypox symptoms. “If you notice any rashes or unusual lesions consistent with monkeypox, please contact NHS 111 or the Sexual Health Service, and call ahead before your visit. A significant proportion of recent cases in the UK and Europe have been found in gay and bisexual men, that is The reason we are particularly encouraging them is to watch out for symptoms. We are working to trace contacts of cases and provide vaccinations where appropriate, while at the same time we are rapidly investigating how the virus is transmitted to understand why we are seeing this unusual outbreak.”