Monkeypox

The Monkeypox virus is endemic in Central and West Africa but there have been increasing numbers of cases reported, with potential community infection, in the rest of the world including the UK. Monkeypox is a potentially serious viral illness that typically involves flu-like symptoms, swelling of the lymph nodes and a rash that includes bumps that are initially filled with fluid before scabbing over. The infection is transmitted by close and intimate contact, including skin to skin contact.

What Is Monkeypox?

Monkeypox is a rare disease that is caused by infection with monkeypox virus.

Monkeypox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research. The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC), and since then the infection has been reported in a number of central and western African countries. Most cases are reported from the DRC and Nigeria.

In 2003, monkeypox was recorded in the US when an outbreak occurred following the importation of rodents 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. No other country outside West and Central Africa has reported similar outbreaks.

What Are The Symptoms of Monkeypox?

The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox can range from 5 to 21 days.

Monkeypox infection is usually a self-limiting illness and most people recover within 2 to 4 weeks. However, severe illness can occur in some individuals.

The illness begins with:

• fever
• headache
• muscle aches
• backache
• swollen lymph nodes
• chills
• exhaustion

Within 1 to 5 days after the appearance of fever, a rash develops, often beginning on the face then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab which later falls off.

An individual is contagious until all the scabs have fallen off and there is intact skin underneath. The scabs may also contain infectious virus material.

How Is Monkeypox Transmitted?

Contact tracing and investigations are ongoing to identify where and how the cases reported since 7 May acquired their infection.

The primary route of infection is animal to human. Person-to-person spread is uncommon, but may occur through:

• contact with clothing or linens (such as bedding or towels) used by an infected person
• direct contact with monkeypox skin lesions or scabs
• large respiratory droplets, through an infected individual coughing or sneezing

What Are The Risks?

The number of cases reported in the UK and indeed globally remain low but the evidence of community infection in non-endemic areas are a concern. Given the routes of transmission those likely to be at risk of infection are:

• Healthcare workers whilst providing close personal care or when handling clothes and linens contaminated with lesion material from an infected person
• Care workers whilst providing close personal care or when handling clothes and linens contaminated with lesion material from an infected person
• Laundry workers whilst handling linens contaminated with lesion material from an infected person
• Leisure industry workers e.g. in gyms, saunas or hotels whilst handling linens contaminated with lesion material from an infected person

Rick Assessments and Infection Control Policies

Employers and service providers should ensure that risk assessments and infection control policies are reviewed and updated to consider the potential risk of Monkeypox. Control measures may include:

• Isolation of any employee/service user reporting symptoms compatible with Monkeypox
• Provision of respiratory protective equipment (RPE)
• Provision of personal protective equipment (PPE) such as gloves for handling potentially contaminated linens
• Refresher training on the need to wash hands regularly with soap and water

Many of the control measures which may have been considered for reducing the risk of COVID-19 infections may be appropriate to mitigate the risks of Monkeypox.

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