The UK monkeypox outbreak is not yet under control, experts have warned, with some suggesting vaccines may need to be offered to all men who have sex with men.
Monkeypox, which will be given a new name by the World Health Organization (WHO), is usually found in West and Central Africa, but an unprecedented outbreak in recent weeks has seen cases appear in a host of countries, from France to Canada and Australia. It is understood that the WHO will hold a meeting next week to decide whether the outbreak should be classified as a public health emergency of international concern.
As of June 12, 470 cases had been identified in the UK, including an increase of 104 cases reported in England last Monday. Experts warn that additional measures may be needed to curb the rise.
“At the moment there is no clear evidence that the current outbreak is under control,” said Paul Hunter, professor of medicine at the University of East Anglia.
Cases have so far mainly been found in gay or bisexual men or men who have sex with men – although experts have raised concerns about stigma in some communities, pointing out that anyone can catch it monkeypox and that it is spread between humans through close contact.
A smallpox vaccine that also provides protection against monkeypox is available, with current guidelines ideally recommending that shots be given to close contacts of cases within four days of exposure to monkeypox to prevent or lessen the impact of the disease. infection, although under certain circumstances it may be given to individuals up to 14 days after exposure to reduce symptoms in case of infection.
“I guess if we don’t see this under control very soon, then we’re looking at offering the vaccination to all men who have sex with men, and possibly sex workers,” Hunter said.
Professor Jimmy Whitworth from the London School of Hygiene and Tropical Medicine also raised concerns. “These numbers of new cases suggest that we are not yet under control of the monkeypox epidemic,” he said, although he cautioned that the trend in cases over a longer period needed to be examined. , while it could take a week or two before the number of new cases has decreased once transmission is brought under control.
But Whitworth said it was clearly a very difficult outbreak to control. “There appear to have been large spread events which allowed infections to spread rapidly to many different countries, and there are chains of transmission which suggest there may have been cases without any obvious signs of infection. infection, which allowed further spread that went undetected,” he said.
Hunter said there were probably many factors at play. “What worries me the most is that for a disease whose transmission may have a significant stigma for some is that people may not not be totally honest about their contacts and if so, public education and a ring vaccination strategy may not be enough,” he said, adding that another concern was to know how well contacts adhered to the self-isolation period.
“For someone who is not openly gay, having to self-isolate for 21 days would be tantamount to coming out,” Hunter said, noting that the situation was sensitive and complex, especially for bisexual men who do not. have not dated their female partners.
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According to the UK Health Security Agency (UKHSA), people who have been tested are usually notified of their result within 24 hours, with contacts identified and followed up as soon as possible, and vaccination offered if appropriate.
However, the agency reported challenges with the outbreak, noting: “Most cases reported having had sexual contact with new or casual partners, sometimes in the context of cruising venues or during chemsex, often when contact details were not available for research.”
Dr Michael Head, senior researcher in global health at the University of Southampton, said public health teams in the UK and overseas had done a great job, both with finding and reporting the contacts as well as specific and sensitive public health messages.
Head said there was a small signal in the UK data that the epidemic was slowing down – although it was not yet certain – while the lack of infections in the wider community showed that transmission was resting. on very close contacts.
“It’s less complex to deal with than, say, a Covid-19 epidemic, and it gives hope that the epidemic will end in the coming weeks or months,” he said.
Dr Hugh Adler from the Liverpool School of Tropical Medicine said there could be a positive view of the rise in the number of cases. “Perhaps this is [reflecting] that public health messages are out and people come in for an assessment,” he said.
Adler said vaccination was not appropriate for all contacts of cases, particularly if they did not have a close or intimate contact. Instead, these people can be monitored for possible symptoms.
“Their risk is so low that vaccination would not be the right thing for them anyway, due to our limited vaccine supplies, as well as side effects,” he said.
