How does monkeypox spread and how transmissible is it?

Monkeypox virus particle. Credit: Science Photo Library

Words by ITV News Multimedia Producer Suzanne Elliott

The community transmission of monkeypox in the UK, where there are now at least 574 confirmed cases, has been described as "undoubtedly worrying" by scientists.

Monkeypox cases are usually found in West Africa, and the virus does not often spread elsewhere which is why outbreaks reported across Europe, Canada, Australia and the United States have caused alarm among public health experts.

The cases in the UK are not all one cluster, with separate cases springing up that are unconnected, and experts are piecing together via contact tracing how the disease is moving through the community.

What do we know about how it spreads and how transmissible is it?

Handout image issued by the UK Health Security Agency of the stages of Monkeypox. Credit: UKHSA/PA

How does it spread?

The virus enters the body through breaks in the skin, some of which may not be visible, and through the eyes, mouth nose or other parts of the respiratory tract.

It can also be spread through touching clothing, bedding or towels used by someone with the monkeypox rash, and through the coughs and sneezes of somebody with the infection.

Monkeypox is not normally a sexually-transmitted infection, but it can be passed on by direct contact during sex. The current cluster of monkeypox cases is in men who have sex with men, but experts warn of drawing conclusions about how the virus was transmitted.

"Very close contact with an infected individual is required for the spread of the monkeypox," Prof Neil Mabbott, personal chair in Immunopathology, the Roslin Institute & Royal School of Veterinary Sciences, University of Edinburgh, but added the transmission of monkeypox virus infection in humans by sexual contact has not previously been documented.

He said the recent UK cases suggest a "potentially novel means of spread" but added that as pox viruses were spread through close contacted, it was not unprecedented.

Dr Michael Skinner, Reader in Virology, Imperial College London, said also urged caution at assuming monkeypox was a sexually-transmitted infection (STI): “By nature, sexual activity involves intimate contact, which one would expect to increase the likelihood of transmission, whatever a person’s sexual orientation and irrespective of the mode of transmission.”

"It is not usually easy to pass on" - Dr Sarah Jarvis says monkeypox is not easily spread but if someone thinks they are infected, or has been in close contact with someone who has the tell-tale rash, they should ring NHS 111

Close-range respiratory or droplet transmission could also spread the virus, while you can also catch the virus by inhaling the lesions (once they heal - but still infectious - the scabs shed as dust which can then be inhaled).

You can also catch the disease from infected animals, either pets or food animals.

There was an outbreak of monkeypox in 2003 in the US after prairie dogs at a pet shop were thought to have been infected with the monkeypox virus by a giant Gambian rat, which is indigenous to Africa. The disease then jumped from pet prairie dogs and was thought to have infected around 70 people.

How transmissible is it?

Monkeypox is a hard virus to transmit between humans, experts say. It needs very close contact, for example, skin to skin contact with an individual who is infected with a monkeypox rash. Between these new cases, there will have been that close contact, experts agree.

Prof Paul Hunter, Professor in Medicine, the Norwich School of Medicine, University of East Anglia, says it has been thought person to person transmission was "quite low" but that a recent outbreak in the Democratic Republic of Congo saw the virus pass quickly through households.

But, Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said it would be "very unusual to see anything more than a handful of cases in any outbreak, and we won’t be seeing Covid-style levels of transmission".

Stefan De Keersmaecker, European Commission spokesperson said on the EU was closely monitoring the outbreak, adding the disease was moderately transmissible among humans with an increased likelihood of transmission through close contact.Is monekypox like Covid?

Monkeypox is a very different virus to Covid with its own characteristics. A big monkeypox outbreak like this is still a very different situation to the coronavirus pandemic.

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