25.09.2022

UK’s monkeypox outbreak passes 1,000 cases as gloomy model warns of doomsday scenario

Monkeypox cases in the UK have risen above 1,000 as the rare disease continues to spread, officials confirmed today. UK Health Security Agency (UKHSA) bosses said there had been 1,076 infections as of Sunday, almost double the number a fortnight ago.

Authorities said they expect cases to continue to rise further in the coming days and are advising anyone going to large events or having sex with new partners to ‘be alert’ for symptoms.

Cases continue to be predominantly among gay and bisexual men and the UK’s outbreak has been linked to raves, saunas and dating apps, with the virus mostly spreading through sex.

It came as modelling by a Strathclyde University professor warned the outbreak could continue for another year and infect tens of thousands of Britons daily in a worst-case scenario. The simulation assumes all under-50s — the last age group to get a smallpox vaccine, which provides cross-protection —  are susceptible to monkeypox.

Other scientists do not expect the virus to ever reach the heights of Covid waves because monkeypox requires prolonged close contact or contaminated surfaces to spread.

Announcing Britain’s new cases today, Dr Sophia Makki, incident director at the UKHSA, said: ‘The monkeypox outbreak in the UK continues to grow, with over a thousand cases now confirmed nationwide.

‘We expect cases to continue to rise further in the coming days and weeks. If you are attending large events over the summer or having sex with new partners, be alert to any monkeypox symptoms so you can get tested rapidly and help avoid passing the infection on.

Monkeypox cases in the UK have risen above 1,000 as the rare tropical disease continues to spread. The UK Health Security Agency (UKHSA) said there had been 1,076 infections as of Sunday, almost double the number a fortnight ago, in a sign the outbreak is not slowing down

Dozens of countries have logged cases of monkeypox, which is usually only spotted in Africa and has until now fizzled out after a handful of cases in other parts of the world

LARGE POPULATION RISK: Professor Kleczkowski calculated the monkeypox outbreak based on the virus R rate, herd immunity threshold and incubation period. Under one ‘very pessimistic scenario’, infections peak at 60,000, the total number of people infected nears 20million and the epidemic lasts for more than one year. ‘The virus will continue spreading, effectively searching for pockets of high-risk and non-immune communities,’ Professor Kleczkowski said.

ENDEMIC: Under separate modelling, Professor Kleczkowski said that due to monkeypox’s low transmissibility and long incubation period — which allows it to survive at low levels in the population — it is possible that the virus has already been spreading in the UK ‘for a long time’. Following the current spike in infections, the disease may ‘settle on a long-term, relatively constant level’ similar to how smallpox and chickenpox spread before vaccines were rolled out. Under this model, ‘mass vaccination programmes might be needed to eradicate the disease’, he said

RECURRENT LARGE EPIDEMICS: In a separate model from Professor Kleczkowski, the current outbreak could be ‘the first instance of a serious of outbreaks’ fuelled by zoonotic transmission — when the disease jumps from an animal to a human — and cause sporadic surges of infection in the future. ‘As the cross-immunity from smallpox vaccines wanes, the epidemics can become even more substantial,’ he said. While little is known about monkeypox’s potential to mutate, there is room for it to ‘evolve into a more rapidly spreading variant’, Professor Kleczkowski said

SELF-LIMITING OUTBREAK: However, in his least severe set of calculations, he suggested that the outbreak took off due to a super-spreader event involving a network of men who have sex with men. In this scenario, the outbreak ‘ends quickly’ once the population at risk becomes immune and heard immunity is reached locally

Timeline of monkeypox

1958: Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research.

1970: The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.

2003: A Monkeypox outbreak occurred in the US after rodents were imported 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.

SEPTEMBER 8, 2018: Monkeypox appeared in the UK for the first time in a Nigerian naval officer who was visiting Cornwall for training. They were treated at the Royal Free Hospital in London.

SEPTEMBER 11, 2018: A second UK monkeypox case is confirmed in Blackpool. There is no link with the first case in Cornwall. Instead, the patient is though to have picked up the infection when travelling in Nigeria. They were treated at Blackpool Victoria Hospital and Royal Liverpool University Hospital.

SEPTEMBER 26, 2018: A third person is diagnosed with monkeypox. The individual worked at Blackpool Victoria Hospital and treated the second Monkeypox case. They received treatment at the Royal Victoria Infirmary in Newcastle.

DECEMBER 3, 2019: A patient was diagnosed with monkeypox in England, marking the fourth ever case.

MAY 25, 2021: Two cases of monkeypox were identified in north Wales. Both patients had travel links to Nigeria.

A third person living with one of the cases was diagnosed and admitted to hospital, bringing the total number ever to seven.

MAY 7, 2022: A person was diagnosed with Monkeypox in England after recently travelling to Nigeria. The person received care at the expert infectious disease unit at Guy’s and St Thomas’ NHS Foundation Trust in London. Experts have suggested the virus was spreading in the UK for months before this case was spotted.

MAY 14, 2022: Two more cases were confirmed in London. The infected pair lived in the same household but had not been in contact with the case announced one week earlier.

One of these individuals received care at the expert infectious disease unit at St Mary’s Hospital in London. The other isolated at home and did not need hospital treatment.

MAY 16, 2022: Four more cases were announced, bringing the UK total to seven. Three of these cases are in London, while one of their contacts is infected in the north east of England.

The UKHSA first confirms that the spate of cases, described as ‘unusual’ and ‘surprising’, are mainly among gay and bisexual men and advises them to look out for new rashes.

MAY 19, 2022: Two more cases were revealed, with no travel links or connections to other cases. The cases were based in the South East and London. Fears began to grow that infections are going undetected.

MAY 20, 2022: Eleven more cases are announced, meaning Britain’s monkeypox outbreak have doubled to 20. Minsters discuss the possibility of a public health campaign to warn gay men the disease may be more prevalent for them

MAY 23-26, 2022: Scotland, Wales and Northern Ireland log their first ever monkeypox cases.

MAY 29, 2022: World Health Organization (WHO) says risk of monkeypox is ‘moderate’, citing concerns about virus infecting children and immunosuppressed people if it becomes more widespread.

JUNE 7, 2022: The UKHSA declares monkeypox a notifiable disease. It means all medics must alert local health authorities to suspected cases. The tropical virus now carries the same legal status as the plague, rabies and measles.

‘Currently the majority of cases have been in men who are gay, bisexual or have sex with men. However, anyone who has had close contact with an individual with symptoms is also at increased risk.

‘If you are concerned that you may have monkeypox, don’t go to events, meet with friends or have sexual contact. Instead, stay at home and contact 111 or your local sexual health service for advice.’

Dozens of countries have logged cases of monkeypox, which is usually only spotted in Africa and has until now fizzled out after a handful of cases in other parts of the world.

Almost all infections so far have been spotted in men who have sex with men abroad, as well.

Professor Adam Kleczkowski, a mathematician at the University of Strathclyde, warned Britain’s infections could keep rising until the end of year — when a peak of 60,000 people could be catching the virus every day.

‘Unless a combination of contact tracing and ring vaccination stops the spread, the monkeypox will continue spreading,’ Professor Kleczkowski said.

To calculate how the monkeypox outbreak could continue to spread in the UK, Professor Kleczkowski estimated that each infected person would go on to infect two more people — known as the R rate.

He said 53 per cent of a population would need to be infected for enough people to have immunity to stop the virus spreading — known as herd immunity.

And the incubation period — the length of time from catching the virus to when symptoms start — was five to 21 days.

Based on these parameters, he modelled how the outbreak would unfold if all males aged 50 and under are susceptible to the virus.

This equates to 40 per cent of the UK’s population — around 26.8million people — and is classified as a ‘large population at risk’.

He said the parameters are based on the over-50s likely having some immunity from smallpox vaccinations, which the UK stopped rolling out in 1971, and the spread so far mainly occurring among men.

Anyone can catch the virus, which is spread by close contact with an infected person.

But most cases in the ongoing surge are among the ‘sexual networks’ of men who have sex with men. Monkeypox is not normally a sexually-transmitted infection. But sex is thought to be the main mode of transmission in the ongoing outbreak.

The virus, first discovered in lab monkeys in the 1950s, can also be spread through touching clothing, bedding or towels used by someone who is infected.

Under the ‘very pessimistic scenario’, infections peak at 60,000, the total number of people infected nears 20million and the epidemic lasts for more than one year.

‘The virus will continue spreading, effectively searching for pockets of high-risk and non-immune communities,’ Professor Kleczkowski said.

However, he noted that he does not have a ‘working model’ of the outbreak but aimed to produce ‘believable scenarios of what could happen in the near future’. The calculations are based on modelling up to June 17 and are ‘likely to change’ as new data emerges, he said.

And since his modelling on June 17, the UK Health Security Agency (UKHSA) confirmed some gay and bisexual men will be offered the smallpox Imvanex vaccine — which is 85 per cent effective against monkeypox — to control the outbreak.

Under the plans, which come from the same experts who advised on the Covid vaccine rollout, medics will offer the jab to men who have multiple partners, participates in group sex or attends ‘sex on premises’ venues.

Until the move was announced last week, the jab was only offered to confirmed cases and their close contacts under a strategy called ring vaccination, which has been proven to work in other outbreaks.

Dr Mary Ramsay, head of immunisation at UKHSA, said: ‘By expanding the vaccine offer to those at higher risk, we hope to break chains of transmission and help contain the outbreak.’

Under separate modelling, Professor Kleczkowski said that due to monkeypox’s low transmissibility and long incubation period — which allows it to survive at low levels in the population — it is possible that the virus has already been spreading in the UK ‘for a long time’.

Following the current spike in infections, the disease may ‘settle on a long-term, relatively constant level’ similar to how smallpox spread before vaccines were rolled out.

Under this model, ‘mass vaccination programmes might be needed to eradicate the disease’, he said.

A third model from Professor Kleczkowski sets out that the current outbreak could be ‘the first instance of a series of outbreaks’ fuelled by zoonotic transmission — when the disease jumps from an animal to a human — and cause sporadic surges of infection in the future.

‘As the cross-immunity from smallpox vaccines wanes, the epidemics can become even more substantial,’ he said.

While little is known about monkeypox’s potential to mutate, there is room for it to ‘evolve into a more rapidly spreading variant’, Professor Kleczkowski said.

However, in a fouth model — his least severe set of calculations — the outbreak ‘ends quickly’ once the population at risk becomes immune and herd immunity is reached locally.

Officials are urging gay and bisexual men to be aware of new lesions, rashes or scabs and get in contact with a sexual health clinic

The infection often starts with small bumps that scab over and are contagious

It comes as US health chiefs yesterday announced that monkeypox has mutated between six to 12 times the generally believed rate for the virus.

A team from the NIH studied 15 samples of the virus from the current outbreak. They restructured the viruses genetic information to find the number of changes the virus had undergone since this strain began its circulation.

The researchers could not determine why the virus is changing faster than expected. But they believe that the finding could be playing a role in how the virus has managed to storm the world this year, which has seen 201 cases in the US.

Meanwhile, the UKHSA last week set out a strategy for some gay and bisexual men at ‘higher risk’ of exposure to monkeypox to be offered a vaccine to control the outbreak. Officials have not put a number on how many men will be included in the rollout.

Under the plans, endorsed by the Joint Committee on Vaccination and Immunisation (JCVI), those eligible for  pre-exposure prophylaxis (PrEP) — a pill that protects against HIV — will also be eligible for the vaccine.

This includes people who do not always use condoms during sex and are likely to continue not using them, as well as sex workers or their clients who report having unprotected sex.

NHS England is due to set out details on how eligible people can get vaccinated. People are advised not to come forward for the vaccine until contacted.

As well as gay and bisexual men, the list of NHS staff eligible for the jab is also being expanded.

Healthcare workers caring for monkeypox patients in specialist high consequence infectious disease (HICD) wards are already offered the jab. But now staff in other hospitals designed to care for monkeypox patients will also be offered the jab, as well as workers in laboratories that test for the virus.

The UKHSA is urging all Britons to be alert to any new spots, ulcers or blisters on any part of their body, particularly if they have had close contact with a new partner. Those with symptoms are told to avoid close contact with others and call NHS 111 or your local sexual health centre.

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