Wednesday, December 04, 2019

UK PHE Confirms Imported Case Of Monkeypox

Geographic Range of Monkeypox - Credit WHO


In the fall of 2017, Nigeria saw their first confirmed Monkeypox outbreak in nearly 40 years, resulting in more than 200 confirmed and suspected cases. While the initial outbreak was reportedly quelled by early 2018, a small number of sporadic cases continue to be reported by Nigerian officials.

The most recent (Epi Week 40) update from the Nigerian CDC lists:
  • Nigeria continues to report sporadic cases of monkeypox after the index case was reported two years ago (September, 2017)
  • In the reporting month (September 2019), 15 new suspected monkeypox cases were reported from five States - Lagos (5), Rivers (2), Akwa Ibom (3), Zamfara (1), Delta (1), Imo (2) and the Federal Capital Teritory, FCT(1)
  • A total of 81 suspected cases have been reported so far in 2019 of which 39 confirmed cases were recorded in nine states (Bayelsa, Lagos, Delta, Rivers,Akwa ibom, Enugu, Anambra, Cross River, and Oyo) and one death
It is likely that Monkeypox remains under-reported in Nigeria, as we've seen a number of exported cases over the past couple of years. 
Fortunately, the West African Monkeypox virus is considered to be less virulent, and less easily transmitted, than its Central African counterpart (cite).

This morning, Public Health England (PHE) is reporting on a new imported case from Nigeria, and their public health response.  First the statement from the PHE, and then I'll return with more.
Monkeypox case confirmed in England

Public Health England (PHE) confirm an individual has been diagnosed with monkeypox in England.

Published 4 December 2019
From: Public Health England
Monkeypox is a rare viral infection that does not spread easily between people and the risk to the general public in England is very low. It is usually a self-limiting illness and most people recover within a few weeks. However, severe illness can occur in some individuals.

The patient is believed to have contracted the infection while visiting Nigeria.

The patient was staying in the south west England prior to transfer to the specialist high consequence infectious disease centre at Guy’s and St Thomas’ NHS Foundation Trust, London, where they are receiving appropriate care.

As a precautionary measure, PHE experts are working closely with NHS colleagues to implement rapid infection control procedures, including contacting people who might have been in close contact with the individual to provide information and health advice.

This includes contacting passengers who travelled in close proximity to the patient on the same flight to the UK. If passengers are not contacted, then there is no action they should take.

Dr Meera Chand, Consultant Microbiologist at Public Health England, said:

Monkeypox does not spread easily between people and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary.

PHE and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed to minimise the risk of transmission.

This is not the first time that the virus has been detected in the UK. PHE reported the first UK cases of monkeypox in September 2018.


Monkeypox is a rare disease caused by monkeypox virus and has been reported mainly in central and west African countries. Monkeypox, in most cases, is a mild condition which will resolve on its own and have no long-term effects on a person’s health. Most people recover within a few weeks.

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, 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.

In this year's  CDC: 8 Zoonotic Diseases Of Most Concern In The United States, Monkeypox ranks 29th; about halfway down their list.  Similarly, in 2018's WHO List Of Blueprint Priority Diseases - while Monkeypox did not make the final list (n=8) - it was mentioned as a disease to watch.
Routine vaccination against smallpox - which supposedly provides about 85% protection against Monkeypox - ended in the 1970s. Today more than half of the world's population is unvaccinated, and the level of protection remaining among those vaccinated 50+ years ago is highly suspect.
Last October in WHO: Monkeypox Update & Risk Assessment - Nigeria, we looked at advice from the World Health Organization, and some studies that raise concerns over the future path of the Monkeypox virus.

For a more detailed look at the Monkeypox virus in Africa, and a limited 2003 outbreak in the United States - you may wish to revisit this blog from May of 2018.
MMWR: Emergence of Monkeypox — West and Central Africa, 1970–2017
And finally, in response to the perceived threat, a little over 2 months ago the FDA Approved the 1st live, Non-replicating Vaccine to Prevent Smallpox & Monkeypox.