The outbreak of monkeypox in the United Kingdom is not yet under control, experts have warned, with some suggesting that vaccines may need to be offered to all men who have sex with men.
Monkeypox, which is to be renamed by the World Health Organization (WHO), is common in West and Central Africa, but an unprecedented outbreak in recent weeks has led to cases in many countries from France to Canada and Australia. The WHO is expected to meet next week to decide whether to identify the outbreak as a public health emergency of international importance.
As of June 12, 470 cases had been identified in the United Kingdom, including an increase of 104 cases reported in England last Monday. Experts warn that further action may be needed to curb the rise.
“There is currently no clear evidence that the current epidemic is under control,” said Paul Hunter, a professor of medicine at the University of East Anglia.
So far, cases have been found mainly among men who are gay or bisexual or otherwise have sex with men – although experts have expressed concerns about stigmatizing certain communities, stressing that anyone can get monkeypox and that it spreads among people through close contact.
Smallpox vaccine is also available, which also offers protection against smallpox, and current guidelines advise that injections should ideally be given to close contact cases within four days of exposure to smallpox to prevent or reduce the infection, although in some circumstances it may be given to individuals up to 14 days after exposure to reduce symptoms if an infection has occurred.
“I guess if we don’t see that this will be controlled very soon, then we are looking to offer vaccination to all men who have sex with men, and probably to prostitutes,” Hunter said.
Professor Jimmy Whitworth of the London School of Hygiene and Tropical Medicine also expressed concern. “These numbers of new cases suggest that we still do not control the monkeypox epidemic,” he said, although he warned that it was necessary to look at the trend in cases over a longer period, while it could take a week or two before of new cases decreased after the transmission was under control.
But Whitworth said it was clearly a very challenging epidemic to control. “There seems to have been some over-spreading events that have allowed infections to spread quickly in many different countries, and there are transmission chains that suggest that there may have been some cases without obvious signs of infection, which has allowed more further dissemination that has not led to has been revealed, “he said.
Hunter said there were probably many factors. “What worries me the most is that for a disease whose transmission can have a significant stigma for some, it is that people may not be completely honest about their contacts and if so, then public education and the approach to the vaccination strategy may not be enough, “he said, adding that another problem was how well the contacts adhered to the period of self-isolation.
“For someone who is not openly gay, isolating themselves for 21 days would be tantamount to going out,” Hunter said, noting that the situation is sensitive and complex, especially for bisexual men who have not dated their partners.
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According to the UK Health Security Agency (UKHSA), people who have been tested are usually informed of their results within 24 hours, with contacts identified and tracked as soon as possible and offered vaccination if necessary. .
However, the agency noted challenges with the outbreak, noting that “most cases report sexual contact with new or casual partners, sometimes in the context of cruise sites or during chemical sex, often when contact details were not available for traceability.” .
Dr Michael Head, Senior Global Health Research Fellow, University of Southampton, said the UK and international public health teams had done an excellent job, both in tracking contacts and reporting, and in accurate and sensitive public health communications.
Head said there was little signal in the UK data that the outbreak was slowing down – although this is not yet certain – while the lack of infections in the wider community indicates that the transmission relies on very close contact.
“This is less difficult to deal with than, say, the Covid-19 epidemic and encourages that the epidemic will end in the coming weeks or months,” he said.
Dr Hugh Adler of the Liverpool School of Tropical Medicine said he could have a positive view of the growing number of cases. “It simply came to our notice then [reflecting] that public health reports are coming out and people are presenting themselves for evaluation, “he said.
Adler said vaccination is not appropriate for all contact cases, especially if they have not had close or intimate contact. Instead, such individuals may 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 supply of the vaccine, as well as the side effects,” he said.
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