Recently, the Health and Safety Executive (HSE) in the United Kingdom reported a public health event of concern: the number of cases of infection with a new strain of monkeypox virus in the United Kingdom has increased to four, marking the first time that clusters of monkeypox infections have occurred outside of Africa. This discovery poses a challenge to public health safety not only in the UK but globally.
The UK’s Health and Safety Executive discovered the first person infected with the new strain of monkeypox virus, ‘Branch Ib’, in London on October 30, 2024, after the patient had traveled to an African country where a monkeypox outbreak had occurred. Subsequently, there were two cases of infection in household contacts of this infected person, and on November 6, another household contact was diagnosed, bringing the total number of monkeypox cases in the UK to four.
Risk of Transmission of Monkeypox Virus
Monkeypox is a rare viral disease caused by the orthopox virus, which is related to smallpox. It was first identified in 1958 and spreads mainly in wildlife in parts of West or Central Africa. Typical symptoms of monkeypox include fever, headache, muscle pain, swollen lymph nodes, chills and fatigue, which then develops into a chickenpox-like rash.
Susan Hopkins, chief medical advisor to the UK’s Health and Safety Executive, said that the monkeypox virus is extremely easy to transmit during close contact, so the risk of monkeypox transmission within the UK remains low. However, the emergence of this new strain and the first appearance of clustered infections hints at the possible transmission potential of monkeypox virus.
Monkeypox is spread from person to person mainly through close contact with people with monkeypox, including family members. Close contact includes skin-to-skin (e.g., touching, or sexual intercourse) and mouth-to-mouth or mouth-to-skin contact (e.g., kissing), which can also include being face-to-face with a person with monkeypox (e.g., talking or breathing in close proximity to each other, which may produce infectious respiratory particles).
Branch Ib” is a mutation of the ‘Branch I’ strain of monkeypox, which appeared in the Democratic Republic of Congo last year and spread rapidly, making it more transmissible than the ‘Branch II’ strain, which will be endemic in 2022. Currently, the monkeypox epidemic has spread to Burundi, Kenya, Rwanda and Uganda. Imported cases of monkeypox have been detected in countries outside Africa, such as Germany, Sweden, India and Thailand.
Impact of Monkeypox Virus
Global Public Health Emergency: The spread of the monkeypox virus has caused great concern to the World Health Organization (WHO), which declared the monkeypox outbreak to be a “public health emergency of international concern” in July 2022, the second time since July 2022 that it had issued the highest level of warning about a monkeypox outbreak. This is the second time since July 2022 that WHO has issued the highest level of warning about a monkeypox epidemic. This is the second time since July 2022 that WHO has issued the highest level of warning for a monkeypox outbreak, indicating that the spread and impact of the monkeypox virus has reached the level of a global public health emergency.
Surge in cases and geographic spread: Between 2022 and July 31, 2024, 103,048 cases of monkeypox have been reported globally in 121 countries, including 229 deaths. This surge in cases and geographic spread demonstrates the ability of monkeypox virus to spread, posing new challenges to global health systems.
Demand for vaccines and treatment resources has increased: A total of three monkeypox vaccines have been approved globally, including OrthopoxVac, MVA-BN, and LC16m8, all of which were originally developed for smallpox prevention. As the monkeypox epidemic has grown, the need for these vaccines has increased, as well as the need to develop new treatments.
Public health policies and prevention and control measures: Countries need to strengthen public health policies and prevention and control measures, including surveillance, quarantine, vaccination, and health education. In addition, international cooperation and coordination are essential to control the global spread of monkeypox outbreaks.
Stigmatization and discrimination issues: Monkeypox epidemics also raise issues of stigmatization and discrimination, particularly against groups initially most affected by the disease, such as men who have sex with men, transgender people, and gender-diverse communities. Global health systems need to take steps to ensure equitable and non-discriminatory healthcare for all patients.
Self-Prevention
Avoid sexual intercourse with persons of unknown health status: One of the main routes of transmission of monkeypox is through sexual contact among men who have sex with men. Therefore, avoiding sexual intercourse with persons of unknown health status is an important preventive measure.
Pay attention to the monkeypox epidemic information in the destination country and region: Outbound travelers should pay attention to the monkeypox epidemic information in the destination country and region, and avoid contact with rodents, primates and other animals that may carry monkeypox virus.
Personal protection: If family members or friends are diagnosed with monkeypox, they should pay attention to personal protection, avoid close contact with the patient, and avoid contact with clothing, bedding, towels and other household items used by the patient. At the same time, you should wash your hands frequently, ventilate the room frequently, and avoid sharing the bathroom.
Vaccination: People who have been vaccinated against smallpox may have some protection against monkeypox. Vaccination is recommended for people at high risk of monkeypox, especially during outbreaks.
In the face of the increasing number of monkeypox cases, the Health and Safety Executive of the United Kingdom has taken a number of countermeasures, including isolation and treatment of cases, contact tracing and surveillance, as well as increasing public awareness and education on monkeypox. The World Health Organization has also distributed about 900 000 doses of vaccine to the nine African countries where monkeypox outbreaks have occurred in order to control the further spread of the outbreak.
The increase in the number of monkeypox cases in the United Kingdom and the first cluster of infections outside Africa remind us of the transmission potential of the monkeypox virus and the vulnerability of global public health security. This requires the international community to strengthen cooperation in responding to the monkeypox outbreak and protecting global public health security.
