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Monkeypox’s threat to the world has been upgraded to ‘moderate’ by global health chiefs, as the tropical virus spreads to dozens of countries.
The World Health Organization (WHO) said the explosion of cases has become more worrying because it is the first time clusters have been reported simultaneously in different places and without any known links to Africa, where the virus is endemic.
So far the outbreak, which was first detected in early May, has spread to 24 countries and been diagnosed in 106 Britons, the majority of whom are men who have sex with men. The WHO said the figures are ‘likely to be an underestimate’.
There are growing concerns the virus will spill into wild animals and never be eradicated. That would also raise the risk of monkeypox mutating.
The WHO said public health risk from the virus ‘could become high’ if it spreads to more vulnerable groups who are at higher risk of becoming very unwell, including young children and immunosuppressed people.
The ‘sudden appearance’ and ‘wide geographic scope’ of cases suggests widespread human transmission of the virus — which spreads through skin-to-skin contact and an infected persons’ droplets — is underway, the WHO said.
WHO chiefs also warned the surge in monkeypox infections suggests the virus ‘may have been circulating unrecognised for several weeks or longer’.
UK health chiefs have warned that music festivals could be monkeypox super-spread events this summer, including at the two-day Mighty Hoopla event in London because it will ‘attract a lot of queer people’.
It comes as the UK Government’s scientific advisers warned that pet hamsters, rabbits and other rodents owned by infected patients should be isolated for three weeks.
The Human Animal Infections and Risk Surveillance (HAIRS) group said these animals were at the highest risk of catching the virus, and they could spread it into wild populations.
Experts fear that if the virus is unleashed into wild animal populations then it will become endemic and be hard to eradicate, as is the case in parts of western and central Africa.
In a risk assessment published yesterday, the WHO warned that its ‘moderate’ grading could be pushed to ‘high’ if the virus ‘exploits the opportunity to establish itself as a human pathogen’ and spreads to vulnerable groups.
Reported cases have so far been mild but there is a risk the virus has a ‘greater health impact’ if it spreads to at-risk people, including children and immunocompromised people, such as some HIV patients, who ‘may be especially at risk of more severe disease’.
The WHO warned there is a ‘high risk’ of further spread of the virus though skin-to-skin contact between families and sexual partners, as well as due to contact with contaminated materials, such as utensils, bedding and clothing.
‘However, at present, the risk for the general public appears to be low,’ the agency said.
It cautioned that a ‘large part’ of the population is vulnerable to monkeypox due to the discontinuation of the smallpox vaccination scheme.
In the UK, youngsters were routinely offered this jab until four decades ago, around the point at which the virus was eradicated. Because smallpox and monkeypox are so similar, those who received the jab, who are now at least in their forties, are thought to have some immunity against the circulating strain.
There is a ‘potential risk’ to health workers who treat someone infected with the virus if they are not wearing personal protective equipment (PPE) to prevent transmission.
No monkeypox cases have been logged among medics in the current outbreak, the WHO said. But an NHS worker became infected in 2018 after treating someone infected with the virus.
In its report, the WHO also warned that people who have recently had multiple sexual partners — either where they live or abroad — ‘may be at risk’ of having monkeypox.
It said health chiefs should reach out to at risk communities, which ‘at the present time’ includes men who have sex with men and their close contacts.
The WHO said it ‘would be prudent’ for people to limit the number of sexual partners they have during the early stage of this outbreak.
It comes as Dr Will Nutland, from the London School of Hygiene and Tropical Medicine, warned that festivals could fuel the spread of the virus.
The current outbreak, first detected in a traveller from Nigeria to the UK on May 6, has been linked to several super-spreader events, including a gay pride festival in Gran Canaria, a fetish festival in Belgium and a ‘sauna’ in Spain.
Dr Nutland hosted a webinar for the LGBTQ+ community about the risks of monkeypox, as part of his roles as co-founder of Prepster, a volunteer group of HIV prevention activists in London.
The doctor warned that it could spread at the Mighty Hoopla in Brockwell Park, south London, on Friday and Saturday.
He told the Sunday Telegraph that the pop festival is ‘going to attract a lot of queer people’.
A spokesperson for the Mighty Hoopla said that they ‘remain committed to working in line with government health guidance regarding public safety at events’.
Earlier this month, Dr Hans Kluge, regional director for Europe at the World Health Organisation, said he is concerned about ‘mass gatherings, festivals and parties’, which could accelerate transmissions.
He said that the cases being identified are ‘among those engaging in sexual activity’, and creates unfamiliar symptoms.
Mateo Prochazka, epidemiologist from the UKHSA, said that it is important people do not assume monkeypox is only a threat to the LGBTQ+ community
He told the BBC that it can spread to anyone through close contact — including contact with items used by someone infected, such as cutlery or their clothes.
So far 24 countries have confirmed monkeypox cases, with Spain, the UK and Portugal logging the most infections.
Sylvie Briand, head of epidemic and pandemic preparedness and prevention at the WHO, last week warned the reported infections may be just the ‘peak of the iceberg’ and ‘many more cases’ could be going undetected.
In its report, the WHO said it is ‘highly likely’ that even more countries will identify infections.
But is said nations should not adopt any travel-related restrictions, like those brought in during the Covid pandemic, ‘based on available information at this time’.
The WHO called for all countries, health authorities and medics to ‘respond quickly to stop the multi-country outbreak of monkeypox’.
It said: ‘Rapid action must be taken before the virus can be allowed to establish itself as a human pathogen with efficient person-to-person transmission in both endemic and non-endemic contexts.
‘Lessons learned from the eradication of smallpox and from the management of other emerging zoonotic diseases must be urgently considered in the light of these rapidly evolving events.’
Health chiefs have warned monkeypox, a virus endemic in parts of Africa and is known for its rare and unusual rashes, bumps and lesions, could also spread to some pets and become endemic in Europe. Undated handout file image issued by the UK Health Security Agency of the stages of Monkeypox
In the UK, 106 cases have been detected. More than 100 of the infections have been logged in England, while Scotland has spotted three and Northern Ireland and Wales have detected one each.
Britons, especially men who have sex with men, have been told to watch out for new spots, ulcers or blisters on any part of their body.
Anyone with these symptoms, especially if they have had a new sexual partner recently, has been asked to limit their contact with others and contact NHS 111 or their local sexual health service by phone.
Teams from the UK Health Security Agency are contacting high-risk contacts of confirmed cases and advising them to self-isolate at home for three weeks and avoid contact with children.
Both confirmed cases and close contacts are being offered the Imvanex vaccine to form a buffer of immune people around a confirmed case to limit the spread of the disease.
The strategy, known as ring vaccination, has been used in previous monkeypox outbreaks and is also being carried out in some EU countries.
Monkeypox, first discovered in lab monkeys in the late 1950s, is usually mild but can cause severe illness in some cases. It can kill up to 10 per cent of people it infects.
The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit.
Monkeypox has an incubation period of anywhere up to 21 days, meaning it can take three weeks for symptoms to appear.
Symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
A rash can develop, often beginning on the face, which then spreads to other parts of the body — including the genitals. The rash can look like chickenpox or syphilis, and scabs can form which then fall off.
In another step to control the monkeypox outbreak, a scientific group advising the UK Government last week called for the pet hamsters, rabbits and other rodents owned by infected patients to be isolated for three weeks.
The Human Animal Infections and Risk Surveillance (HAIRS) group said these animals were at the highest risk of catching the virus, and they could spread it into wild populations.
Experts fear that if the virus is unleashed into wild animal populations then it will become endemic and be hard to eradicate, as is the case in parts of western and central Africa.
In new guidance, the group said: ‘Based on current evidence, for pet rodents in households where there are infected people, temporary removal from the household for a limited quarantine period (21 days) and testing to exclude infection is recommended, particularly where there are infected human contacts who have had close direct and prolonged contact with the animal or its bedding and/or litter.’
The panel warned that hedgehogs, rats, mice, squirrels, rabbits and hares could all harbour the virus if monkeypox was to spill into Britain’s wildlife populations.
There were already fears before the report was released that the global outbreak of monkeypox may mean it can never be eradicated in the UK and Europe forever.
The concerns are centred around the virus leaking into animal populations, with rodents known harbourers of monkeypox.
The HAIRS group said that it was ‘unlikely’ that an infected pet could spread the disease to wild animals but added it ‘cannot be ruled out’.
It is recommending that rodent pets are removed from households where there are infected patients and put in ‘secure accommodation’, where they will be PCR tested and isolated for 21 days.
Dogs, cats and other pets will be allowed to stay in the home with their owner under HAIR’s recommendations but must undergo ‘regular vet checks’ after their isolation period to make sure they do not have the virus.
