Health

Monkeypox Q&A: how do you catch it and what are the risks? An expert explains

Published

3 years ago

May 24, 2022

THE LATEST outbreak of monkeypox has, at the time of writing, reached 17 countries with 110 confirmed cases and a further 205 suspected cases. It’s a fast-moving story, so if you need to catch up on the latest, here are answers to some of the most pressing questions.

How is monkeypox spreading?

The first patient in the current outbreak had returned to the UK from travels to Nigeria where monkeypox is endemic. However, cases are now spreading among people who have not travelled to west or central Africa, suggesting local transmission is occurring.

Monkeypox usually spreads by close contact and respiratory droplets. However, sexual transmission (via semen and/or vaginal fluid) has been posited as an additional possible route. The World Health Organization (WHO) says: “Studies are needed to better understand this risk.”

Most cases in the current outbreak have been in youngish men, but the virus can spread to anyone.

There are no confirmed cases in Pembrokeshire at the present time.

What are the symptoms?

Early symptoms are flu-like, such as a fever, headaches, aching muscles and swollen lymph nodes.

Once the fever breaks, a rash can develop, often beginning on the face and then spreading to other parts of the body – most commonly the palms of the hands and soles of the feet.

Monkeypox lesions. — Evolution of monkeypox lesions. UK government/Wikimedia

How deadly is monkeypox?

Monkeypox is mostly a mild, self-limiting disease lasting two-to-three weeks. However, in some cases, it can cause death. According to the WHO, the fatality rate “in recent times” has been around 3% to 6%. The west African monkeypox virus is considered to be milder than the central African one.

Monkeypox tends to cause more serious disease in people who are immunocompromised – such as those undergoing chemotherapy – and children. There have been no deaths from monkeypox in the current worldwide outbreak, but, according to the Daily Telegraph, one child in the UK is in intensive care with the disease.

Why is it called monkeypox?

Monkeypox was first identified in laboratory monkeys (macaques) in Denmark in 1958, hence the name. However, monkeys don’t seem to be the natural hosts of the virus. It is more commonly found in rats, mice and squirrels. The first case in humans was seen in the 1970s in the Democratic Republic of the Congo.

Is monkeypox related to smallpox and chickenpox?

Monkeypox is related to smallpox – they are both orthopoxviruses – but it is not related to chickenpox. Despite the name, chickenpox is a herpes virus, not a poxvirus. (How “chicken” got in the name is not entirely clear. In his dictionary of 1755, Samuel Johnson surmised that it is so named because it is “of no very great danger”.) Nevertheless, the vesicles (little pus-filled blisters) caused by monkeypox are similar in appearance to those of chickenpox.

Are cases likely to continue rising?

Cases are likely to continue to rise significantly over the next two-to-three weeks, but this is not another pandemic in the making. Monkeypox doesn’t spread anywhere near as easily as the airborne virus SARS-CoV-2 that causes COVID-19.

Has monkeypox evolved to be more virulent?

RNA viruses, such as SARS-CoV-2, don’t have the ability to check their genetic code for mistakes each time they replicate, so they tend to evolve faster. Monkeypox is a DNA virus, which does have the ability to check itself for genetic mistakes each time it replicates, so it tends to mutate a lot slower.

The first genome sequence of the current outbreak (from a patient in Portugal) suggests that the virus is very similar to the monkeypox strain that was circulating in 2018 and 2019 in the UK, Singapore and Israel. So it is unlikely that the current outbreak is the result of a mutated virus that is better at spreading.

How is monkeypox diagnosed?

In the UK, swab samples taken from the patient are sent to a specialist laboratory that handles rare pathogens, where a PCR test is run to confirm monkeypox. The UK Health Security Agency has only one rare and imported pathogens laboratory.

Is there a vaccine for it?

Vaccines for smallpox, which contain the lab-made vaccinia virus, can protect against monkeypox. However, the vaccine that was used to eradicate smallpox can have severe side-effects, killing around one in a million people vaccinated.

The only vaccine specifically approved for monkeypox, Imvanex, is made by a company called Bavarian Nordic. It uses a nonreplicating form of vaccinia, which causes fewer side-effects. It was approved by the US Food and Drug Administration and the European Medicines Agency in 2019 – but only for use in people 18 years of age or older.

UK health secretary Sajid Javid said that the UK government will be stocking up on vaccines that are effective against monkeypox. The UK currently has about 5,000 doses of smallpox vaccine, which has an efficacy of around 85% against monkeypox.

Are there drugs to treat it?

There are no specific drugs to treat monkeypox. However, antivirals such as cidofovir and brincidofovir have been proven to be effective against poxviruses in animals and may also be effective against monkeypox infections in humans.

By Ed Feil, Professor of Microbial Evolution at The Milner Centre for Evolution, University of Bath

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health

Pressures remain high despite the end of ambulance ‘critical incident’

Published

4 days ago

January 1, 2025

Tom Sinclair

AMBULANCE service pressures remain high despite the end of a 48-hour critical incident declared by the Welsh Ambulance Service.

The incident, triggered by overwhelming demand and a backlog of 340 emergency calls on Monday, was formally stood down after significant strain on resources.

Judith Bryce, assistant director of operations, said: “While the critical incident is behind us, significant pressures remain, and it’s really important that the public play their part to protect our precious resources for those who need them most.”

Ambulance chiefs have urged the public to use the service responsibly, advising people to only dial 999 in life-threatening emergencies and consider alternatives such as NHS 111 Wales symptom checkers, pharmacists, minor injuries units, or GPs.

“For anyone under the weather after New Year’s Eve celebrations, consider what you can do at home to self-care, including for common ailments like coughs, sore throats, and diarrhoea,” Ms Bryce added.

She also warned the public to take extra care while yellow weather warnings for heavy rain and high winds remain in place, highlighting the risk of accidents on the road and injuries from slips, trips, and falls.

The pressures extended beyond the ambulance service, with health boards including Cwm Taf Morgannwg, Hywel Dda, Aneurin Bevan, and Cardiff and Vale reporting increased demand. These boards introduced mask-wearing measures last week due to rising flu cases.

Jason Killens, chief executive of the ambulance service, described the critical situation as “very rare” and stressed the importance of using emergency services wisely.

This is not the first time a critical incident has been declared during winter pressures. In December 2020, south Wales experienced a similar crisis, while an extraordinary incident was declared in 2023 after an ambulance waited over 28 hours outside a hospital.

The Welsh government acknowledged the ongoing pressures on urgent and emergency care services and urged the public to carefully consider their options before seeking care.

Health

Critical incident declared by Welsh Ambulance Service due to demand

Published

5 days ago

December 31, 2024

Tom Sinclair

A “CRITICAL INCIDENT” was declared by the Welsh Ambulance Service on Monday (Dec 30) evening due to significantly increased demand and extensive handover delays.

The service, which covers more than three million people across Wales, reported over 340 calls waiting to be answered at the time the incident was declared.

More than half of the ambulance vehicles were stuck outside hospitals waiting to hand over patients, resulting in some people waiting “many hours” for an ambulance and delays in answering emergency calls.

***Ambulances outside Withybush Hospital in Haverfordwest (Image: Herald)***

Welsh Conservative Shadow Cabinet Secretary for Health and Social Care, James Evans MS, said: “Another critical incident declared by the Welsh Ambulance Service with over 340 calls waiting, ambulances stuck outside hospitals, and patients waiting hours for care.

“This is not just a winter crisis, it is a symptom of long-term failures in Labour-run Wales. Patients and frontline workers deserve better.

“It’s time for real leadership to fix this problem once and for all.”

The public has been urged to call 999 only in the event of serious emergencies.

The Welsh Ambulance Services University NHS Trust said it had implemented additional measures to ensure services could continue.

Stephen Sheldon, Head of Service, said: “It is very rare that we declare a critical incident, but with significant demand on our service and more than 90 ambulances waiting to hand over patients outside of hospital, our ability to help patients has been impacted.

“Regrettably, this means that some patients will wait longer for an ambulance to arrive and for their calls to be answered.

“For that, we are very sorry because this is not the level of service we want to provide.

“We understand that this is frustrating for patients, but can assure them that we are doing everything we can to relieve the pressure on our service.”

A critical incident is the highest alert level used by the NHS, allowing management to take immediate steps to create capacity.

Sheldon added: “The public can help by only calling 999 in the event of a life-threatening emergency – that’s a cardiac arrest, chest pain, breathing difficulties, loss of consciousness, choking, or catastrophic bleeding.

“If it’s not a life-threatening emergency, then it’s important you use one of the many alternatives to 999, starting with the symptom checkers on our NHS 111 Wales website, as well as your GP, pharmacist, and minor injuries unit.”

Earlier on Monday, Walsall Healthcare NHS Trust, which operates Walsall Manor Hospital, also declared a critical incident due to rising numbers of people needing urgent and emergency hospital care, predominantly for respiratory conditions.

Health

Hospital visiting precautions in place ‘to protect patients’

Published

5 days ago

December 30, 2024

Tom Sinclair

VISITORS to hospitals across Carmarthenshire, Ceredigion, and Pembrokeshire are being asked to only attend if they are free of any potential flu-like symptoms, or any sickness or diarrhoea. Additionally, they may be requested to wear face masks before entry to certain wards or departments.

Seasonal flu and winter vomiting viruses are affecting patients on several wards with infection prevention and control actions being taken, as necessary.

Visitors are asked to only come to see their loved ones if they are free of any infections, to wash hands before leaving home and clean hands on arrival at the hospital/ward using the hand sanitiser. Visitors may also be asked to wear face masks/coverings on the ward/department they are visiting. Masks will be available at the hospital entrance or can be provided on affected wards.

There are additional restrictions in place that limit visitors to:

Acute Medical Assessment Unit (AMAU) at Prince Philip Hospital, Llanelli. Please discuss individual patient visiting arrangements at AMAU with the nurse in charge.
This arrangement will be reviewed daily, and restrictions will be lifted as soon as possible. The health board’s website will be updated daily with details of wards with enhanced restrictions on visiting.

Janice Cole Williams, Assistant Director of Nursing at Hywel Dda University Health Board
said: “Within affected wards, all staff are wearing masks and visiting is limited at Prince Philip Hospital’s AMAU to help stop spread of infection.

“Our local community can help us avoid outbreaks of infection by not visiting family and friends in hospital if they are feeling unwell themselves.

“Annual flu vaccination is also undoubtedly the best way to protect against catching or spreading flu. Not only can it prevent you from becoming very unwell, it can also help reduce your risk of secondary infections such as pneumonia, which can be dangerous if you are clinically vulnerable.”

Vaccination centres are open, with no appointment needed today (Monday), until 5.30pm and tomorrow, Tuesday, December 31 for all people eligible for flu and COVID-19 vaccinations. This includes children aged two years (on 31 August 2024) to those in year 11 who can access the nasal flu vaccine at the centres.

Drop in any time between 9.15am and 5.30pm to your nearest vaccination centre:

Aberaeron (Aberaeron Integrated Care Centre, Vicarage Hill, Aberaeron, SA46 0DY)
Llanelli (Unit 2a, Dafen Industrial Estate, Heol Cropin, SA14 8QW)
Neyland (Unit 1 Honeyborough Retail Park, SA73 1SE)
The following groups are eligible for vaccination:

Flu vaccination

Children aged two and three years on 31 August 2024 
Children in primary school from reception class to year 6 (inclusive)  
Children in secondary school from year 7 to year 11 (inclusive)   
People aged six months to 64 years in clinical risk groups   
People aged 65 years and older (age on 31 March 2024)   
Pregnant women  
Carers aged 16 and over 
People aged six months to 65 years who live with someone who has a weakened immune system   
People with a learning disability  
Frontline health and social care workers  
All staff working in care homes with regular client contact
Poultry workers at high risk
COVID-19 vaccination

People aged six months to 64 years with a long-term health condition (which includes pregnant women and people with a weakened immune system)
Residents in a care home for older adults
People aged 65 years and older (age on 31 March 2025)
Unpaid carers
Frontline health and social care workers
Staff working in care homes for older adults
If you have any questions about accessing the flu and/or COVID-19 vaccine, please phone the health board on 0300 303 8322 option 1 or email: [email protected]