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Home Infectious diseases

Guidance
Monkeypox

The epidemiology, symptoms, diagnosis and

management of monkeypox virus infections.

From: UK Health Security Agency

Published 8 September 2018
Last updated 21 May 2022 — See all updates

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Contents
Related content
— Epidemiology
— Transmission Crimean-Congo haemorrhagic
fever: origins, reservoirs,
— Clinical features
transmission and guidelines
— Diagnosis
Imported fever service (IFS)
— Treatment
— Infection prevention and control Viral haemorrhagic fever: ACDP
algorithm and guidance on
— Guidance for primary care
management of patients
— Guidance for environmental cleaning and decontamination
Lassa fever: origins, reservoirs,
— Further information
transmission and guidelines

Rare and imported pathogens

laboratory (RIPL)
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Detailed guidance
Epidemiology
High consequence infectious
Monkeypox is a rare disease that is caused by infection with diseases (HCID)
monkeypox virus.

Monkeypox was first discovered in 1958 when outbreaks of a

pox-like disease occurred in monkeys kept for research. The
first human case was recorded in 1970 in the Democratic
Republic of the Congo (DRC), and since then the infection has
been reported in a number of central and western African
countries. Most cases are reported from the DRC and Nigeria.

In 2003, monkeypox was recorded in the US when an

outbreak occurred following importation of rodents from
Africa. Cases were reported in both humans and pet prairie
dogs. All the human infections followed contact with an
infected pet and all patients recovered. No other country
outside West and Central Africa has reported similar
outbreaks.

As of 16 May, a total of 14 monkeypox cases have been

reported in the UK since 2018, 7 of which have been reported
in May 2022.

2022
On 7 May 2022, a monkeypox case was identified in an
individual with recent travel history to Nigeria.

On 14 May, 2 further cases, with no known links to the case

announced on 7 May, were reported in individuals from the
same household.

On 16 May, 4 additional monkeypox cases were reported in

England. These cases have no known connections with the
cases reported on 7 and 14 May. Contact tracing and
investigations are ongoing to identify where and how the
cases reported on 14 and 16 May acquired their infection.

2021
In May and June 2021, 3 monkeypox cases were reported from
within the same family; the index case had recent travel
history to Nigeria.

2019
In December 2019, an individual in England was confirmed to
have monkeypox after recently travelling from Nigeria to the
UK.

2018
In September 2018, 2 cases of monkeypox were identified in
individuals who had recently travelled from Nigeria to the UK.
The cases were epidemiologically unconnected.

A third monkeypox case was reported in September 2018. The

case was a healthcare worker involved in the care of one of the
previous cases in 2018 and was infected following contact
with contaminated bed linen.

Travel related monkeypox cases have also been reported in

the US in 2021, Singapore in 2019, Israel in 2018 and Benin in
1978.

Transmission
Monkeypox does not spread easily between people.

Spread of monkeypox may occur when a person comes into

close contact with an infected animal (rodents are believed to
be the primary animal reservoir for transmission to humans),
human, or materials contaminated with the virus. Monkeypox
has not been detected in animals in the UK.

The virus enters the body through broken skin (even if not
visible), the respiratory tract, or the mucous membranes
(eyes, nose, or mouth).

Person-to-person spread is uncommon, but may occur

through:

contact with clothing or linens (such as bedding or towels)

used by an infected person
direct contact with monkeypox skin lesions or scabs
coughing or sneezing of an individual with a monkeypox
rash

Clinical features
The incubation period is the duration/time between contact
with the infected person and the time that the first symptoms
appear. The incubation period for monkeypox is between 5
and 21 days.

Monkeypox infection is usually a self-limiting illness and most

people recover within several weeks. However, severe illness
can occur in some individuals.

The illness begins with:

fever
headache
muscle aches
backache
swollen lymph nodes
chills
exhaustion

Within 1 to 5 days after the appearance of fever, a rash

develops, 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.

An individual is contagious until all the scabs have fallen off

and there is intact skin underneath. The scabs may also
contain infectious virus material.

Images of individual monkeypox lesions

Notes
Areas of erythema and/or skin hyperpigmentation are often
seen around discrete lesions.

Lesions can vary in size and may be larger than those shown.

Lesions of different appearances and stages may be seen at

the same point in time.

Detached scabs may be considerably smaller than the original

lesion.

Diagnosis
Clinical diagnosis of monkeypox can be difficult, and it is often
confused with other infections such as chickenpox. A definite
diagnosis of monkeypox requires assessment by a health
professional and specific testing in a specialist laboratory.

In the UK, the Rare and Imported Pathogens Laboratory

(RIPL) at the UK Health Security Agency (UKHSA) Porton
Down is the designated diagnostic laboratory.

Suspected cases should be discussed with the Imported

Fever Service prior to submitting samples for laboratory
testing.

Treatment
Treatment for monkeypox is mainly supportive. The illness is
usually mild and most of those infected will recover within a
few weeks without treatment.

Smallpox vaccine, cidofovir, and tecovirimat can be used to

control outbreaks of monkeypox.

Vaccination against smallpox can be used for both pre and

post exposure and is up to 85% effective in preventing
monkeypox. People vaccinated against smallpox in childhood
may experience a milder disease.

Infection prevention and control

Prevention of transmission of infection by respiratory and
contact routes is required. Appropriate respiratory isolation is
essential for suspected and confirmed cases. Scabs are also
infectious and care must be taken to avoid infection through
handling bedding, clothing, and so on.

Monkeypox virus is classified as an ACDP Hazard Group 3

pathogen. However, some routine laboratory testing (such as
for biochemistry, haematology, microbiology) can be done
with additional precautions in standard clinical laboratories.

Clinical laboratories should be informed in advance of

samples submitted from suspected or confirmed diagnosis of
monkeypox, so that they can take the appropriate precautions
to minimise risk to laboratory workers so that they can safely
perform laboratory tests that are essential to clinical care.

Guidance for primary care

Monkeypox: guidance for primary care (PDF, 197 KB, 5 pages)

Guidance for environmental cleaning and

decontamination
Monkeypox: Guidance for environmental cleaning and
decontamination (PDF, 91.2 KB, 6 pages)

Further information
See WHO factsheet.

Additional monkeypox resources are also available on

GOV.UK, including information on case definitions, contact
tracing and vaccination.

Published 8 September 2018

Last updated 21 May 2022 + show all updates

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