Number of reported cases continues to rise in multi-country monkeypox outbreak

Published:

Current situation:
In recent weeks more than two hundred confirmed cases of monkeypox have been reported worldwide including the UK (with one case recently reported in Northern Ireland), several European countries, North America, Israel, United Arab Emirates, and Australia. The vast majority of these cases do not have a travel link to a country where monkeypox is endemic. Many of the cases were diagnosed in sexual health clinics and self-identify as gay, bisexual or other men who have sex with men (gbMSM).

A multidisciplinary Incident Management Team has been established by the HSE to actively monitor this evolving international situation and prepare services in Ireland for the possibility of monkeypox cases arising in Ireland. To assist in Ireland’s response, monkeypox has been made a notifiable disease. This means that medical practitioners (and laboratories) are required to notify the local Medical Officer of Health/Director of Public Health of monkeypox cases in Ireland.

There are no known monkeypox cases in Ireland at present.

About monkeypox
Monkeypox is a rare disease that is caused by infection with monkeypox virus. The virus is found in some animal populations in remote parts of Central and West Africa, and in the past has caused occasional outbreaks among local people and travellers. The cases being reported across multiple countries now are unusual because most of the cases do not have a link to travel to these parts of Africa.

There are two types of monkeypox: West African monkeypox and Congo Basin monkeypox. It is the milder, West African, type that is causing the current outbreak.

Monkeypox spreads through close contact, including contact with the skin rash of someone with monkeypox. People who closely interact with someone who is infectious are at greater risk for infection: this includes household members, sexual partners and healthcare workers. The risk of spread within the community in general, is very low.

Symptoms of monkeypox
Symptoms of monkeypox virus infection include:

  • itchy rash (see below),
  • fever (>38.50C),
  • headache,
  • muscle aches,
  • backache,
  • swollen lymph nodes,
  • chills,
  • exhaustion.

The rash starts as raised red spots that quickly change into little blisters. It usually develops within 1 to 3 days of the start of the fever or other symptoms, but some people may only have a rash. Sometimes the rash first appears on the face and spreads to the mouth, palms of the hands and soles of the feet. However, following sexual contact, the rash may be found initially in the anogenital areas. In the recent cases seen internationally, systemic symptoms have not always been a feature, and rash in the anogenital area may be the main symptom.

The rash goes through different stages before finally forming scabs which later fall off.

Images of the different stages of the rash can be found on the HPSC website at the following link: www.hpsc.ie/a-z/zoonotic/monkeypox/factsheets

Treating Monkeypox:
Monkeypox infection is usually a self-limiting illness and most people recover within weeks, although severe illness can occur in people with very weak immune systems, pregnant women and in very small babies. Severe illness and death outside Africa are unlikely.

There is no medicine that can cure monkeypox. Treatment of monkeypox is mainly supportive. This involves treating any uncomfortable symptoms, such as pain or itch, that occur, keeping the patient warm, comfortable and relaxed, and making sure they get plenty of fluids. This allows the patient’s own body defences to fight the infection.

Gay, bisexual and men who have sex with men (gbMSM):
Many of the cases in this multi-country outbreak are in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM). Many of these cases were diagnosed at sexual health clinics. The reason we are currently hearing more reports of cases of monkeypox in gbMSM communities may be because of positive health seeking behaviour in this community and increased awareness since this outbreak was alerted to the public and to healthcare workers across the world. Monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, which may explain why these cases are being picked up at sexual health clinics.

As the virus spreads through close contact, the HSE is advising those who self-identify as gbMSM (especially if they have undertaken international travel in the past month), to be alert to any unusual rashes or vesicular lesions on any part of their (or their partner’s) body, especially their genitalia. If they do notice any such changes, they should contact their local STI Clinic or their General Practitioner (GP) for advice.

A list of public STI services is available on the HSE’s Sexual Wellbeing website https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.

Further information on monkeypox infection can be found on the HPSC website: https://www.hpsc.ie/a-z/zoonotic/monkeypox/

HPSC will continue to closely monitor this situation and provide relevant updates to the public as appropriate.