Mpox due to monkeypox virus clade Ib case reported in UK

Published:

On 30th October 2024, the UK Health Security Agency (UKHSA) confirmed that the first case of Clade 1b mpox has been diagnosed in the UK. The case had recently travelled to countries in Africa that are seeing community cases of Clade Ib mpox.

Sporadic imported cases of mpox may occur among travellers from endemic areas / countries (places where cases are regularly being reported in the community). On 22nd October 2024, the first case of mpox clade Ib was reported by Germany in a person who had travelled abroad. Since August, when the outbreak of mpox was declared as a public health emergency, with cases identified in the Democratic Republic of Congo and neighbouring countries, imported cases have been seen in Sweden, Thailand, India, Germany and the UK.   

HSE National Health Protection are monitoring the situation in Ireland, UK and internationally. The risk to the Irish public is very low.

The public are asked to follow Public Health advice, particularly if travelling to or from a country in Africa where mpox cases are occurring.

Mpox in 2024
On 14th August 2024, WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus, declared mpox a public health emergency of international concern. There has been a recent upsurge in the number of mpox cases identified in the Democratic Republic of the Congo and neighbouring countries.

There are two different types of the mpox virus – called clade I and clade II. Each clade of the virus has subclades, clade Ia and clade Ib and clade IIb. Outbreaks from the subclades can have different characteristics, like who they affect, how they're spread, or even how many deaths they cause.

The type of mpox that is causing concern in Africa is caused by clade I mpox, both clade Ia and Ib. To date clade Ib has a lower case-fatality rate (fewer cases have led to death) than clade Ia mpox.

This is different to clade IIb which caused the global outbreak in 2022-2023, mainly affecting gay, bisexual and other men who have sex with men.

Ireland
No cases of clade Ia or Ib mpox have ever been detected in Ireland.

Cases of clade IIb mpox in Ireland remain low, with 14 cases reported so far in 2024. There were 13 cases of mpox confirmed in Ireland in 2023 and 227 cases in 2022.

European situation
In October, the European Centre for Disease Prevention and Control (ECDC) and WHO published up to date information on mpox in their quarterly surveillance bulletin. One case of clade Ib mpox was reported in Sweden in August in a person who had travelled to a country in Africa where mpox is circulating and there was no spread to anyone else. On 22nd October 2024, a case of Mpox clade Ib has been reported by Germany in a person who had travelled abroad.  On 30th October 2024, an imported case was reported by the UK in a person who had travelled to countries in Africa with cases in the community.

ECDC states that more imported mpox cases due to clade I mpox are likely to occur in the EU/EEA. The overall risk for the EU/EEA general population is currently assessed as low, though the risk for people who have close contact with a confirmed or suspected case from affected areas in Africa is moderate.

Ireland continues to work with the ECDC and international partners and continues to prepare the healthcare system so that we can rapidly identify and manage any potential imported cases and prevent secondary transmission.

About mpox
Mpox is an uncommon disease in Ireland 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 limited outbreaks in local communities and travellers. Since December 2022, a large outbreak of mpox has been ongoing in the Democratic Republic of the Congo, and in recent months, cases have been seen in neighbouring countries, Rwanda, Burundi, Kenya and Uganda.

Mpox spreads through close contact, including contact with the skin rash of someone with mpox. People who closely interact with someone who is infectious are at greater risk for infection: this includes sexual partners, household members, and health & care workers.

For symptoms and signs of mpox and advice on what to do if you think you have mpox, please see https://www2.hse.ie/conditions/mpox/

Vaccination
In response to the mpox cases in Ireland in 2022, HSE delivered a vaccine programme to risk groups. Over 11,000 doses of vaccine were delivered, with more than 5,000 people fully vaccinated, which was among the best performing mpox vaccine programmes in Europe. Given the effectiveness of that campaign in controlling infection, the programme had been paused pending a decision on a different approach to vaccination.

With the emergence of a new clade of mpox in Africa, Clade Ib, and the declaration of a Public Health Emergency of International Concern (PHEIC) by the WHO, HSE is considering the need for a new vaccine programme now, in line with advice from the National Immunisation Advisory Committee (NIAC). Ireland has sufficient supplies of mpox vaccine through the EU HERA Joint Procurement Action to meet predicted potential needs over the next months. 

People who have received two doses of the mpox vaccine or have previously had mpox are considered protected from severe illness caused by mpox clade Ib. At this time, booster shots are not recommended.

Travel Advice
To protect yourself and others against mpox, know the signs and symptoms of mpox, how the virus spreads, what to do if you get sick, and the risk of mpox infection in the area that you are planning to travel to. Information on countries affected by mpox is available from the World Health Organization (WHO)

ECDC has assessed the risk for people travelling to or living in the countries affected by Clade I mpox.

  • For those who have close contact with affected communities in countries affected by mpox, such as healthcare workers, those who are living in households or those who have multiple sexual contacts, the risk is moderate. The risk is high for those who have a weak immune system.
  • For those who do not have close contact with the affected communities in countries affected by mpox, the risk is low.

Mpox needs close or intimate contact to spread, so casual (passing) contact like you might have during travel is not likely to cause infection. If the virus is spreading in the area that you are travelling to, have open conversations with those you come into close contact with about any symptoms they may have. Avoid close contact with anyone who has mpox, including sexual contact. Clean your hands frequently with soap and water or an alcohol-based hand rub.

People can protect themselves by:

  • Avoiding close contact (including sexual contact) with people who are sick with signs and symptoms of mpox, including those with a rash (blisters or scabs)
  • Avoiding contact with wild animals (alive or dead and including their meat and blood) in areas where mpox regularly occurs. Any food containing animal parts or meat should be cooked thoroughly before eating
  • Avoiding contact with contaminated materials used by people who are sick (such as clothing, bedding, towels etc.) or that had been in contact with wild animals
  • Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 70% alcohol.

If you think you might have mpox when you are abroad, seek medical advice as soon as possible, and isolate from others until you have been checked and tested. If you have mpox, you should isolate yourself from others until all your lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.

When you return from travel
As symptoms of mpox may take time to develop, in the 21 days after your return, if you have any symptoms suggestive of mpox, self-isolate and phone your doctor promptly, telling them about your recent travel, so that you can be assessed.