What is monkeypox and what ’ s the background to this outbreak ? Monkeypox is caused by a virus belonging to the Orthopoxvirus genus of the virus family Poxviridae , which famously includes smallpox , and also cowpox and molluscum contagium , a common wart-like disease . ( Although sharing the ‘ pox ’ name , chickenpox is caused by a herpes virus .)

Monkeypox is associated with animals ( rodents and some vertebrates , such as monkeys ) as its main hosts ; the infection was first identified in 1958 in monkeys in Central and West Africa . Spread to humans has occurred since , and it is endemic in human populations in nine African countries . ¹ Until recently it has been rare outside Africa but the current global outbreak is affecting more than 100 countries , with most cases in Europe , the US and South America . ²

As of the end of August , there had been 3,413 confirmed or highly probable cases of monkeypox infection in the UK . Almost all have occurred in England , largely concentrated in the London area . ³

How serious is the infection ? There are two main strains ( or ‘ clades ’) of monkeypox . The more severe is from Central Africa ( Clade I ), with an

associated mortality of approximately 10 %; the milder of the two , the West African clade ( Clade II ), has a mortality of around 1 %.

A subclade of the milder virus , Clade IIb , is the main circulating variant in the current global outbreak . Most people who are infected recover within a few weeks without treatment . Nonetheless , the World Health Organization ( WHO ) has warned of an increased risk to vulnerable people , including those who are pregnant and children , and says there is a danger of the disease becoming established in non-endemic countries . ⁴

As such , public health bodies are working to isolate cases and prevent wider spread of the virus , which is now an identifiable disease in the UK . It is therefore vital for all healthcare professionals to be vigilant , implement appropriate infection prevention and control ( IPC ) measures , and help to ensure potential cases and contacts follow self-isolation advice .

How is the virus spread between people ? Monkeypox spreads primarily through direct contact with an infected person or animal ( live or dead ).

Person-to-person spread can occur if someone is in direct contact with an infected person ’ s skin lesions ( pox ) or their scabs , bedlinen or clothing . If someone

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