Experts fear monkeypox will now never be eliminated in Europe

Monkeypox may NEVER be eliminated because too many infections are going under radar and our PETS could continue to harbour virus, says SAGE adviser

  • Epidemiologist warned that new cases may slow down but risk is they will ‘not be eliminated in some places’
  • Dr Adam Kucharski said this means monkeypox may spread to animals and become well-established in UK
  • Experts are confident monkeypox won’t turn into a pandemic like Covid because it does not spread as easily
  • But EU health chiefs this week warned it could circulate in animal populations and trigger sporadic outbreaks

Monkeypox may now be endemic in the UK and Europe forever, leading experts have warned as the virus normally confined to areas of Africa continues to spread around the world.

Dr Adam Kucharski, from the London School of Hygiene and Tropical Medicine, said it was unlikely the current outbreak would spiral into a pandemic like Covid because it spreads through prolonged close contact.

But the epidemiologist, who is also a member of the UK’s Scientific Advisory Group for Emergencies (SAGE), warned the ‘biggest risk’ is that cases will ‘not be eliminated in some places’.

He said any persistent transmission increases the risk that the virus — closely related to smallpox — could be passed onto pets, meaning there will be permanent reservoirs of infection, as is the case in Africa.

EU health chiefs have already acknowledged this threat and are considering a cull for all hamsters, gerbils and guinea pigs owned by monkeypox patients.

In the UK, officials are also expected to release guidance telling infected Britons to keep their distance from family pets.

Monkeypox has now been identified in all four nations of the UK, as the number of confirmed domestic cases yesterday rose to 90. A disproportionate number are among gay and bisexual men.

Twenty countries across the world have now been affected by the current outbreak, with Finland today becoming the latest to confirm an infection. Argentina, Bolivia and Sudan are all probing suspected cases.

Until now, cases outside of western and central Africa were confined to a handful of people with travel links to the continent.

1958: Monkeypox was first discovered when an outbreak of a pox-like disease occurred in monkeys kept for research.

1970: The first human case was recorded in 1970 in the Democratic Republic of Congo and the infection has been reported in a number of central and western African countries since then.

2003: A Monkeypox outbreak occurred in the US after rodents were imported 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.

SEPTEMBER 8, 2018: Monkeypox appeared in the UK for the first time in a Nigerian naval officer who was visiting Cornwall for training. They were treated at the Royal Free Hospital in London.

SEPTEMBER 11, 2018: A second UK monkeypox case is confirmed in Blackpool. There is no link with the first case in Cornwall. Instead, the patient is though to have picked up the infection when travelling in Nigeria. They were treated at Blackpool Victoria Hospital and Royal Liverpool University Hospital.

SEPTEMBER 26, 2018: A third person is diagnosed with monkeypox. The individual worked at Blackpool Victoria Hospital and treated the second Monkeypox case. They received treatment at the Royal Victoria Infirmary in Newcastle.

DECEMBER 3, 2019: A patient was diagnosed with monkeypox in England, marking the fourth ever case.

MAY 25, 2021: Two cases of monkeypox were identified in north Wales. Both patients had travel links to Nigeria.

A third person living with one of the cases was diagnosed and admitted to hospital, bringing the total number ever to seven.

MAY 7, 2022: A person was diagnosed with Monkeypox in England after recently travelling to Nigeria. The person received care at the expert infectious disease unit at Guy’s and St Thomas’ NHS Foundation Trust in London.

MAY 14, 2022: Two more cases were confirmed in London. The infected pair lived in the same household but had not been in contact with the case announced one week earlier.

One of these individuals received care at the expert infectious disease unit at St Mary’s Hospital in London. The other isolated at home and did not need hospital treatment.

MAY 16, 2022: Four more cases were announced, bringing the UK total to seven. Three of these cases are in London, while one of their contacts is infected in the north east of England.

The spate of cases was described as ‘unusual’ and ‘surprising’ as experts warn gay and bisexual men to look out for new rashes.

MAY 19, 2022: Two more cases were revealed, with no travel links or connections to other cases. The cases were based in the South East and London. Fears began to grow that infections are going undetected.

MAY 20, 2022: Eleven more cases are announced, meaning Britain’s monkeypox outbreak have doubled to 20. Minsters discuss the possibility of a public health campaign to warn gay men the disease may be more prevalent for them

MAY 23, 2022: Scotland logs its first ever monkeypox case and 36 more infectioned announced in England. It brings the UK total to 57.

MAY 24, 2022: England logs another 14 cases, bringing the UK total to 71.

MAY 25, 2022: Another seven infections are spotted in England, meaning 78 cases have been detected in the UK.

MAY 26, 2022:  Wales detects its first monkeypox case in the recent outbreak, bringing the UK total to 79.

Dr Kucharski said on Twitter: ‘For me, biggest risk with monkeypox isn’t that it will rapidly grow into a pandemic (it’s not a novel flu or coronavirus).

‘Instead, the the risk is that ‘after initial superspreading events and focused control efforts, case numbers will slow down but not be eliminated in some places.

‘And transmission will continue to persist in new places at low-ish levels via highly connected parts of the interaction network and hence further risk of spilling back in humans.’

The current outbreak, first detected in a traveller from Nigeria to the UK on May 6, has been linked to several super-spreader events, including a gay pride festival in Gran Canaria, a fetish festival in Belgium and a ‘sauna’ in Spain. 

Experts this week revealed sexual transmission at these events is the leading theory behind the origins of the current cluster of cases.

Dr Kucharski’s comments echo a warning made by the European Centre for Disease Prevention and Control (ECDC) this week that monkeypox may become endemic if transmission continues and that it spreads to pets or wildlife.

The ECDC said it is ‘theoretically possible’ that people in Europe could pass on monkeypox to their domestic pets, which could then act as a host and transmit it back to humans. 

This is because rodents and squirrels have already been identified as carriers of the virus in west and central Africa, it noted.

The report states: ‘Currently, little is known about the suitability of European peri-domestic (mammalian) animal species to serve as a host for monkeypox virus. 

‘However, rodents, and particularly species of the family of Sciuridae (squirrels) are likely to be suitable hosts, more so than humans (see disease background), and transmission from humans to (pet) animals is theoretically possible. 

‘Such a spill-over event could potentially lead to the virus establishing in European wildlife and the disease becoming an endemic zoonosis.’

The ECDC noted that the likelihood of this spill-over is ‘very low’, however.

But it said national health authorities should work with veterinary experts to ensure there is a sufficient testing capacity to swab and quarantine pets which have been exposed to monkeypox.

The agency said exposed rodent pets — such as hamsters, gerbils and guinea pigs — should be isolated in monitored facilities and tested again before their quarantine ends. 

These pets should be killed ‘as a last resort’ if there is no testing or isolation capacity, the report states.

Mammalian pets, such as cats and dogs, can be isolated at home if there is a suitable outdoor space and a vet can check on them, the ECDC said.

The UK’s Department for Environment, Food and Rural Affairs (Defra) is already drawing up guidelines in an attempt to limit the risk of monkeypox patients infecting their pets.

There are also fears infected patients could contaminate their pet’s fur and the illness be passed on to others in their household. 

Justine Shotton, president of the British Veterinary Association, said the association was monitoring the situation closely.

She believes the risk of infecting pets remains low but is ‘supportive of a cautious approach’ while officials seek to learn more about the virus.

Ms Shotton said: ‘It would be a sensible decision to keep your distance from a pet while in quarantine.

‘If I was diagnosed with monkeypox I would do whatever I could to limit contact, such as asking a friend or relative to take care of it.’ 

She added: ‘There is currently no evidence of transmission between humans and cats and dogs but we know rabbits and rodents are susceptible.

‘If you have concerns about your pets health — if they have a fever, respiratory issues, poor appetite or lethargy — speak to a vet.

Health chiefs have warned monkeypox, a virus endemic in parts of Africa and is known for its rare and unusual rashes, bumps and lesions, could also spread to some pets and become endemic in Europe. Undated handout file image issued by the UK Health Security Agency of the stages of Monkeypox

Dr Adam Kucharski, a UK Government scientist and epidemiologist, said that while new cases may slow down, the ‘biggest risk’ is that they will ‘not be eliminated in some places’. The smallpox vaccine, called Imvanex in the UK and Jynneos in the US, can protect against monkeypox because the viruses causing the illnesses are related

‘The chances are it will be something other than monkeypox but it’s worth getting it checked.’

It comes after an ex-WHO official claimed monkeypox may have been spreading under the radar in Europe for four years. 

Professor David Heymann, a former former director-general for health security and environment at the WHO, said the current global outbreak may date back to a handful of isolated cases in the UK in 2018.

Two Britons were diagnosed with the tropical disease in September 2018 after returning from Nigeria. A third case was found in an NHS worker who treated one of the patients.

In December 2019, a fourth person unrelated to the previous three tested positive for the virus after returning from Nigeria. Three further cases with similar travel history arrived in 2021.

Professor Heymann suggested the virus may have been seeded in around this time and spread unchecked. All of the cases are believed to have had the milder western African clade of the virus — the same one that is spreading now.

It comes as monkeypox has now been detected in every UK nation, as Northern Ireland and Wales yesterday confirmed their first cases of the tropical virus. 

Some 90 patients in Britain have been sickened with the illness in the past three weeks. 

Health chiefs are alarmed about the ever-growing cluster of cases, given the smallpox-like infection is usually only spotted in Africa. A disproportionate number are among gay and bisexual men.

Teams from the UK Health Security Agency (UKHSA) are contacting high-risk contacts of confirmed cases and advising them to self-isolate at home for three weeks and avoid contact with children.

They are also being offered the Imvanex vaccine to form a buffer of immune people around a confirmed case to limit the spread of the disease. The strategy, known as ring vaccination, has been used in previous monkeypox outbreaks and is also being carried out in some EU countries. 

The disease, first discovered in lab monkeys in the late 1950s, is usually mild but can cause severe illness in some cases. It can kill up to 10 per cent of people it infects. 

The milder strain causing the current outbreak kills one in 100 — similar to when Covid first hit.

Monkeypox has an incubation period of anywhere up to 21 days, meaning it can take three weeks for symptoms to appear.

Symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

A rash can develop, often beginning on the face, which then spreads to other parts of the body — including the genitals. The rash can look like chickenpox or syphilis, and scabs can form which then fall off.

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