Monkeypox in Scotland - first case of virus identified in Scotland

The first case of monkeypox in Scotland has been reported as infections soar across the UK.

The individual is being treated at hospital and contact tracing is underway, Public Health Scotland confirm.

Cases of the virus have been reported across Europe, North America and Australia with more expected to be confirmed this week. The UKHSA has identified 20 cases in England but more are expected.

The UK Government said contacts of monkeypox cases at high risk of having caught the infection should self-isolate for 21 days.

What is monkeypox?

Monkeypox is a viral infection usually found in West and Central Africa. The West African strain that has been recently detected in the UK is generally a mild self-limiting illness, spread by very close contact with someone already infected and with symptoms of monkeypox. Most people recover within a few weeks.

The UK Health Security Agency (UKHSA) guidance recommends people who have had “unprotected direct contact or high-risk environmental contact” should isolate for three weeks and avoid contact with children under 12-years-old.

It usually takes between five and 21 days for the first symptoms to appear. The infected person may experience fever, headache, aching muscles, backache, swollen lymph nodes, chills and exhaustion. The symptoms usually subside in two to four weeks.

A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.

The rash changes and goes through different stages, and can look like chicken pox or syphilis, before finally forming a scab, which later falls off.

The risk of catching monkeypox

There is a very low risk of transmission to the general population. A significant proportion of cases have been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics. However, it is not limited to any community and anyone with close contact with someone infected is at risk.

As the virus spreads through close contact, the UKHSA advises the public to be alert to any unusual rashes or lesions on any part of their body.

It can be spread through:

Touching clothing, bedding or towels used by someone with the monkeypox rash
Contact with monkeypox skin blisters or scabs
Coughs or sneezes of a person with the monkeypox rash

Anyone with unusual rashes or lesions on any part of their body should contact NHS 111 or call a sexual health service if they have concerns.

What’s the latest?

Contact tracing is being carried out after the first case of monkeypox in Scotland was confirmed.

The person is “being managed and treated in line with nationally agreed protocols and guidance”, according to Dr Nick Phin, the medical and public health science director at PHS said on Monday.

On Friday May 21, the UK Health Security Agency (UKHSA) announced 20 people in England had been confirmed to have the virus, with more expected.

As of that date, the World Health Organization (WHO) received reports of 92 laboratory-confirmed cases and 28 suspected cases from 12 countries not endemic for the disease.

PHS is working with the UK Health Security Agency (UKHSA), Public Health Wales and Northern Ireland HSC Health Protection Agency to monitor and respond to potential and confirmed cases of monkeypox in the UK.

Dr Phin described the risk to the public as low, but warned anyone with “blister-like sores” on their body to seek medical attention.

The agency did not confirm details of the person being treated in Scotland, or where they were located, but said close contacts were being traced and would be given support, including the possibility of a vaccination against the virus.

Dr Phin said: “Public Health Scotland is aware of an individual in Scotland who is confirmed to have monkeypox.

“The affected individual is being managed and treated in line with nationally agreed protocols and guidance.

“We have well established and robust infection control procedures for dealing with such cases of infectious disease and these will be strictly followed.

“We are working with NHS Boards and wider partners in Scotland and the UK to investigate the source of this infection.

“Close contacts of the case are being identified and provided with health information and advice. This may include the offer of vaccination.”

He added: “The overall risk to the general public is low.

“Anyone with an unusual blister-like rash, or small number of blister-like sores on any part of their body, including their genital area, should avoid close contact with others and seek medical advice if they have any concerns.”

The smallpox vaccine is currently being used to immunise close contacts of the 20 monkeypox patients that have been detected since May 6, and is around 85 per cent effective preventing infection.

Timeline

May 7: One case confirmed in England who had recently travelled to Nigeria

May 14: Two people who live together in London confirmed as having monkeypox

May 16: Four more cases confirmed: three in London and one in the North East of England

May 18: Two more cases confirmed: one in London, the other in the South East of England

May 20: Eleven more cases in England confirmed

‘Unusual’ spread of virus across borders

The UK’s response to monkeypox should be praised, an expert in infectious diseases has said, as he noted that superspreader events are likely to be behind the rise in global cases.

Sir Jeremy Farrar, the director of Wellcome, said “we have never seen anything like this before, with such a number of cases” in so many countries.

Sir Jeremy told BBC Radio 4’s Today programme that there have been small outbreaks in the past, with cases recorded in the UK, but “this is different, something has changed”.

Monkeypox is usually found in West Africa, and the virus does not often spread elsewhere.

He added: “The virus may have changed, but I think that’s unlikely. More likely is, I think, that the niche that this virus now finds itself in has allowed for some superspreader events and those individuals involved in that have then travelled to other parts of the world and taken the infection with them.”

He said the fact that the virus has “spread across borders so quickly is different” from what has been seen before.

At a superspreading event, the number of cases transmitted will be disproportionately high compared with general transmission.

Sir Jeremy said he thinks the UKHSA “deserves great credit” for its “textbook example” response to the outbreak.

“The action is what’s happening in the UK at the moment, which is very detailed, very painstaking contact tracing, identifying people who come forward and identifying their contacts and tracking everybody to see that you can break those chains of transmission, and making sure that that’s done in a trusted way…

“The worst thing is if we have any stigma associated with these infections, and people are fearful or don’t want to come forward, and that’s when epidemics can really take off.”

Cases ‘to increase in the coming days’

Dr Susan Hopkins, Chief Medical Adviser, UKHSA, said: “We anticipated that further cases would be detected through our active case finding with NHS services and heightened vigilance among healthcare professionals.

“We expect this increase to continue in the coming days and for more cases to be identified in the wider community. Alongside this we are receiving reports of further cases being identified in other countries globally.

“We continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals. We are contacting any identified close contacts of the cases to provide health information and advice.

“Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact NHS 111 or a sexual health service if they have any concerns.

“Please contact clinics ahead of your visit and avoid close contact with others until you have been seen by a clinician.

“A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging them to be alert to the symptoms and seek help if concerned.

“Clinicians should be alert to any individual presenting with unusual rashes without a clear alternative diagnosis and should contact specialist services for advice.”