Close contacts of UK’s monkeypox cases are being given ‘off-label’ vaccine

Another two monkeypox cases have been detected in the UK.

Health bosses confirmed the latest infected Britons, one of whom is in London while the other is in the South East, have no links to other cases or travel to countries where the virus is endemic.

The latest cases bring the total in the recent outbreak, which began on May 6, to nine. 

Most of the patients are gay or bisexual men, and officials say the pattern of transmission is ‘highly suggestive of spread in sexual networks’.

Seven Britons have tested positive for the virus in the past fortnight, six of whom appear to have been infected in the UK.

The majority of the patients are not linked, which suggests more cases are going undetected.

It comes as MailOnline revealed Britons who have been in close contact with monkeypox cases are being given an ‘off-label’ vaccine.

They are being offered a jab that in 2013 was approved to prevent smallpox, which is part of the same family of viruses and is genetically very similar.

There are no specific drugs or vaccines licensed for monkeypox in Britain, leaving doctors will limited options in preventing or treating it.

Health sources said close contacts of monkeypox cases were being offered the Imvanex vaccine ‘based on their risk factor’.

They added it has been used in this way, known as ‘ring vaccination’, since 2018 when a small number of cases were detected with travel links to Africa.

The strategy is being deployed again now that the virus appears to be spreading in the community for the first time.

Studies have shown Imvanex — known as Jynneos in the US — is around 85 per cent effective at preventing a monkeypox infection.

Seven Britons have been diagnosed with monkeypox and six of them appear to have contracted it in the UK — in a sign the virus is spreading in the community. The seventh UK patient had brought the virus back from Nigeria, where the disease is widespread. At least three patients are receiving care at specialist NHS units in London and Newcastle

The US and EU have approved Imvanex specifically as a preventative for monkeypox, unlike the UK where it has only been green-lit for smallpox.

It means in theory it is harder for medics in the UK to prescribe it to patients as it has to be used ‘off-label’ and doctors can be held responsible for negative side effects.

Professor Hunter said it would ‘probably be easier to get a hold of if it was approved’ for monkeypox, especially if cases rise and more doses are needed.

The sources did not say how many people have been given the Imvanex jab.

But studies during Covid suggest people have between three and 10 close contacts on average, meaning tens of Britons may already have received it. 

A spokesperson for the Medicines and Healthcare products Regulatory Agency (MHRA) told MailOnline: ‘There is no approved vaccine or medicine for monkeypox in Great Britain.’

But they added: ‘We are monitoring the situation closely and working with companies to speedily bring forward suitable treatments for monkeypox.’

But the vaccine itself can cause unpleasant side effects in certain people, including making eczema symptoms worse, according to Professor Paul Hunter, an infectious disease expert at the University of East Anglia.

‘So it is not something that we would give unless we had good reasons,’ he added.

Monkeypox is a rare viral infection which kills up to one in ten of those infected but does not spread easily between people. The tropical disease is endemic in parts of Africa and is known for its rare and unusual rashes, bumps and lesions (file photo)

Nurses and doctors are being advised to stay ‘alert’ to patients who present with a new rash or scabby lesions (like above)

Imvanex contains a modified form of the vaccinia virus, which is similar to the family of viruses that cause smallpox and monkeypox but does not cause disease in humans.

Because of its similarity to the pox viruses, antibodies produced against this virus have cross protection.

There are several other smallpox vaccines believed to be able to treat monkeypox, but they are less well researched.

Doctors in the UK also have the power to use antiviral drugs for smallpox off-label to treat monkeypox.

It comes after Portugal and Spain announced they had detected cases of monkeypox, in what could be the first global outbreak of the disease.

Spain is monitoring eight men who it believes are infected, with tests being carried out to confirm they have the virus.

All of the men are gay or bisexual, according to local media, and most were detected at STI clinics in Madrid.

Five men in Portugal have also tested positive and at least 15 more cases are being investigated, health officials there said today.

These cases are all male and mostly ‘young’ — but it is not yet clear how they caught the virus.

Until now, monkeypox cases were confined to travellers and their relatives returning from western and central Africa, where the virus is endemic.

But experts now fear it is spreading more widely for the first time, after seven Britons were diagnosed in the past fortnight. 

Officials say the pattern of transmission is ‘highly suggestive of spread in sexual networks’. 

Dr Simon Clarke, a microbiologist at the University of Reading, told MailOnline he suspects UK case numbers are already ‘in the tens’.

But he insisted the disease will not spread like Covid, adding: ‘I would be surprised if we ever got to more than 100 cases [in Britain]’.

Health experts investigating the new monkeypox outbreak in Britain believe the virus may be spreading sexually between people for the first time.

It was thought that monkeypox could only be passed on through close contact with the likes of body fluids, respiratory droplets and lesions.

But an expert from the UKHSA said the latest UK cases ‘appear to have acquired the infection via sexual contact’.

Dr Mateo Prochazka, who leads the UKHSA team which is investigating monkeypox, described this route of transmission as ‘novel’.

Seven people have been diagnosed with the virus in England over the past two weeks, five of which are in London.

Four are gay or bisexual men and only one has recent travel links to a country where the virus is endemic, which is ‘highly suggestive’ of spread in ‘sexual networks’, Dr Prochazka added.

Writing on Twitter, he said: ‘Transmission is not easy but can happen person to person from direct contact with lesions, or respiratory secretions.

‘The closer and longer the contact, the more likely it is to transmit.

‘Close contact between two people (such as during sex) could also facilitate transmission – but this has never been described before.

‘However, the high proportion of cases in the current outbreak in England that are gay or bisexual (4/7, 57%) is highly suggestive of spread in sexual networks.

‘This is further suggested by the fact that common contacts have been identified for only 2 of the 4 latest cases.’ Dr Prochazka continued: ‘Finding monkeypox cases that do not have travel links is rare, and suggestive of importation followed by some extent of community transmission.

‘This situation is being rapidly assessed.

‘What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact – this is a novel route of transmission that will have implications for outbreak response and control.’ 

Sexual health services are now working to identify more cases, control its spread and tackle potential stigma.

Other experts said further research is necessary before it will be possible to conclude if the virus is sexually transmissible.

Other infections that are not technically STIs but can spread during sex include shigella.

Monkeypox can kill up to one in ten people who get it but the new cases have the West African variant, which is deadly for around one in 100.

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

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 chickenpox or syphilis, before finally forming a scab, which later falls off.

EVERYTHING you need to know about monkeypox: Strain ‘transmits through sex’ and is about as deadly as the Wuhan Covid variant 

Monkeypox appears to be spreading globally for the first time in an outbreak that has caught health officials off-guard.

The UK has recorded seven cases of the virus but the majority of them are not linked which suggests more are going undetected.

Spain and Portugal have also spotted the virus for the first time ever and the US is monitoring six people who were on a flight with a positive case.

The majority of patients in the UK are gay or bisexual men, as are the eight Spanish men suspected of having the disease.

Portuguese officials have confirmed five men tested positive and over a dozen more are thought to be infected.

Health chiefs in the UK say the pattern of transmission is ‘highly suggestive of spread in sexual networks’.

Until now monkeypox had only been detected in four countries outside of Africa — the UK, US, Israel and Singapore, all of whom had links to Nigeria and Ghana.

Infections are more common in central and western Africa, where they can result from direct contact with infected animals.

Monkeypox can kill up to one in 10 people it infects — but the strain spreading globally is milder and has a fatality rate of about one in 100.

That is roughly the same as the first strain of Covid that came out of Wuhan, however vaccines and natural immunity have since made the coronavirus much weaker.

Monkeypox’s similarity to smallpox means jabs and drugs against that virus are also effective.

Here is everything we know about the UK monkeypox outbreak so far:

What is monkeypox?

Monkeypox is a rare viral infection which people usually pick up in the tropical areas of west and central Africa.

It is usually spread through direct contact with animals such as squirrels, which are known to harbour the virus.

However, it can also be transmitted through very close contact with an infected person. 

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

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.

Only a handful of cases have been reported outside of Africa and they were confined to people with travel links to the continent.

How deadly is it?

Monkeypox is usually mild, with most patients recovering within a few weeks without treatment. Yet, the disease can prove fatal.

Monkeypox kills up to 10 per cent of people it infects.

However, with milder strains the fatality rate is closer to one in 100 — similar to when Covid first hit.

The UK cases all had the West African strain of the virus, which is mild compared to the Central African strain. 

It is thought that cases in Portugal and Spain also have the milder version, though tests are underway.

Is there a cure? 

Because monkeypox is closely related to the virus that causes smallpox, jabs for smallpox can also protect people from getting monkeypox.

One vaccine, Jynneos, also known as Imvamune or Imvanex, has been licensed in the US, but it’s not approved in the UK.

The vaccine was shown to be around 85 per cent effective in preventing monkeypox infection.

Antivirals and pooled blood from individuals vaccinated against smallpox can be used to treat severe cases.

What is the situation with the current UK outbreak?

Seven cases of monkeypox have been confirmed in the UK between May 6 and 15. 

Six of the infected Brits had not recently travelled abroad, suggesting there is transmission between people in the UK for the first time.

Some of the cases are believed to have caught the virus through sex — which health experts have described as ‘bizarre’.

Monkeypox was not thought to spread via sexual intercourse but through close contact with lesions or respiratory droplets. However, just because it can spread during sex does not mean it is the virus’ primary route of transmission, nor does it make it an STI.

The NHS is tracking down contacts of those infected to identify additional cases, as it is not clear how all of the infected people caught Monkeypox.

Health leaders are also working with international agencies to determine if similar outbreaks are occurring elsewhere. 

What do we know about the British cases so far?

Five are based in London, one in the South East, and one in the North East. 

The first case was confirmed on May 7 in an individual who had recently travelled to Nigeria. 

They received care at the expert infectious disease unit at Guy’s and St Thomas’ NHS Foundation Trust in London.

Two more cases in London were announced on May 14. The infected pair live together in the same household but had not been in contact with the case announced one week earlier.

One of these individuals is receiving care at the expert infectious disease unit at St Mary’s Hospital in London. The other is isolating at home and does not need hospital treatment.

Four more cases were announced on May 16, bringing the UK total to seven.

Two of the cases were in London, with the other two in the North East and South East of England.

The most recent four cases have no known connections with the earlier three cases, but two of them were known to each other.

The four new cases were in gay and bisexual men.

Mateo Prochazka, an STI expert and head of UKHSA team probing the outbreak, claimed the pattern of spread is ‘highly suggestive of spread in sexual networks’.

Are there any cases in the US?

There are no confirmed cases in the US, but officials are keeping tabs on six people who were in close contact with an infected person.

The Americans were on the same flight as a British patient who travelled from Nigeria to the UK on May 4, and became the first case of the virus there.

The potential US cases sat within a three-row radius of his seat, according to Jennifer McQuiston, a senior CDC official.

She told STAT news they will be monitored for 21 days.

McQuiston also warned that Britain’s current spate of cases could be the tip of the iceberg.

The lack of travel links and connections between the UK cases suggest there are ‘unknown chains of transmission happening’, she said.

‘You have two clusters that have no link to travel or to other people who are known to be associated with a recognised outbreak.

‘It suggests that there are unknown chains of transmission happening. If there appears to be unknown chains of transmission, it just puts on alert to be thinking: “Could this be spreading outside the UK?”‘

How worrying is it?

UK health chiefs say the risk of a major outbreak is low. 

But they have urged gay, bisexual and other men who have sex with men to be extra vigilant because they appear to be at higher risk of catching it. 

These groups have been urged to look out for any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service without delay if they have concerns.

Most scientists believe the outbreak will be small and transmission nothing like the levels seen with Covid.

This is because monkeypox is poor at spreading between humans and relies on very close and prolonged contact between people.

How does it spread?

Monkeypox is not a sexually transmitted infection by nature, though it can be passed on by direct contact during sex. 

Contagious lesions, through which infections are most likely to be passed on, can appear on any part of the body. 

The infection can also be passed on through contact with clothing or linens used by an infected person.  

Until now, monkeypox had only ever been detected in four countries outside of Africa – the UK, US, Israel and Singapore.

And all of those cases had travel links to Nigeria and Ghana. 

What are the symptoms?

Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

But its most unusual feature is a rash that often begins on the face, then spreads to other parts of the body, commonly the hands and feet.

The rash changes and goes through different stages before finally forming a scab, which later falls off.

What do I do if I have symptoms? 

Anyone worried that they could be infected with monkeypox is advised to make contact with clinics ahead of their visit. 

Health chiefs say their call or discussion will be treated sensitively and confidentially.