Monkeypox isolation guidance: high-risk close contacts told to isolate for 21 days in new UK advice

Anyone at high risk of having caught monkeypox must self-isolate for three weeks, under new guidance from the UK Health Security Agency (UKHSA).

The advice applies to anyone who has had “unprotected direct contact or high-risk environmental contact” with a confirmed case.

The guidance comes after 57 monkeypox cases have been identified in the UK so far, the UKHSA announced on Monday (23 May).

There are 56 confirmed cases in England and Scotland confirmed its first case on Monday. Northern Ireland’s Public Health Agency and Public Health Wales each said they have had no confirmed cases.

Globally, 14 countries have now reported outbreaks, bringing the total number of known cases to at least 80, according to epidemiologists at Harvard University who are tracking the spread, including 40 cases in Spain and 23 in Portugal.

What does the new guidance mean?

People are considered to be at high risk of having caught monkeypox if they have had household contact, sexual contact, or have changed an infected person’s bedding without wearing protective equipment.

Anyone deemed to be at high risk of having caught the infection should self-isolate for 21 days, latest government guidance says.

This means that they must not travel or have direct contact with immunosuppressed people, pregnant women and children under 12. They must also provide details for contact tracing and the UKHSA advises that they are offered a smallpox vaccine.

How is monkeypox spreading?

Dr Susan Hopkins, chief medical adviser for UKHSA, warned that monkeypox is spreading through community transmission and said updated figures for the weekend will be given on Monday as she warned of more cases “on a daily basis”.

The disease, first found in monkeys, can be transmitted from person to person through close physical contact, including sexual intercourse, and is caused by the monkeypox virus.

Dr Hopkins warned that doctors are seeing community transmission, with cases predominantly being identified in individuals who self-identify as gay or bisexual or men who have sex with other men.

Speaking to BBC One’s Sunday Morning, Dr Hopkins said: “We are finding cases that have no identified contact with an individual from west Africa, which is what we’ve seen previously in this country.

“The community transmission is largely centred in urban areas and we are predominantly seeing it in individuals who self-identify as gay or bisexual, or other men who have sex with men. That’s because of the frequent close contacts they may have.

“We would recommend to anyone who is having changes in sex partners regularly, or having close contact with individuals that they don’t know, to come forward if they develop a rash.”

Asked if people will need to be vaccinated, she said: “There is no direct vaccine for monkeypox but we are using a form of smallpox vaccine – a third-generation, smallpox vaccine that is safe in individuals who are contacts of cases.

“So we’re not using it in the general population. We’re using it in individuals who we believe are at high risk of developing symptoms, and using it early, particularly within four or five days of the case developing symptoms.

“For contacts, (this) reduces your risk of developing disease, so that’s how we’re focusing our vaccination efforts at this point.”

The new guidance comes as US president Joe Biden said that recent cases of monkeypox which have been identified in Europe and the United States are something “to be concerned about”.

In his first public comments on the disease, Mr Biden added: “It is a concern in that if it were to spread it would be consequential.”

What are the symptoms of monkeypox?

If you are infected with monkeypox, it can take between five and 21 days for the first symptoms to appear. The first symptoms include:

• a high temperature
• a headache
• muscle aches
• backache
• swollen glands
• shivering (chills)
• exhaustion

A rash usually appears between one and five days after the first symptoms, and will typically begin on the face before spreading to other parts of the body.

The rash is sometimes confused with chickenpox as it starts as raised spots, which turn into small blisters filled with fluid.

These blisters eventually form scabs which later drop off and symptoms should clear up within two to four weeks.