Monkeypox contact tracers are probing gay bars and spas as they scramble to contain an outbreak of the rare disease.
Health chiefs in the UK are ‘actively investigating’ venues visited by six homosexual and bisexual men who tested positive in the past week.
They include bars, clubs and saunas, according to an update by the World Health Organization (WHO).
Six of Britain’s nine confirmed cases are men who have sex with men, which officials say is ‘highly suggestive of spread in sexual networks’.
A similar pattern is emerging in Europe, where seven gay or bisexual men have tested positive in Spain and nine ‘mostly young’ males in Portugal.
The UK Health Security Agency (UKHSA) today issued a direct plea to men to be vigilant for new rashes on their face or genitals.
Experts fear the known cases are the tip of the iceberg because the majority of patients are not linked to each other, suggesting it is spreading more widely.
Nine Britons have been diagnosed with monkeypox and all but one of them appear to have contracted it in the UK. The original 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
Seven countries outside of Africa have confirmed or suspected cases of monkeypox. Patients with confirmed monkeypox have been recorded in the UK, US, Spain, Sweden, Italy and Portugal, while Canada is probing potential cases.
The WHO released an update on monkeypox last night that included a section on the situation in the UK.
It came before two more cases in gay or bisexual British men were announced.
The WHO said: ‘Health authorities in the UK have established an incident management team to coordinate the extensive contact tracing which is currently underway in health care settings and the community for those who have had contact with the confirmed cases.
‘Contacts are being assessed based on their level of exposure and followed up through active or passive surveillance for 21 days from the date of last exposure to a case. Vaccination is being offered to higher risk contacts.
‘A detailed backwards contact tracing investigation is also being carried out to determine the likely route of acquisition and establish whether there are any further chains of transmission within the UK for all cases.
Contact tracers are responsible for interviewing venue owners and tracing people who may have come into contact with infected patients unknowingly.
The UKHSA has said it is ‘particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if they have concerns’.
The Italian patient tested positive at a hospital in Rome after returning from the Canary Islands and the Swede was diagnosed in Stockholm.
No further details have been given. It brings the number of countries outside of Africa with confirmed or suspected cases to seven.
The outbreak has been described as ‘unusual’ by experts because person-to-person transmission of monkeypox was thought to be extremely rare.
Until now the virus had only ever been detected in four countries outside of western or central Africa, and all of the cases had direct travel links to the continent.
‘One person in the Stockholm region has been confirmed to be infected with monkeypox,’ Sweden’s Public Health Agency said in a statement.
The infected person ‘is not seriously ill, but has been given care,’ according to the agency.
‘We still don’t know where the person was infected. An investigation is currently underway,’ Klara Sonden, an infectious disease doctor and investigator at the agency, said in a statement.
The health authority is now ‘investigating with the regional infection control centres whether there are more cases in Sweden,’ it said.
Italy’s patient was holidaying in the Canary Islands and is now in isolation at the Spallanzani hospital in Rome, the hospital said.
Another two other suspected cases are being monitored, it added.
The WHO has warned it expects more cases in more countries in the coming weeks.
Six of the UK’s nine cases are based in London, with two in the South East of England and one in the North East.
All but one of the UK patients — the first, who flew in from Nigeria — appear to have got infected in the UK, and most are not connected.
The US reported its first monkeypox case overnight, in a man from Massachusetts who had recently returned from Canada.
At least thirteen probable cases are being investigated in Canada, with tests being carried out to confirm the virus.
Seven people have been diagnosed in Spain and dozens more are being monitored and tested for the disease. Portugal said nine cases have been confirmed.
Until now, monkeypox cases were confined to travellers and their relatives returning from western and central Africa, where the virus is endemic.
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.
Monkeypox has an incubation period of up to 21 days, meaning it can take three weeks after an infection for symptoms to appear.
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.
Dr Simon Clarke, a microbiologist at the University of Reading, said the virus kills by shutting down the immune system and leaving people open to lethal infections.
He told MailOnline: ‘The mechanisms by which smallpox and monkeypox kill have only fairly recently begun to be understood. Because smallpox has been eradicated, it can’t be studied anymore, so studies of monkeypox have had to take its place.
‘In common with smallpox, monkeypox shuts down some aspects of your body’s ability to fight infections.
‘Because of the presence of other viruses and bacteria which your body can’t fight off, in the worst cases patients can succumb to a lethal shock throughout the body and blood poisoning.
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)
‘Death is more likely to occur in younger patients. The skin lesions are painful and disfiguring, and can be the source of further infections.’
Dr Clarke also suspects UK case numbers are already ‘in the tens’ because of the lack of a link between cases.
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]’.
Professor Bill Hanage, a public health expert at Harvard University, said it was plausible that transmissions has been happening ‘for some time unnoticed’.
He tweeted: ‘Because folks don’t expect to see monkeypox and so don’t diagnose it.
‘You hear hoofbeats you expect horses, not unicorns. You see lesions, you don’t expect monkeypox and assume it is something else.’
Experts believe young people are most at risk of catching or falling ill with the disease because they are less likely to have been vaccinated against smallpox, which was eradicated in the 1980s.
They are still trying to work out its main route of transmission but health experts investigating the new monkeypox outbreak in Britain say the virus can spread through sex.
Until now, it had never been found to be transmitted sexually.
But it was known that it could be passed on through close contact with the likes of body fluids, respiratory droplets and lesions — meaning it was theoretically possible to transmit through sex.
It comes after MailOnline revealed the UK is stockpiling thousands of drugs and vaccines to combat the outbreak.
Antiviral drugs and jabs designed to target smallpox have cross protection against monkeypox, with the two viruses genetically very similar.
The UK’s drug watchdog told MailOnline it was monitoring the current outbreak and ‘working with companies to speedily bring forward suitable treatments’.
Britons who have been in close contact with monkeypox cases are being given an off-label vaccine known as Imvanex (file)
There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox, including the drug tecovirimat, which was approved for monkeypox in the EU in January
Health chiefs also revealed to MailOnline they have bought thousands of vaccine doses and are already deploying them to close contacts of infected Britons.
The latest outbreak has been described as ‘unusual’ by experts because person-to-person transmission of monkeypox was thought to be extremely rare.
Six of Britain’s cases are in gay or bisexual men, which officials say is ‘highly suggestive of spread in sexual networks’.
A vaccine, known as Imvanex, was approved in 2013 in the UK to treat smallpox, but studies have since shown it is 85 per cent effective at preventing monkeypox.
It is not approved for monkeypox in the UK but health professionals can use it ‘off-label’.
Imvanex is already being offered to close contacts of positive cases and medics treating cases ‘based on their risk factor’.
A spokesperson for the Department of Health said: ‘We have taken active steps to be prepared for further cases of monkeypox in the UK and have secured thousands of doses of vaccines that are effective against monkeypox which are being used to protect key healthcare workers and at-risk individuals who may have been exposed.’
The Imvanex jab has been used to treat close contacts of monkeypox cases since 2018, when a small number of cases were detected with travel links to Africa.
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 people.
Because of its similarity to the pox viruses, antibodies produced against this virus offer cross protection.
There are a handful of antivirals and therapies for smallpox that appear to work on monkeypox, including the drug tecovirimat, which was approved for monkeypox in the EU in January.
A spokesperson for the Medicines and Healthcare Regulatory Authority (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.’
Professor Kevin Fenton, London’s public health regional director, said if the outbreak in the capital continues to grow then the rollout of vaccines and treatments could be broadened to more groups.
He told BBC Radio 4’s Today programme: ‘If we see more cases and it continues to spread then there are plans in place to ensure we have more antiviral agents in place to deal with that.
‘We’re watching closely to see how this spreads over the next week or two and then we’ll get a better sense of how to project and plan for the month ahead.’
TIMELINE OF MONKEYPOX IN THE UK
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.