Monkeypox Q&A

Following our community Q&A event, we have themed questions and answered them up to the date of 11th August. Please note that this information may be out-of-date when you're reading it, because of how quickly the monkeypox outbreak is changing. Please refer back to lgbt.foundation/monkeypox for up-to-date information as and when it comes to us

Useful sources include:

https://www.gov.uk/government/publications/monkeyp...

https://thenorthernsexualhealth.co.uk/monkeypox

Vaccines

Why is there such a limited quantity of vaccines across the country? Transmission is happening and people know they’re high risk. Why is Manchester not currently getting the numbers of jabs to prevent this growing? Why has there been a delay in getting the vaccines?

The Monkeypox vaccines (MVA) are not made to be routinely used in any country, so global supplies are limited. London has been the epicentre of the outbreak and therefore the limited vaccine we had nationally has quite rightly been prioritised there over other parts of the country. The UK has secured a limited supply to cover this outbreak and the vaccine batches will become available as each batch is manufactured and supplied. UKHSA is working with the manufacturer to expedite delivery of more doses as soon as possible.

For up-to-date information on the monkeypox vaccine from UKHSA: https://www.gov.uk/government/publications/monkeypox-vaccination-resources

If clinics are going to contact people for a vaccine how can we make sure we are on the list to be contacted and won't miss out?

In Manchester, The Northern have been inviting their registered patients who fall into eligibility criteria to book an appointment or attend a drop in. When drop in clinics are arranged they may also be open to registered patients who meet the criteria but have not received an invite yet. Their eligibility will be assessed on the day.

Please look out for information at https://twitter.com/thenorthernish

Can you outline the process of getting the vaccine, who is considered eligible and how are they currently being approached?

The UK Health Security Agency (UKHSA) currently recommends that MVA is offered to:

  • healthcare workers who are caring for and who are due to start caring for a patient with confirmed monkeypox (2 doses are normally required). This includes some staff in sexual health clinics who are assessing any suspected cases
  • gay, bisexual and other men who have sex with men (GBMSM) at highest risk of exposure. Your doctor or nurse will advise vaccination for you if they consider you are at high risk – for example if you have multiple partners, participate in group sex or attend ‘sex on premises’ venues. Staff who work in such premises may also be eligible
  • people who have already had close contact with a patient with confirmed monkeypox. Vaccination with a single dose of vaccine should be offered as soon as possible (ideally within 4 days of contact but sometimes maybe given up to 14 days

Because of the limited supply, only one dose of vaccine will be offered now to as many eligible people as possible. It is important to come forward for your first dose as soon as you are invited. If the outbreak continues a second dose may be advised later by your doctor to those at on-going risk.

Vaccinations in Greater Manchester are being offered at sexual health clinics and hospitals to people considered at high risk of acquiring monkeypox. Only people who are known to sexual health services are being invited to attend an appointment to receive a vaccine. All those identified as being eligible for a vaccination are being invited by text message or phone call to book an appointment, or to attend an invite-only walk-in clinic. The clinics are being held at a range of venues, dates, and times to maximise accessibility and uptake.

https://www.gov.uk/government/publications/monkeypox-vaccination-resources

I’ve heard that you need two vaccines but you are only giving one for now?

After 2 doses of vaccine, almost all people develop antibodies and should therefore have a good level of protection against monkeypox. It is less clear what level of protection you get from a single dose – this may be a reason to avoid high risks until after the second dose.

Vaccines work in different ways. No vaccine is 100% effective. While the vaccine may not always prevent an individual getting monkeypox, the symptoms experienced are likely to be milder. The first dose prepares your immune system so it can respond much more quickly if you come into contact with monkeypox.

The vaccine also takes time to work. Protection will start to build after a few days and should reach the highest levels after about 4 weeks.

Because there are currently limited supplies of the vaccine, the NHS will start by giving one dose to as many eligible people as possible. This is a fair way to provide some protection to the whole community. As more vaccines become available, a second dose will be given to those at highest risk. This will be at least 2 to 3 months after the first vaccine.

A longer time between the first and second doses should improve your long term protection. Even after 2 doses you should continue to be aware of the risks and symptoms of monkeypox. If you develop symptoms, stay at home and call 111 or a sexual health clinic

Is there anyone who can’t have the vaccine?

The only people who cannot receive the vaccine are those who suffered a sudden life-threatening allergic reaction to a previous dose of the vaccine, or any ingredient of vaccine before. The vaccine contains trace amounts of chicken protein, benzonase and gentamicin and ciprofoxacin (antibiotics).

Are there any side effects of the vaccine?

The vaccine has a very good safety profile. Like all vaccines it can cause side effects, but most of these are mild and short-lived and not everyone gets them. Unlike the old smallpox vaccine, vaccination does not leave a scar. Side effects may be more common in people who have previously received a dose of live smallpox vaccine. These people only need a single dose of MVA to boost their existing protection.

Common side effects include pain and itching at the injection site and headache, muscle ache, sickness and tiredness. About 1 in 10 people will have chills and fever, but these should not last more than a few days. If you experience any of the side effects listed above, you should rest and you can take the correct dose of paracetamol to help relieve the symptoms. If you already have atopic dermatitis (a form of eczema), you may experience more intense local skin reactions (such as redness, swelling and itching) and other general symptoms (such as headache, muscle pain, feeling sick or tired), as well as a fare-up or worsening of your skin condition.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1095496/UKHSA-12370-monkeypox-vaccination-leaflet.pdf

Has Manchester used up all their vaccine now?

Vaccines are slowly coming into the country and Greater Manchester will receive an allocation. There is no guarantee of how many doses we will receive and we are advocating for additional supply. This is one of the reasons it is difficult to give advance information of when vaccination clinics will be running. .

Owing to vaccine availability and time taken to procure more vaccines, there are likely to be gaps in supply from some time in August until further batches arrive in September.

Why are vaccines not available via a GP?

The vaccine is being delivered through sexual health clinics as they are most aware of the level of risk people have. For now, you should wait to be contacted by your local sexual health clinic. To make the best use of current supply, and to help stop the spread of the virus, the NHS is prioritising vaccination in line with UKHSA advice.

How does The Northern know who is in a high risk category (thus eligible for a vaccine) if they haven't captured this data at a previous clinic visit, or haven't used The Northern services before. E.G. Visits to sex on premise venues?

The number of high risks patients for the Northern and for other sexual health services across GM is solely based on the data held by each clinic. We are currently looking at how we can reach other high risk individuals who are either engaged with other parts of the health system such as primary care or not in contact with the health system at all.

This is a strategy to target the limited number of vaccines to people with known risk given there are insufficient vaccines to vaccinate everyone at this time (11th August 2022).

Do we know how long it takes after receiving the vaccine for it to become effective?

Vaccines work in different ways. One dose may not completely prevent infection but even if you catch monkeypox, the symptoms should not be as bad. The first dose prepares your immune system so it can respond much more quickly if you come into contact with monkeypox. The vaccine also takes time to work. It might start to work after a few days and should reach the highest protection by about 4 weeks.

How much protection does a single dose of the vaccine give you?

No vaccine is 100% effective. While the vaccine may not always prevent an individual getting monkeypox, the symptoms experience are likely to be milder. The first dose prepares your immune system so it can respond much more quickly if you come into contact with monkeypox. The vaccine also takes time to work. Protection will start to build after a few days and should reach highest levels after about 4 weeks.

About Monkeypox

What’s the current stats, climate and understanding for the number of cases in the North/North West at the moment?

Data on the outbreak is provided by UKHSA - see here for latest updates including national and regional figures by Local Authority. https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates

What are the symptoms of monkeypox?

Symptoms of monkeypox include:

  • unusual rashes or blisters on the body, including mouth, genitals and anus. Some people get just one spot.
  • a high temperature
  • a headache
  • muscle aches
  • backache
  • swollen glands
  • shivering (chills)
  • exhaustion
  • proctitis (anal or rectal pain or bleeding)

How is monkeypox passed on?

Monkeypox is a viral infection, spread by close contact with someone with the virus. Monkeypox can be passed on from person to person through:

  • any close physical contact with monkeypox blisters or scabs (including during sexual contact, kissing, cuddling, or holding hands)
  • the coughs or sneezes of a person with monkeypox when they're close to you

Anyone can get monkeypox, but currently most cases are in men who are gay, bisexual or have sex with men. As the virus spreads through close contact, we are advising these groups to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia.

Is there any evidence for respiratory spread?

The most likely route of monkeypox transmission is close physical contact, such as through:

  • touching clothing, bedding or towels used by someone with the monkeypox rash
  • touching monkeypox skin blisters or scabs

There is a lesser risk of spread by the airborne droplet route (coughs and sneezes). Large respiratory droplets are expelled when someone with monkeypox breathes, coughs or sneezes. These generally only travel a few feet and fall to the ground quite quickly due to their weight so prolonged face-to-face contact would be required for this route of transmission. This is not one of the main routes of transmission for the monkeypox virus.

This is different to airborne aerosol transmission, which can be a route of transmission for other viruses such as COVID-19. This is when small aerosol particles carrying a virus are exhaled by an infected person and remain suspended in the air for a period of time and can cause infection if a sufficient number are exhaled.

Do we know if it can be transmitted asymptomatically?

Monkeypox does not usually spread easily between people. Latest UKHSA data shows monkeypox transmission continuing primarily in interconnected sexual networks of gay, bisexual and men who have sex with men (GBMSM). Information from cases strongly suggests the virus is passing primarily via close or sexual contact.

Is it appropriate for sexual health services to take on the testing and vaccination, when public health officials have been saying this is not sexually transmitted?

While Monkeypox has not previously been described as a sexually transmitted infection, it can be passed on by direct contact during sexual contact.

Sexual health clinics are a good option for people with symptoms because they have expertise in infectious diseases, are experienced with infection control, and are regularly accessed by many people. While they are a good option for people worried about symptoms that could be monkeypox, they can also offer advice and treatment if people don’t have monkeypox but are suspected of having a sexually transmitted infection.

Who is most ‘at risk’ of monkeypox? How is this reflected in who is being approached with the vaccine offer currently?

While anyone can get monkeypox, cases in the UK are predominantly in gay, bi and other men who have sex with men (GBMSM), with the virus being passed on in closely connected sexual networks and so the smallpox vaccine is being prioritised at those men at higher risk of getting the virus, as well as some contacts of cases and some healthcare professionals.