Mpox (previously referred to as monkeypox)

UKHSA (United Kingdom Health Security Agency) has released a strategy for mpox control from December 2022 to 2023. You can read the full strategy here.

We want to give huge thank you to our communities who since the outbreak, have shared information about symptoms and how to reduce the spread of mpox. This has meant that there has been a steady decline in mpox since July 2022. Mpox hasn't gone away, so it's important to keep the conversation going and look out for one another.

Updated information - August 2023

What is mpox and how is it passed on?

Mpox, formerly known as Monkeypox, is a rare disease caused by the mpox virus. Mpox can be passed on from person to person through:

• Close physical contact with mpox blisters or scabs (including during sexual contact, kissing, cuddling, or holding hands)
• Touching clothing, bedding or towels used by someone with mpox
• The coughs or sneezes of a person with mpox when they're close to you
• Most cases seen in the UK have been passed on in sexual contact.

What are the signs and symptoms of mpox?

Anyone can get mpox, though most cases have been in men who are gay, bisexual or men who have sex with other men. The risk of getting mpox remains low for most people. While the infection is mild for many, it can cause severe symptoms for others.

Symptoms can include:

• Unusual rashes or blisters on the body including mouth, genitals, and anus (these may start after other symptoms),
• Flu-like symptoms including muscle and back aches, shivering (chills) and tiredness,
• A high temperature, sometimes called a fever,
• Swollen glands in the neck, armpits, or groin and
• Proctitis (anal or rectal pain)

If you're infected with mpox, symptoms usually start five to 21 days later. The symptoms often get better by themselves over two to four weeks.

The skin lesions (pox) go through four phases:

• Flat spots
• Raised spots
• Blisters
• Healing by scabbing or crusting over

Mpox rash can sometimes be confused with other diseases that can look similar, like chickenpox. A diagnosis of mpox requires an assessment by a health professional and specific testing.

A rash usually follows these symptoms in around one to five days. This can include on or around the face, mouth, genitals and anus. Some people also experience pain and bleeding from their bottom. Sometimes people may confuse the rash for chickenpox. The rash has spots/blisters which fill with fluid, then scab over and fall off. You can pass mpox on while you have symptoms.

For more information:https://www.nhs.uk/conditions/mpox/

What should I do if I have symptoms of mpox?

In the first instance, contact your local sexual health clinic if:

• You have a new unexplained rash or lesion on your body, especially the face or genitals.
• You have been in contact with someone who has had mpox in the last three weeks.

Do not attend a clinic, hospital, or your GP in person, unless they arrange an appointment. Tell the person you speak to if you've had close contact with someone who has or might have mpox.

People who cannot contact a sexual health clinic or GP should call 111. If you are concerned about a child, please contact your GP.

Mpox is usually diagnosed by taking a swab taken from one or more mpox blisters or ulcers. Sometimes, a throat swab can be used for high-risk contacts of a confirmed or highly probable case who have developed symptoms of monkeypox, but no rash.

Stay at home and avoid close contact with other people, including sharing towels or bedding, until you've been told what to do.

Most people who have mpox recover well in a few days at home, but some people might need treatment in hospital. It’s important to isolate until your symptoms have fully cleared up.

If you need help to find a sexual health clinic –click here– or contact us for support.

How can I protect myself and my partners?

• Keep it clean by ensuring you thoroughly wash both before being intimate, and as soon as possible after, ensuring you don’t share towels. Don’t share sex toys or consider covering them with a condom.Clean your hands regularly with soap and water, or alcohol-based hand sanitiser.
• Know the symptoms if you’re sexually active, especially with new partners.
• Talk to partners about their sexual health and remember symptoms can take three weeks to develop, so keep checking yourself.
• Swap contact details if hooking up with someone new even if this is casual fun.
• If you have symptoms, take a break from all intimate contact (including kissing) until you’ve seen a doctor and had the all-clear.
• If you’re recovering from mpox infection, remember to use condoms for 12 weeks as a precaution.
• Be kind and remember that if you see somebody with spots or sores on their skin, it’s not necessarily mpox. Lots of other skin conditions can look similar and may not be infectious.

What is the treatment for mpox?

Treatment for most people with mpox is aimed at relieving symptoms. Care may include managing skin damage from the mpox rash, drinking enough liquids to help keep stools (poo) soft, and pain management.

If you have mpox, isolate at home in a separate room from family and pets until your rash and scabs heal.

Health care professionals may treat mpox with some antiviral drugs used to treat smallpox.

Does mpox affect PrEP effectiveness?

No. PrEP (pre-exposure prophylaxis) is still effective at preventing HIV. People who use PrEP should continue to take it.

Vaccinations

What is the best protection against mpox?

The most effective way to protect yourself from mpox is to get vaccinated.

A safe smallpox vaccine is available and currently offered as a pre-exposure (preventative) vaccination, primarily to gay, bisexual, and other men who have sex with men who are at highest risk of exposure to mpox.

The vaccine is also offered to close contacts of people diagnosed with mpox and healthcare professionals who are seeing potential monkeypox cases.

The vaccine is given in two doses, and it is recommended people have both to secure the best protection against mpox.

Although a vaccine reduces the chance of becoming severely unwell and further transmission, like any vaccine, it won’t give 100% protection, and won’t be effective immediately, so stay alert for symptoms.

Who is eligible for a vaccine?

A vaccination is being offered to people who are most at risk to help protect them against mpox.

The NHS is offering the smallpox (MVA) vaccine to people who are most likely to be exposed to mpox.

People who are most likely to be exposed include:

• Men who are gay, bisexual or have sex with other men, and who have multiple partners, participate in group sex or attend sex-on-premises venues (staff at these venues are also eligible)
• People who've been in close contact with someone who has mpox – ideally, they should have one dose of the vaccine within 4 days of contact, but it can be given up to 14 days after
• Healthcare workers caring for patients with confirmed or suspected mpox

Healthcare workers will usually be offered two doses of the vaccine.

Men who are gay, bisexual or have sex with other men will be offered two doses of the vaccine. The second dose will be offered a minimum of 28 days after the first dose.

There was an initial mpox vaccination campaign in the second half of 2022 during an outbreak of mpox. As cases fell, the targeted vaccination programme was wound down. Following two recently identified cases in Greater Manchester, local vaccine appointments will be made available to people who are eligible.

How can I get a vaccine?

The NHS in Greater Manchester has been working to step-up its vaccination programme to meet any unmet demand and is offering a limited service whilst more vaccination clinics are re-established. This will ensure people considered at high risk of getting mpox can protect themselves and others from severe illness.

Will there be more chances to get vaccinated?

Plans are being worked up for the vaccination offer to be made more widely available in Greater Manchester to those at highest risk, and more details will follow soon.

Clinics will be advertised on the national mpox vaccine finder site:Find an mpox vaccination site - NHS (www.nhs.uk). The risk of mpox remains low and if you have previously been vaccinated, you do not need to have another vaccine. If you are concerned about symptoms, please contact your/a sexual health clinic.

Are there side effects to the vaccine?

The most common side effects of the vaccine are itching and pain at the injection site, with some muscle ache or tiredness. This is normal and will usually go away after a few days. One in 10 people may experience chills and fever, but as with the more common effects, this will subside after a few days.

Some people may experience very rare side effects, like difficulty breathing or a swollen tongue, immediately after the vaccine is given to them. For this reason, you might be asked to wait for 15 minutes in a waiting room after the vaccine is given.

Can I have the vaccine if I have an HIV positive diagnosis?

The vaccine can be given to people living with HIV. However, if your CD4 count is less than 100 then you may not respond as well to the vaccine, which means you could be vulnerable to catching mpox, even if you’ve been vaccinated. If you are identified as a close contact who is eligible for the vaccine you should have a conversation with your doctor about whether you should have the vaccine.

What is the current mpox situation?

Case numbers across England remain very low.

The latest data from UKHSA shows most recent cases, among those seen from April 2023 onwards, have been focused in London, with a small number of cases reported from Greater Manchester.

We should not be complacent about mpox.

For more information about mpox please visit:

https://www.nhs.uk/conditions/mpox/ https://ukhsa.blog.gov.uk/2023/05/14/one-year-on-7-things-weve-learnt-about-mpox/

How to stay safe?

Help others avoid mpox (previously referred to as monkeypox) by isolating if you’re asked to do so by a healthcare professional.

Try to get contact details for your sexual partners so you can get in touch later if anybody suspects they’ve got mpox. If you can talk openly with your partners and trust them enough to talk about sexual history and testing, that’s ideal!

Keep it clean by ensuring you thoroughly wash both before and as soon as possible after, ensuring you don’t share towels. Your clothing should be washed after contact with other people, and think about where you’re having sex - can you use a surface that’s easy to wipe down or wash afterwards?

If you’re using saunas or licenced sex clubs you can still reduce your risk by not sharing towels and not using rooms or equipment directly after somebody else. LGBT Foundation and colleagues from Manchester council and UKHSA have been working with staff in these venues to make sure they understand how to keep staff and customers safer, for example by cleaning more frequently and continuing to provide clean towels for each customer.

Don’t share your toys - sharing sex toys increases the risks of passing on the virus and STIs, but may be safer than having sex. If you do use sex toys, ensure they are thoroughly cleaned before and after use, and consider covering them with a condom.

Stay informed  and stick to trusted information to understand what you should be watching out for. Not everyone with mpox has the same symptoms - some people might not have a rash but still be able to pass on the infection. If you’re feeling unwell in general or have a fever, wait until you’re feeling better.

Safer Sex is key!  Using condoms and lube is as important as ever in protecting you and your partner(s). We’re providing free postal condoms and lube to Greater Manchester residents, which you can order here. If you've recovered from mpox, keep using condoms for 12 weeks. It is currently unclear how long the virus stays in semen and genital fluids, so it's better to be safe than risk passing it on!

The fewer people, the better - while mpox is out there, you may choose to limit the number of people you have sexual contact with and the number of times you have sex. The more time you leave between sexual or non-sexual physical contact with other people, the less likely you are to pass on infections to others.

Be kind and remember that if you see somebody with spots or sores on their skin, it’s not necessarily mpox. Lots of other skin conditions can look similar, and may not be infectious. If you suspect somebody else has symptoms and you talk to them about it, be respectful and don’t make judgements.

As always, if you want to talk to someone about the type of sex you’re having, or the sex that you want to have, you can contact our sexual health team for non-judgemental sex positive discussions at  [email protected]. If you prefer to have this discussion over the phone, send us your number and we will arrange to call you back.

The most up-to-date information and advice on mpox can be found at  https://www.gov.uk/guidance/monkeypox