Monkeypox is a rare disease that is caused by infection with monkeypox virus. There has been a sharp increase in monkeypox cases reported in the UK since May 2022, compared to the 7 cases that were reported between 2018 and 2021.

Monkeypox does not spread easily between people. The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).

Person-to-person spread is uncommon, but may occur through:

• contact with clothing or linens (such as bedding or towels) used by an infected person
• direct contact with monkeypox skin lesions or scabs
• coughing or sneezing of an individual with a monkeypox rash

The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for monkeypox is between 5 and 21 days.

Monkeypox infection is usually a self-limiting illness and most people recover within several weeks. However, severe illness can occur in some individuals.

The illness begins with:

• fever
• headache
• muscle aches
• backache
• swollen lymph nodes
• chills
• exhaustion

Within 1 to 5 days after the appearance of fever, a rash develops, often beginning on the face then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab which later falls off.

An individual is contagious until all the scabs have fallen off and there is intact skin underneath. The scabs may also contain infectious virus material.

Clinical diagnosis of monkeypox can be difficult, and it is often confused with other infections such as chickenpox. An initial diagnosis of monkeypox requires assessment by a health professional and specific testing in a specialist laboratory. The use of photographic images (of the patient’s rash or any presenting lesion) may be suitable to provide an initial virtual diagnosis, for example by a dermatologist.

Suspected cases should then be discussed with the Imported Fever Service prior to arranging for samples to be submitted for laboratory testing.

Treatment for monkeypox is mainly supportive. The illness is usually mild and most of those infected will recover within a few weeks without treatment.

Smallpox vaccine, cidofovir, and tecovirimat can be used to control outbreaks of monkeypox.

Vaccination against smallpox can be used for both pre and post exposure and is up to 85% effective in preventing monkeypox. People vaccinated against smallpox in childhood may experience a milder disease.

Prevention of transmission of infection by respiratory and contact routes is required. Appropriate respiratory isolation is essential for suspected and confirmed cases. Scabs are also infectious and care must be taken to avoid infection through handling bedding, clothing, and so on.

Guidance for primary care

Monkeypox: guidance for primary care

Guidance for environmental cleaning and decontamination

Monkeypox: Guidance for environmental cleaning and decontamination

Further information

See WHO factsheet.

Additional monkeypox resources are also available on GOV.UK, including information on case definitions, contact tracing and vaccination.

See NHS Conditions – Monkeypox and DermNet