With the World Health Organization declaring a recent rise in mpox cases in Central and Eastern Africa a Public Health Emergency of International Concern, Dr Kirsty Roy and Dr Kate Smith, Consultants in Public Health at PHS, explain more about the current international situation and what is being done to prepare for any cases seen in Scotland. 

The recent rise of mpox cases in Central and Eastern Africa is of global concern due to the potential for the virus to spread beyond the affected countries. It’s therefore important that we’re prepared in the event a case is identified in Scotland. 

Mpox is an uncommon viral infection compared to viruses like influenza or COVID-19.  

It typically causes a blistering rash which can last 2 to 4 weeks and can be accompanied by fever, headaches, muscle and back aches, tiredness and swollen lymph nodes.   

There are two main types of mpox clade 1 and clade 2 that are then further divided into clade 1a, clade 1b and clade 2b. Each type can differ in who they affect, how they spread, and the severity of the outcomes.  

Clade 1 mpox is more serious than clade 2, as it can be passed on more easily, can make people more severely ill, and has a higher fatality rate. This is why clade 1 is classified as a high consequence infectious disease (HCID). HCIDs are rare in the UK, and established protocols and guidance are in place to manage these.  

What’s the current global situation? 

Historically, clade 1 mpox has been associated with Central Africa and linked with more severe disease and higher death rates. Recently, a new type (clade 1b) has emerged and is circulating, particularly in sexual networks in the Democratic Republic of Congo (DRC) and neighboring countries.  

It was the emergence and rapid spread of clade 1b that prompted the World Health Organization to declare the outbreak as a Public Health Emergency of International Concern (PHEIC) in August 2024.  

Although most cases are currently confined to Central and Eastern Africa, there is the potential for the virus to spread out with the continent to other countries, as we saw with the global outbreak of mpox clade 2 in 2022. 

It’s therefore important to be aware of the above symptoms. Anyone with these should stay at home, avoid close contact with others and get medical help by phone. More information can be found on NHS inform. 

How is mpox passed on? 

Mpox is not passed on very easily between people. However, you can get it from close contact with an infected person, including during sex or by contact with contaminated materials (for example bedding or towels).  

It’s possible that mpox may also be passed on through close and prolonged contact that can include talking, breathing, coughing or sneezing. There is currently limited evidence around this, and information will be updated when new evidence becomes available. 

What's the current situation in Scotland? 

Currently, no cases of clade 1 mpox have been confirmed in Scotland. The UK Health Security Agency (UKHSA) confirmed it had detected the first case of mpox clade 1b in England on 30 October, however, the risk to the UK population is still considered low.   
 
PHS is working closely with public health partners across the UK, as well as NHS boards, to monitor the situation and prepare for any cases of clade 1 mpox in Scotland.  

As part of this, we have rapidly put testing in place to ensure suspected cases can be quickly tested in Scotland at the Edinburgh Specialist Virology Centre (SVC) and the West of Scotland Specialist Virology Centre (WoSSVC) Glasgow. 

What's the travel advice? 

Currently the risk to most travellers is small. A list of countries where cases of Clade 1 mpox have been identified can be found on the UK Government website  

Anyone travelling to an affected country is encouraged to take precautions, such as minimising physical or sexual contact - especially with individuals showing signs of a rash - to reduce the risk of infection. 

Working in partnership with Scottish airports, we have ensured that information about the clade 1b international situation is visible to travellers in Scottish Airports. These signpost to key information on affected countries and how to access healthcare services in Scotland if an individual develops mpox symptoms. 

Is there a vaccine to protect against mpox? 

Mpox belongs to a family of viruses that includes smallpox and a vaccine that was developed to protect against smallpox is also considered effective against mpox. 

This vaccine was used as part of the response to the 2022 outbreak of clade 2 mpox, which mainly affected gay, bisexual or other men who have sex with men (GBMSM), and Scotland continues to offer mpox vaccination to those at greatest risk. 

On behalf of Scotland, and other devolved nations, the UK Government has procured more mpox vaccine doses to strengthen the UK preparedness against clade 1 mpox. More information about vaccine eligibility can be found on NHS inform. 

Scotland has a robust public health intelligence system, is now able to rapidly identify and test potential cases and has a supply of effective vaccines. There is also public health information available to ensure people are prepared if they are visiting an area of higher risk. These should all ensure Scotland is prepared should cases emerge within the country. 

View more information on the first case of mpox Clade1B identified in England  

Further information on the current situation in Scotland is available on the PHS website 

Further information and advice on mpox, including details on vaccine eligibility, can be found on NHS inform 

Further information for those travelling to an affected country is available on Fit For Travel   

Last updated: 31 October 2024