The UK Health Security Agency (UKHSA) has detected 2 additional cases of monkeypox, one in London and one in the South East of England.

The latest cases bring the total number of monkeypox cases confirmed in England since 6 May to 9.

The 2 latest cases have no travel links to a country where monkeypox is endemic, so it is possible they acquired the infection through community transmission.

The virus spreads through close contact and UKHSA is advising individuals, particularly those who are gay, bisexual or MSM, to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns.

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

The 2 new cases do not have known connections with previous confirmed cases announced on 16, 14 and 7 May.

UKHSA is working closely with the NHS and other stakeholders to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other.

The virus does not usually spread easily between people. The risk to the UK population remains low.

Anyone with concerns that they could be infected with monkeypox is advised to contact NHS 111 or a sexual health clinic. People should notify clinics ahead of their visit. We can assure them their call or discussion will be treated sensitively and confidentially.

Monkeypox is a viral infection usually associated with travel to West Africa. It is usually a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks.

Dr Susan Hopkins, Chief Medical Adviser, UKHSA, said:

These latest cases, together with reports of cases in countries across Europe, confirms our initial concerns that there could be spread of monkeypox within our communities.

UKHSA has quickly identified cases so far and we continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals.

We are 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. Please contact clinics ahead of your visit.

We are contacting any identified close contacts of the cases to provide health information and advice.

Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact specialist services for advice.

Symptoms

Initial symptoms of monkeypox 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.

Scientists at the Centers for Disease Control and Prevention are watching the outbreak in Europe closely. "We do have a level of concern that this is very different than what we typically think of from monkeypox," Jennifer McQuiston, a senior CDC official, told health news site STAT on Tuesday.

UPDATE

On May 18, 2022, a U.S. resident tested positive for monkeypox after returning to the U.S. from Canada. As of May 18, 2022, no additional monkeypox cases have been identified in the U.S.

Scientists at the Centers for Disease Control and Prevention (CDC) are collaborating with the Massachusetts Department of Public Health to investigate a situation in which a U.S. resident tested positive for monkeypox on May 18 after returning to the U.S. from Canada.

CDC is also tracking multiple clusters of monkeypox that have been reported in early- to mid-May in several countries that don’t normally report monkeypox, including in Europe and North America.

For more information on exposure risk, see Monitoring Persons Exposed.

It’s not clear how people in those clusters were exposed to monkeypox but cases include people who self-identify as men who have sex with men. CDC is urging healthcare providers in the U.S. to be alert for patients who have rash illnesses consistent with monkeypox, regardless of whether they have travel or specific risk factors for monkeypox and regardless of gender or sexual orientation.