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Monkeypox Now Treated 'Same as Plague' Following Severity Level Increase

Monkeypox upgraded to same severity level as leprosy and plague.

UK Doctors are now compelled by law to inform authorities of all suspected cases of Monkeypox, a level of that also includes Leprosy and Plague.

Since early May, more than 1,100 confirmed and suspected infections have been reported in 40 countries - including 302 in the UK.

As of Wednesday, it will be a legal requirement for doctors to inform their local council or health protection team if they even suspect a patient has the virus, while labs must tell the UK Health Security Agency (UKHSA) if a sample tests positive. The move elevates monkeypox to the same legal status as 33 other diseases – including leprosy, rabies, plague and yellow fever – which are designated as “notifiable” under the UK’s health protection regulations.

Covid-19 was first made a notifiable disease on 5 March 2020, before the UK went into lockdown. But Dr Meaghan Kall, an epidemiologist at the UKHSA, said the latest move has “no direct link to [disease control] measures” and should not be interpreted as a precursor to coronavirus-like restrictions. “It just means that clinicians and laboratories have a statutory requirement to report cases,” she told The Telegraph. “We need to monitor cases for surveillance and [epidemiological] purposes.” The change also means all overseas visitors who are diagnosed or treated for monkeypox will be exempt from charges. “This is important as a cost to access testing and treatment from NHS can be a huge barrier and stop people from coming forward – increasing risk of transmission,” Dr Kall added. It comes amid mounting concerns about the global spread of monkeypox outside west and central Africa, where the disease is endemic. Since early May, more than 1,100 confirmed and suspected infections have been detected in 40 countries – including 302 in the UK. The World Health Organisation (WHO) says that the “sudden and unexpected” explosion of cases suggests the virus has been spreading silently for months, possibly even years. The agency’s latest update also warned that some countries were reporting cases unlinked to confirmed patients, “suggesting that chains of transmission are being missed”. Prof David Heymann, a former WHO director and professor of infectious disease epidemiology, said the UK’s decision to make monkeypox a notifiable disease may reflect a concern that transmission is taking place outside the most at-risk groups. So far, the bulk of cases have been among gay, bisexual and other men who have sex with men. Although monkeypox is not normally a sexually-transmitted infection, it is transmitted through close contact, and the latest outbreak appears to be driven by sexual networks. “Making it a notifiable disease means that they want to be sure to have reporting from all sectors and all parts of the NHS,” he told the Telegraph. “It suggests that they want to focus surveillance on the entire population – not only on the risk groups identified so far.” The Telegraph reports that health authorities do not expect cases to significantly increase as a result of the legal change, although it is difficult to predict. The UKHSA has asked all registered medical practitioners to tell them about cases since the early days of the outbreak, but the latest move formalises that process. “Rapid diagnosis and reporting is the key to interrupting transmission and containing any further spread of monkeypox,” said Wendi Shepherd, monkeypox incident director at the UKHSA. “This new legislation will support us and our health partners to swiftly identify, treat and control the disease.”

Asymptomatic Cases may well be coming. The first person in the UK to speak about contracting the illness, a gay man from London, said that he had no rash or spots anywhere on his body when he was diagnosed with Monkeypox leading many to believe that the WHO will shortly redefine the list of symptoms to include asymptomatic transmission. Once that is established everyone can potentially be a 'case'.

“In any outbreak, the actual number of infections will be higher than the ones diagnosed,” said Prof Francois Balloux, director of the University College London Genetics Institute. “This is particularly the case for a disease which can often be mild with fairly unspecific symptoms such as monkeypox. It is difficult to work out at the moment whether cases are going up, down or plateauing worldwide" The UKHSA added on Tuesday that cases in the UK will be announced on a Monday, Wednesday and Friday going forward and an agreement with the BBC to report those figures will undoubtedly raise the panic level further.


First published in August 2020

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