Monkeypox surfaces in three cases the U.K. What you need to know about the rare virus

Now there are three.

Officials in the U.K. announced Wednesday that a health worker in Blackpool, in northwestern England, had contracted monkeypox, the third patient in the country to be infected with the rare virus in the past month. The health care worker was infected by a patient who was recently cared for at the hospital.

Britain’s first-ever case of monkeypox was reported on Sept. 8, in a man from Nigeria who had been at a naval base in Cornwall. Only three days later a second imported case was spotted, in a man who had also recently returned from travel in Nigeria.

That second individual, who was not immediately recognized as a monkeypox patient, was initially cared for at Blackpool Victoria Hospital. During that time before diagnosis, a health worker became infected.

Monkeypox is rare, especially outside of Africa. Here’s what you need to know about the virus, how it is spread, and how that spread can be stopped.

What is monkeypox?

It is a disease caused by the monkeypox virus, a cousin of the now-eradicated virus that caused smallpox. Although smallpox is no more — it’s the only human disease ever eradicated to date — there are a number of related pox viruses: buffalopox, camelpox, cowpox.

It is from a different virus family than chickenpox. However, like chickenpox and smallpox, monkeypox causes a rash that forms into rounded poxes that scab over and can scar.

Why is it called monkeypox? Does it infect monkeys?

Monkeypox was first seen in laboratory monkeys in 1958, hence the name. And monkeys are among a number of species — including humans, prairie dogs, rats, mice, and squirrels — that can be infected with this virus. But they aren’t thought to be the reservoir, the natural source of the virus.

Scientists are still trying to identify the reservoir of monkeypox and why a disease that was rarely seen for decades seems to be becoming more common. Last year, the Washington Post accompanied some scientists from the Centers for Disease Control and Prevention and the Democratic Republic of the Congo on an expedition to find the source. You can read about it here.

How bad is monkeypox?

There are two groups, or clades, of monkeypox viruses, one from West Africa and one from Central Africa. The former causes milder disease. Public Health England said preliminary analysis of the viruses from the first two newly identified cases — one of whom infected the third case — suggests these are West African viruses.

The illness itself comes in two phases, the invasion phase and the skin eruption period. During the former, people feel lousy: They have fever, intense headache, swollen glands, back and muscle aches, and lethargy. It can last up to five days.

In the second phase, a rash starts to appear, generally first on the face and then elsewhere on the body. The face, palms of the hands, and soles of the feet are most likely to be affected. The rash forms into pustules that scab. The illness can last up to three weeks in total.

There is no cure, but most people recover. That said, some cases are fatal. In monkeypox outbreaks, a case fatality rate of between 1 percent and 10 percent has been observed.

How does it spread?

People get monkeypox by handling infected animals, through contact with their blood, bodily fluids, or the lesions the virus causes. Eating undercooked meat from infected animals may also be a route of transmission, the World Health Organization says.

Once a person gets infected, he or she can pass it on to other people, either through contact with skin lesions or objects contaminated with pus from lesions or body fluids. People can also spread the virus to other people through respiratory droplets — tiny drops of saliva — the way colds and flu are transmitted.

Where is monkeypox generally found?

Central and Western Africa. The first human case was recorded in 1970 in the Democratic Republic of the Congo, which was then Zaire. Since then cases have been diagnosed in the Republic of the Congo, Cameroon, Central African Republic, Nigeria, Ivory Coast, Liberia, Sierra Leone, Gabon, and South Sudan.

There have been a puzzling number of monkeypox cases recorded in Nigeria over the past year. The Nigeria Center for Disease Control recently reported that between September 2017 and the end of August, 262 suspected cases had been reported from 26 states. Of these, 113 were laboratory confirmed and seven of those people died.

The first monkeypox outbreak outside of Africa happened in the United States.

Say what?

Yup. There was a big monkeypox outbreak in the United States in the spring and summer of 2003, just as the global SARS outbreak was ending.

There were 47 cases — the biggest outbreak on record to that point. Of those, 37 were lab-confirmed and 10 were probable cases. Cases were found in Illinois, Indiana, Kansas, Ohio Missouri, and Wisconsin.

The virus made its way to the U.S. in exotic animals imported from Ghana. The shipment contained roughly 800 small mammals with rope squirrels, tree squirrels, African giant pouched rates, brush tailed porcupines, dormice, and striped mice among them. Testing done by the CDC found a number of infected animals.

The exotic animals were housed close to prairie dogs in the facility of an animal vendor located in Illinois. The prairie dogs also became infected.

How do you stop person-to-person spread?

Once health care facilities realize they’re dealing with monkeypox, they isolate infected patients, and health workers treating them wear the appropriate protective equipment. This infection at Blackpool Victoria Hospital occurred before the hospital diagnosed monkeypox in its initial patient.

In the U.S. outbreak, people working with cases or investigating the animals were offered smallpox vaccine. Public Health England is also using smallpox vaccine to protect people who have had contact with cases.