Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 26, Number 4—April 2020

Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018

Aisling Vaughan1, Emma Aarons, John Astbury, Tim Brooks, Meera Chand, Peter Flegg, Angela Hardman, Nick Harper, Richard Jarvis, Sharon Mawdsley, Mark McGivern, Dilys Morgan, Gwyn Morris, Grainne Nixon, Catherine O’Connor, Ruth Palmer, Nick Phin, D. Ashley Price, Katherine Russell, Bengu Said, Matthias L. Schmid, Roberto Vivancos, Amanda Walsh, William Welfare, Jennifer Wilburn, and Jake DunningComments to Author 
Author affiliations: Public Health England, London, UK (A. Vaughan, E. Aarons, J. Astbury, T. Brooks, M. Chand, A. Hardman, R. Jarvis, M. McGivern, D. Morgan. G. Morris, G. Nixon, C. O’Connor, N. Phin, K. Russell, B. Said, R. Vivancos, A. Walsh, W. Welfare, J. Wilburn, J. Dunning); NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, London (A. Vaughan, T. Brooks, D. Morgan, R. Vivancos, J. Dunning); Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK (P. Flegg, N. Harper, S. Mawdsley, R. Palmer); The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK (D.A. Price, M.L. Schmid)

Main Article


Public Health England risk assessment and public health recommendations for persons potentially exposed to 2 patients with monkeypox, United Kingdom, 2018*

Risk group Description Public health surveillance Postexposure vaccination with Imvanex No. persons in risk group† No. (%) persons in risk group who received postexposure vaccination†
No risk
No known contact (direct or indirect) with a symptomatic monkeypox case-patient‡
Laboratory staff handling specimens from a monkeypox case-patient, in a laboratory conforming to UK laboratory standards§
Not recommended
Not applicable
HCW involved in care of monkeypox case-patient while wearing appropriate PPE (with no known breaches) for all contact episodes
HCW involved in care of monkeypox case-patient while not wearing appropriate PPE for all contact episodes but not within 1 m of case-patient and with no direct contact with body fluids or potentially infectious material
Community contact not within 1 m of case-patient
Not recommended
Intact skin-only contact with a symptomatic (with rash) monkeypox case-patient, their body fluids, or potentially infectious material# or contaminated fomite
No direct contact but within 1 m of symptomatic monkeypox case-patient without wearing appropriate PPE (including disposable FFP3 respirator or equivalent)
Vaccination may be considered
84 (67)
High Direct exposure of broken skin or mucous membranes to monkeypox symptomatic case-patient, patient’s body fluids, or potentially infectious material** (including clothing or bedding) without wearing appropriate PPE (including disposable FFP3 respiratory or equivalent). Exposure includes inhalation of respiratory droplets or material from scabs from cleaning rooms where a monkeypox case-patient has stayed, mucosal exposure to splashes, penetrating injury from used sharps, device or through contaminated gloves or clothing Active# Vaccination recommended 5 5 (100)

*Imvanex (modified vaccinia Ankara, Bavarian Nordic, was approved by the European Medicines Agency in July 2013 for active immunization against smallpox in adults. Jynneos (modified vaccinia Ankara; Bavarian Nordic) was approved by the US Food and Drug Administration in September 2019 for the prevention of smallpox and monkeypox disease in adults >18 y of age determined to be at high risk for smallpox or monkeypox infection. FFP3, filtering facepiece 3; HCW, healthcare worker; PHE, Public Health England; PPE, personal protective equipment.
†For patients 2 and 3 combined.
‡Case-patients are considered potentially infectious 24 h before the onset of rash.
¶A person requiring passive surveillance is given information about monkeypox and what to do if illness develops.
#A person requiring active surveillance is given information about monkeypox and instructed to report health status daily to PHE, regardless of symptoms, for 21 d from the date of most recent exposure, and to report any illness immediately. In addition, HCWs with high-risk exposures are to be excluded from work for 21 d after the most recent exposure (note this recommendation was introduced after diagnosis of the third case-patient).
**Potentially infectious biological material consists of skin lesions and detached scabs.

Main Article

1Current affiliation: London School of Hygiene and Tropical Medicine, London, UK.

Page created: March 17, 2020
Page updated: March 17, 2020
Page reviewed: March 17, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.