• We are closely monitoring the outbreak of a new variant of mpox (monkeypox) that has emerged in Central and East Africa. 
• There are multiple known variants of mpox (referred to as clades) each with different characteristics which are outlined below.
• There are currently no reported cases of the new variant in the UK.
• The risk to the general population in the UK is considered low.
• An effective vaccine for mpox already exists and is available to people who meet criteria set by the UK Health Security Agency (UKHSA).

The context

Following the 2022 mpox outbreak in the UK, many people are concerned about the news of a new mpox variant which has emerged in the Democratic Republic of the Congo (DRC) as well as parts of Central and East Africa. Our thoughts are with the communities affected by this new strain of mpox and we affirm that globally, resources and vaccines should be prioritised for the affected region. 

Our team is in constant touch with UK public health authorities and is working hard to monitor the situation. We will keep you updated through our website and social media channels.

In this blog post, we'll talk about:

• The developing situation with mpox.
• The work we've been doing on mpox for the last two years.
• The questions our service users are asking.

There are two variants of mpox known as clades: Clade 1 and Clade 2 

Within each clade, subclades have emerged related to ongoing human to human transmission. 

Clade 2b – the strain involved in the ongoing outbreak in the UK since 2022
Clade 2b mpox was the strain that emerged and transmitted rapidly globally in 2022 and almost 100,000 cases have been detected globally. In Europe, the case fatality rate was low with 4 deaths reported per 10,000 cases detected. In the UK, this strain has predominantly affected gay & bisexual men and other men who have sex with men.

Clade 1a – the strain circulating in DRC for many years
Clade 1a mpox has circulated for many years in the Democratic Republic of the Congo, most frequently related to contact with animals or their meat. This clade has transmitted readily in households and healthcare facilities and has a higher mortality rate than Clade 2 mpox, particularly in children.

Clade 1b – the new strain related to the current outbreak which emerged in 2023
Clade 1b mpox is the new, more transmissible strain of mpox, with a higher mortality rate, has been circulating both within sexual networks and between other close contacts in the Democratic Republic of the Congo since 2023. It has now been detected in countries neighbouring DRC.

On 15 August 2024, Sweden reported an imported case of Clade 1b mpox related to travel to these affected countries. UKHSA will be updating their website with a list of countries affected by the outbreak.

Whilst the UKHSA says that the risk to the general population in the UK remains low, we are keeping the situation under constant review. Given the rapid spread of these cases, it is likely that a case will be detected in the UK.

Please note: this situation may change rapidly. Please check our website and social media channels for the latest updates.

Communication and preparation

We were heavily involved in the response to the 2022 outbreak of mpox (Clade 2b) in the UK, particularly because most of the transmission was happening through close contact during sex. This new mpox variant (Clade 1b) may be different in nature to that of the 2022 outbreak, with much higher community and household transmission rates reported. It is also sexually transmissible and reported to be transmitted in sexual networks.

Our THT Direct helpline is available for people who have questions. People with symptoms or who have recently visited the countries affected by the current outbreak and/or have had contact with people from the affected area can call NHS 111 or our helpline.

We're monitoring the queries coming into Terrence Higgins Trust so that we can best respond to the needs of our service users for timely and accurate information and support. We have set up a task force with daily briefings to keep on top of the latest information and questions that people have. Updates will be reflected in this blog. 

Policy and campaigning

Since 5 July, we have been having conversations about mpox preparedness with the new ministerial team at the Department of Health and Social Care.

On 9 July our briefing for the new Public Health Minister warned of the possibility of future outbreaks of mpox and highlighted that sexual health services have not recovered from the impact of the mpox outbreak of 2022. We therefore urged the government to implement the recommendations of the Joint Committee on Vaccination and Immunisation (JCVI) to introduce routine mpox and gonorrhoea vaccination programmes. 

We spoke to the Minister for Public Health on 18 July and the Secretary of State for Health and Social Care on 30 July about mpox preparedness.

Coordinating with sexual health services and community organisations

We are coordinating with our colleagues at the British Association of Sexual Health & HIV (BASHH) and the British HIV Association (BHIVA) as well as community organisations across the HIV and sexual health sector, sharing messaging and responses to the questions that our service users and stakeholders have.

Read the joint statement from BASHH and BHIVA.

Working with public health teams and the government

Our teams have been in contact with the UK Health Security Agency and public health officials in Scotland and Wales.

We are determined to avoid a repeat of the stigmatising and confusing communications by the government and public health authorities at the start of the 2022 outbreak.

What symptoms should I look out for?

If you have recently travelled to the affected region in Central and East Africa and are worried about symptoms you can check the links below or call NHS 111 or THT Direct on 0808 802 1221.

If you develop a rash and have had recent new sexual partner(s) then you should continue to contact sexual health services by phone, as it is still more likely that you have the mpox variant (Clade 2b) that we have been seeing in the UK for the last 2 years.

Read more information on symptoms and treatment for mpox.

Find information about the symptoms and clinical features of mpox from UKHSA.

Access case definitions, diagnosis, testing, vaccination and principles of infection control for clinicians from UKHSA.

How is mpox passed on?

Mpox is passed on through close contact, including during sex.

The mpox variant present in the UK since 2022 (Clade 2b) has mostly been passed on during sex and the vast majority of cases have been in gay and bisexual men and other men who have sex with men.

Read more information about transmission of Clade 2 mpox since 2022. 

The new mpox variant circulating in Central and East Africa (Clade 1b) appears to be primarily transmitted through close contact during sex and may also be more easily passed on through household contact.

Read more information on mpox transmission from the UKHSA website.

Is it likely that the current mpox (Clade 1b) outbreak will reach the UK?

We can’t say for sure. While the UKHSA says 'the risk to the UK population is currently considered low', we are keeping the situation under constant review. Given the rapid spread of these cases, it's likely that a case will be detected in the UK.

It's important, however, that people recognise that the previous mpox variant (Clade 2b) is continuing to circulate and be detected in sexual health services so if you have a rash, please contact your local sexual health service by phone or call NHS 111.

How is this mpox variant different to the previous outbreak?

The variant involved in the current outbreak in Central and East Africa (Clade 1b) seems to be more transmissible and to have a higher mortality rate than the outbreak that started in 2022. It also appears that non-sexual close contact accounts for a higher level of transmission than for the previous variant (Clade 2b).

How many cases of the previous mpox variant (Clade 2b) have there been recently?

There were 43 new cases in the UK in July 2024, the highest level for nearly two years, but much lower than during the monthly high of 1,339 in July 2022. Monthly reporting from the UKHSA can be found here.

If I had both doses of MVA vaccine in response to the 2022 outbreak am I still protected?

Vaccination with the smallpox vaccine does not give full immunity but gives some protection against the most serious outcomes for all variants of mpox. If you've already had two vaccine doses since 2022 there is no evidence that any additional doses are needed at this time.

If I had mpox during the previous outbreak do I have protection from other variants?

The World Health Organization states, 'Our understanding of how long immunity lasts following mpox infection is currently limited. We do not yet have a clear understanding whether a previous [mpox] infection gives you immunity against future infections and if so, for how long.'

If I only had one dose of mpox vaccine should I get a second dose?

If you only had one dose of vaccine you may want to get a second dose at some point. One dose gives a good level of protection against mpox. However, two doses are recommended to improve protection. The system is already under pressure so where possible you should wait until your next routine sexual health appointment or until a more routine programme is established - something we are pushing for.

I haven’t had the mpox vaccine but I am eligible. Should I get vaccinated?

If you're eligible and haven't been vaccinated it may be a good idea to get vaccinated at some point. The system is already under pressure, so where possible you should wait until your next routine sexual health appointment, or until a more routine programme is established - something we are pushing for.

Who is eligible for mpox vaccination under the current programme and guidelines?

The vaccine programme is prioritising gay and bisexual men and other men who have sex with men, who meet one or more of the criteria (in the previous 12 months).

Trans and non-binary people and some cis women are also eligible if they meet the criteria.

The criteria also apply to people living with HIV. 

The criteria are:

• You have multiple sexual partners.
• You are taking PrEP (pre-exposure prophylaxis), or having sex without condoms.
• You have been diagnosed with a sexually transmitted infection (STI) in the last year.
• You have group sex (including chemsex).
• You visit sex-on-premises venues such as saunas, sex clubs or dark rooms.
• You are doing sex work.
• You have already had contact with a person with a confirmed diagnosis of mpox (ideally within four days but up sometimes up to 14).
• Or you are likely to meet any of these criteria in the near future.

In England, the vaccine is only available in Greater London and Greater Manchester, where the majority of cases are detected.

Find out more about vaccination in:

England
Scotland
Wales
Northern Ireland

I need to travel to the affected region (the Democratic Republic of the Congo and neighbouring countries in Central and East Africa). Are travellers to the region recommended to get the vaccine? Can I get it at a sexual health clinic?

No. Travel vaccines are available at travel clinics and not in sexual health services. The UK has not currently recommended this as a routine vaccine for travel. However, if you are considering having sex while traveling then you should discuss what you can do to protect yourself from sexually transmitted infections (STIs) at your next sexual health clinic visit.

I'm worried about mpox but I'm not eligible for the current vaccine programme. Can I still get vaccinated?

The vaccination programme prioritises those most at risk from the variant of mpox that has been circulating in the UK since 2022. Only these groups are eligible at the moment. More information on vaccines.

How many vaccines have been administered in the UK since 2022?

According to the UKHSA, in England more than 120,000 vaccines have been delivered in sexual health services with more than 77,000 receiving at least one dose.