Unusual outbreak of monkeypox identified in the UK
Cases of monkeypox have been identified in England, Scotland and Wales, as part of a wider global outbreak. Monkeypox is a viral infection, usually associated with travel to West or Central Africa. Cases have been reported in Australia, Canada and the United States, as well as several European countries including Italy and Spain.
Close physical contact
Monkeypox does not spread easily and requires close physical contact with clothing or linens (such as bedding or towels) used by an infected person direct, contact with monkeypox skin lesions or scabs, or exposure to coughing or sneezing of an individual with a monkeypox rash. The majority of cases have been found in gay and bisexual men, but UNAIDS stated, ‘WHO notes that available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, and that risk is not limited to men who have sex with men.’
The UK Health Security Agency (UKHSA) note: ‘a notable proportion of cases detected have been in gay and bisexual men, so UKHSA continues to urge this community to be alert to monkeypox symptoms.’
The WHO have urged against stigmatizing those who may be infected to avoid detering people from accessing healthcare. In a press statement they said: ‘Stigmatizing groups of people because of a disease is never acceptable. It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread.’
Signs and symptoms
The illness begins with (UKHSA, 2022):
- Fever
- Headache
- Muscle aches
- Backache
- Swollen lymph nodes
- Chills
- Exhaustion.
Within 1–5 days after the appearance of fever, a rash develops, often beginning on the face then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab which later falls off (Figure 1). The incubation period for monkeypox is between 5 and 21 days. Diagnosis can be difficult and the disease is sometimes confused with chickenpox or syphilis.
Dr Susan Hopkins, Chief Medical Adviser, UKHSA, said: ‘Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms.’
Risk to the population remains low
The UKHSA stress that the risk to the UK population remains low.
Dr Hans Henri P Kluge, WHO Regional Director for Europe, said: ‘Monkeypox is usually a self-limiting illness, and most of those infected will recover within a few weeks without treatment. However, the disease can be more severe, especially in young children, pregnant women, and individuals who are immunocompromised.’
Immunisation of close contacts
UKHSA health protection teams are contacting people considered to be high-risk contacts of confirmed cases and are advising those who have been risk assessed and remain well to isolate at home for up to 21 days. High risk contacts are being vaccinated with Imvanex, a vaccine against smallpox. As monkeypox is related to the virus causing smallpox, vaccines designed for smallpox will likely provide some cross-protection (UKHSA, 2022).
The right emollient for children with eczema is the one that they like to use, study finds
A study into the best emollients for eczema has found that no one type is better than another, highlighting the importance of patient choice when deciding which moisturiser to prescribe (Ridd et al, 2022; Sutton et al, 2022).
Over 100 different moisturisers are prescribed on the NHS, costing over £100 million each year. Lack of research has meant local guidelines differ widely across the NHS.
No difference in effectiveness
In the study 550 children with eczema aged under 12 years were randomised to use one of four types of emollient (lotion, cream, gel or ointment) as their main moisturiser for 16 weeks. Parents completed diaries about their child's eczema for a year, and some were interviewed to gain an in-depth understanding of how they used the moisturisers and what they thought of them. All children also had an independent examination of their skin. There was no difference in effectiveness of the four types of moisturiser used in the study.
Users had different preferences based on how the moisturisers look and feel: some people liked how lotions quickly soaked in whereas others preferred the ‘barrier’ provided by ointments.
Challenging conventions
Professor Matthew Ridd, a GP and study lead from Centre for Academic Primary Care at the University of Bristol, said: ‘A study of this type has been long overdue. It has not been in the interest of the manufacturers to directly compare types of moisturiser in the way we have done in this trial. Our findings challenge conventions about how often moisturisers need to be applied, which types are less likely to cause problems and which patients should be recommended certain types. For example, ointments are often suggested for more severe eczema, yet they were found to be no better.’
Tiffany Barrett, pharmacist and co-researcher added: ‘NHS prescribing of moisturisers is determined by locally agreed formularies. These formularies are based on both cost and perceived effectiveness. What this study does is emphasise the importance of having the four main types of moisturisers available on formularies for children with eczema, so that the right product can be used at the right time.’
One size does not fit all
Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham, explained: ‘Our study shows that one size does not fit all, and points to the need for doctors to make parents aware of the different emollient types and to help them choose which one is mostly likely to work for them. At last we have evidence that supports the saying, “The best moisturisers are the ones the patient will use.”’