As 113 cases of monkeypox are reported in Ireland - among thousands of confirmed cases worldwide - here's what you need to know about this viral outbreak.
Today, the interim Chief Medical Officer, Professor Breda Smyth, said she expects Ireland to receive additional vaccines by December as limited supplies mean only around 10% of people at heightened risk will receive a shot when the vaccination programme begins in coming weeks.
"We would hope at some stage that everyone who is at risk will be offered a vaccination but as we know vaccination isn't the only tool in our box," Prof Smyth told RTÉ's News at One.
Earlier today, the Department of Health confirmed the establishment of a strategic advisory group on monkeypox, chaired by Professor Smyth.
What is monkeypox?
Monkeypox is a very uncommon viral infection that produces a spotty, itchy and sore rash, and sometimes a fever.
The HSE says that monkeypox does not spread easily between people and can affect anyone, regardless of their sexual orientation or gender.
But the biggest risk of spread between people, by far, is through close physical contact, including sexual contact and close contact with household members.
The HSE says that monkeypox spreads from person to person through very close contact, which can include: sexual contact; other types of very close contact, for example with people in your household;
touching clothing, bedding or towels used by someone with the monkeypox rash or scabs; touching monkeypox skin blisters or scabs; the coughs or sneezes of a person with monkeypox when they're very close to you.
It says vaccination does not guarantee that a person cannot become infected, so it urges those who are vaccinated to be alert to the signs of monkeypox infection.
There are two types of monkeypox: West African monkeypox and Congo Basin monkeypox.
It is the milder West African type that is causing the current outbreak.
Monkeypox has long been endemic in parts of west and central Africa. But in recent months, there has been a surge in infections reported in many countries around the world.
Worldwide
Worldwide, more than 35,000 cases have been confirmed since the start of the year, according to the World Health Organization, which has designated the outbreak a global health emergency.
Most of these cases are in countries that have not historically reported monkeypox.
It has been identified in 92 countries.
Around 12 deaths related to monkeypox have been reported.
On 17 August, WHO's Director General Dr Tedros Adhanom Ghebreyesus said: "Almost 7,500 cases were reported last week, a 20% increase over the previous week, which was also 20% more than the week before.
"Almost all cases are being reported from Europe and the Americas among men who have sex with men, underscoring the importance for all countries to design and deliver services and information tailored to these communities that protect health, human rights and dignity.
"However, for the moment, supplies of vaccines, and data about their effectiveness, are limited, although we are starting to receive data from some countries."
He said work in renaming the virus was "ongoing".
How many cases are in Ireland?
To date, the Health Protection Surveillance Centre has been notified of 113 confirmed cases of monkeypox in Ireland.
In each case, public health is following up those who had close contact with the case while they were infectious.
Public health risk assessments are undertaken, and those who were in contact with the cases are being advised on what to do in the event that they become ill.
Who is at risk?
Health authorities here say that many countries have reported that the cases are predominantly, but not exclusively, in men who self-identify as gay, bisexual or other men who have sex with men (gbMSM).
The HSE says currently notified cases of monkeypox in Ireland are in people who self-identify as gbMSM.
It is advising those who self-identify as gbMSM to be alert to any unusual rashes or vesicular lesions on their (or their partner's) body, especially their genitalia.
They urge people with such changes to contact their local STI clinic or their General Practitioner (GP) for advice.
Monkeypox has not been designated as a sexually transmitted disease.
Symptoms
The Health Protection Surveillance Centre says symptoms of monkeypox include:
- itchy rash
- fever (>38.5C)
- headache
- muscle aches
- backache
- swollen lymph nodes
- chills
- exhaustion
Vaccination
There is currently a limited supply of vaccines available in Ireland, and the European Union, so the HSE said it is prioritising those who are at high risk of contracting monkeypox in the first phase in vaccination in the next few weeks.
It estimates that around 6,000 people may be at heightened risk of monkeypox infection, but current supplies will see around 10% vaccinated in the first phase. The second phase of vaccine roll out in Ireland is likely to commence later this year and into next year.
The HSE is now widening the vaccination process and is implementing the most recent National Immunisation Advisory Committee (NIAC) advice, which is to vaccinate people at risk before they are exposed to the virus.
The HSE said: "Given the current limited vaccine supply, and following detailed clinical discussions the HSE will prioritise the vaccine for gbMSM and transgender people who have had a notification to the HSE's Infectious Disease Monitoring system known as CIDR, of early infectious syphilis (EIS) between December 2021 and July 2022."
"This group is being prioritised because the nature of the spread of syphilis is similar to that of monkeypox, and syphilis also disproportionately affects gbMSM when compared to other STIs.
"In addition, the majority of these patients are diagnosed through sexual health clinics which means they can be more quickly identified and invited for vaccination.
"People in this group will therefore be prioritised in the first phase of the Monkeypox vaccinations process."
First phase of vaccination
The HSE said it it working closely with Infectious Disease and Genitourinary Medicine Consultants and the clinical teams in STI clinics around the country to put a process in place to identify and call forward people for vaccination.
"In this first phase of the pre-exposure vaccination programme, the STI teams will offer approximately 600 people, two doses of the vaccine – 28 days apart as per the NIAC guidelines," it said.
"Services will begin to contact these people directly in the coming days and it is expected that people identified will receive the vaccine over the coming weeks. The confidentiality of these individuals will be protected."
Executive Director of HIV Ireland Stephen O'Hare said the short supply of vaccines will not be sufficient to stem the spread of the virus in Ireland and "90% of those who need to get the vaccine won't get it in the first phase".
He said: "As NIAC has identified we need to vaccinate against monkeypox at the pre-exposure phase and though it's good we are vaccinating people, with only 10% of people going to be covered it is going to be insufficient to stem the onward transmission of monkeypox in the population."
Mr O'Hare said at present the transmission is not confined people who are gay, bisexual or transgender, but that is where most of the cases are occurring.
Overall risk
Monkeypox is much less contagious than Covid-19 and much less likely to result in death.
There are also treatments and vaccines, originally developed to treat smallpox, that work to protect people.
