Last reviewed: December 2018
Last updated: October  2018
28 Sep 2018

Third case of monkeypox diagnosed in the UK

Public Health England (PHE) has confirmed that three patients have been diagnosed with monkeypox in England. The first two patients are believed to have acquired the infection in Nigeria before travelling to the UK, while the third patient is a healthcare worker involved in the care of the second patient before monkeypox was diagnosed.

The first patient is a resident of Nigeria, and has received treatment at the Royal Free Hospital in London under strict isolation procedures. Prior to this, the patient was staying at a naval base in Cornwall. The second patient had travelled to Nigeria, and first presented to Blackpool Victoria Hospital, before being transferred to Royal Liverpool University Hospital for specialist care. The third patient is now isolated and is being looked after in a specialist unit at Royal Victoria Infirmary, Newcastle.

PHE said it would be contacting people who may have been in close contact with the individuals to provide information and health advice. The cases are the first ever diagnoses of monkeypox in the UK.

PHE has stressed that the infection does not spread easily between people and that the risk of transmission to the wider public is very low. However, it has produced guidance on diagnosis and treatment of the condition and commented that following a large sustained outbreak in Nigeria in 2017, monkeypox could continue to affect travellers returning from this area.

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • fever
  • vesicular rash
  • oropharynx and tongue enanthem
  • lymphadenopathy

Other diagnostic factors

  • headache
  • backache
  • pharyngitis
  • vomiting
  • diarrhoea
  • delirium
  • convulsions

Risk factors

  • contact with laboratory (smallpox)
  • bioterrorism (smallpox)
  • close contact with known case (smallpox)
  • contact with monkeypox in animals or humans

Diagnostic investigations

1st investigations to order

  • vesicle specimen PCR
  • FBC
  • urea and electrolytes
  • LFTs
  • venous lactate
  • clotting screen
Full details

Investigations to consider

  • blood culture
  • malaria antigen test
Full details

Treatment algorithm


Authors VIEW ALL

Consultant in Infectious Diseases

Department of Infectious Diseases and Tropical Medicine

North Manchester General Hospital




TB is the principal investigator on an MRC/Wellcome/Newton Fund grant to make a Zika vaccine based on recombinant modified vaccinia Ankara.

Peer reviewers VIEW ALL

Professor of International Public Health

London School of Hygiene & Tropical Medicine




JW declares that he has no competing interests.

Epidemic Intelligence Service Officer

Poxvirus and Rabies Branch

Centers for Disease Control and Prevention




AS declares that she has no competing interests.

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