Since early May, more than 100 cases of monkeypox have been reported in 16 countries in Europe, North America and Australia. While the first human infection was found in Africa half a century ago, it is the first time it has spread to many non-endemic countries, raising concerns among scientists and health authorities. Germany to release monkeypox guidance, mulls vaccine options – minister On Monday, the UK Health Security Agency said it had detected 36 more cases, bringing the total since May 7 to 56. Meanwhile, Belgium has become the first country to introduce a 21-day mandatory quarantine for patients, while doctors in Hong Kong have been told to report any suspected cases . However, scientists say there is no cause for panic because monkeypox is not like Covid-19 and does not easily spread. Here is what is known about the disease. What is monkeypox? It is caused by a virus from the same family as those that cause smallpox and cowpox. The disease was first discovered among laboratory monkeys in 1958, while the first human case was recorded in the Democratic Republic of the Congo in 1970. Since then, human cases have been reported in central and western African countries. The World Health Organization records two strains of the disease: the milder west African strain – which includes all the recent cases – and a more severe central Africa, or Congo, strain. What are the symptoms? The symptoms are similar to smallpox and the WHO has said the authorities should be alerted if people develop an unusual rash and develop one or more of the following: headaches, fevers above 38.5 degrees Celsius (101 degrees Fahrenheit), swollen lymph nodes, muscle and body aches, back pain or abnormal physical weakness. The incubation period ranges from five to 21 days and a rash usually appears within one to three days after developing a fever. The rashes tend to be concentrated on the face, palms and soles of the feet, although they can also affect the inside of the mouth and genitalia. People usually recover within weeks. Severe cases occur more commonly among children, while those with underlying immune deficiencies may also have worse symptoms. In recent times, the case fatality ratio has been around 3 to 6 per cent, according to the WHO. How is it transmitted? Monkeypox is a zoonotic disease that can affect many animals, including rats, monkeys, rope squirrels and tree squirrels. The animal reservoir is not known though rodents are the most likely suspects. Direct contact with the blood, fluids or lesions of infected animals can spread the disease to humans. However, it does not spread easily among people. Human-to-human transmission happens as a result of close contact – for example prolonged face-to-face contact, touching skin lesions or bodily fluids or from contaminated bedding and clothing. Monkeypox is not a sexually transmitted disease, but infections can occur through intimate physical contact. ‘US let monkeypox loose’ conspiracy theories swirl on China’s Weibo platform “Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men seeking care in primary care and sexual health clinics,” the WHO said. John Brooks, an official with the US Centres for Disease Control and Prevention, told CNBC that most of the identified cases were gay or bisexual men, though he said the disease could be spread via sexual contact regardless of orientation. He also said it was important to be aware that some symptoms – particularly anal or genital lesions – could be confused with chickenpox or sexually transmitted diseases such as herpes or syphilis. “We want to help people make the best informed decisions to protect their health and the health of their community from monkeypox,” Brooks said. Should we be worried? Britain, Portugal and Spain have recorded the highest number of cases in the current outbreak and the WHO is expecting more confirmed infections. It warned there was an urgent need to raise awareness and improve care, isolation and contact tracing for confirmed cases – but stressed there was no cause for panic. “This is a containable situation,” the WHO’s emerging disease lead Maria Van Kerkhove said on Monday: “We can [stop human-to-human transmission] in non-endemic countries.” “For the broader population, the likelihood of spread is very low,” said Andrea Ammon, the director of the European Centre for Disease Prevention and Control. WHO says no evidence monkeypox virus has mutated “However the likelihood of further spread of the virus through close contact, for example during sexual activities amongst persons with multiple sexual partners, is considered to be high”. The US has recorded seven cases and officials there say the risk is low. “This is not Covid,” Jennifer McQuiston, from the CDC, said on Monday. Are there vaccines available? Two types of approved vaccines for smallpox could be used to contain monkeypox although scientists believe there is no need to vaccinate the general public. The newer type Jynneos, made by Bavarian Nordic, was approved in the US in 2019 and the American government holds 1,000 doses in stockpile. The older type of smallpox vaccines, ACAM2000, now produced by Emergent BioSolutions, has some significant side effects and can be risky for immunosuppressed people, such as HIV carriers, and even be fatal for people with eczema. On Sunday, China National Biotec Group, China’s largest vaccine producer, posted on WeChat that China has preserved monkeypox strains in case it needed to make vaccines after the eradication of smallpox.