Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018

Aisling Vaughan; Emma Aarons; John Astbury; Tim Brooks; Meera Chand; Peter Flegg; Angela Hardman; Nick Harper; Richard Jarvis; Sharon Mawdsley; Mark McGivern; Dilys Morgan; Gwyn Morris; Grainne Nixon; Catherine O'Connor; Ruth Palmer; Nick Phin; D. Ashley Price; Katherine Russell; Bengu Said; Matthias L. Schmid; Roberto Vivancos; Amanda Walsh; William Welfare; Jennifer Wilburn; Jake Dunning


Emerging Infectious Diseases. 2020;26(4):782-785. 

In This Article

Abstract and Introduction


In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.


Monkeypox is a reemerging zoonosis caused by Monkeypox virus (MPXV), a member of the genus Orthopoxvirus. MPXV is related to Variola virus, the causative agent of smallpox. Although infections with these 2 viruses share many clinical features, monkeypox is generally less severe than smallpox.[1] Among unvaccinated persons, the monkeypox case-fatality rate can be up to 10%, although case-fatality rates are lower for infection with the West African than the Central African clade of MPXV.[2] In recent years, the number of cases and geographic spread of monkeypox have been increasing, possibly because of waning immunity to smallpox.[3–5] Before 2018, the only human cases of monkeypox outside Africa occurred in the United States in 2003; that outbreak was associated with rodents imported from Ghana, and human-to-human transmission did not occur.[6]

In September 2018, Public Health England (PHE) was notified of 2 unrelated cases of monkeypox affecting travelers who had recently returned from Nigeria.[7] We describe transmission of monkeypox virus from the second of these cases to a healthcare worker (HCW) and the public health measures implemented to prevent further cases.