Just as the Covid-19 pandemic was beginning to lift, a new disease has been declared a public health emergency of international concern.
Monkeypox, a disease similar to the smallpox virus, has been around for years, with sporadic outbreaks occurring mostly in and around West Africa where it originated. This outbreak is different, however. It is spreading around the world rapidly – the number of cases has now risen to more than 26,000 across the globe, including nearly 2,700 in the UK, according to the Centre for Disease Control and Prevention. The UK government has already procured more than 100,000 vaccine doses, and there are now more than 18 clinics in London offering jabs, given that three quarters of UK cases are in the capital. The vaccines minister, Maggie Throup, is urging people to wait to be invited for their first dose.
In addition to Monkeypox, in June the UK Health Security Agency (UKHSA) said it had detected Polio – a virus that can infect the spinal cord – in London’s sewage system. Although the UK has officially been polio free since 2003, officials announced that several closely-related viruses were found in sewage samples taken between February and May. “This could imply that the virus has evolved into what’s known as vaccine-derived poliovirus type 2 (VDPV2) – which can, in rare cases, cause serious illness in people who are not fully vaccinated,” said Stephen Sosler, head of vaccine programmes at Gavi, the vaccine alliance.
Scientists are now warning that as climate change, health worker shortages and urbanisation increase, pandemics and infectious disease outbreaks are likely to occur more frequently.
In the UK, the UKHSA and Office for Health Improvement and Disparities (which have replaced Public Health England — PHE) have put a number of measures and strategies in place to deal with emerging infectious diseases in order to help the country prepare for, and respond to, the next inevitable outbreak.
What is an “outbreak” – and how is it detected?
The Royal College of Nursing defines an outbreak as “the occurrence of more cases of disease than would be expected within a specific place or group of people over a given period of time”.
An outbreak of a disease does not necessarily have to be transferred from person to person. It can also be “common source” – where victims acquire infection from the same source, such as a contaminated water supply, infected food or a chemical. This specific type of transmission occurred during the 2014 Novichok chemical weapon attack in Salisbury, where a number of people became seriously ill after coming into contact with the poison.
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UKHSA is the organisation tasked with monitoring and managing disease outbreaks, but as frontline health workers are often the first to notice a specific outbreak, Health Protection Regulations require registered medical practitioners to notify the authorities of specified infectious diseases should they present in patients.
What happens when an infectious disease of concern is identified?
When it was still the PHE, the health agency published specific guidance for what should happen when there is an outbreak of communicable (transmissible from person to person) disease. This guidance states that as soon as it “becomes apparent that an outbreak may exist”, PHE (now UKHSA), local authorities and the NHS are all required to discuss next steps”.
After that, “immediate control measures” should be implemented, as well as an investigation into the potential nature of the outbreak. This includes gathering information, such as preliminary interviews and risk assessments.
Once an outbreak has been confirmed, it will be formally declared and NHS England should be notified. Following this, a decision regarding the need to create an “Outbreak Control Team” is made and, if appropriate, that team will convene.
After that, measures will be put into place accordingly. In some instances, such as in the case of the Covid-19 pandemic, some emergency measures may need to be brought into law – such as the closure of non-essential businesses, stay-at-home orders and social distancing measures. Such extraordinary measures will depend upon the transmissibility of the disease, and how severe and lethal it is.
What measures are in place for current infectious disease outbreaks here in the UK?
The government has scrapped the remaining domestic restrictions in the UK for Covid-19, but still offers tips on staying safe on the government’s website.
Monkeypox is being closely monitored by UKHSA, which has released guidance for medical professionals. There are currently no statutory restrictions in place for the general public, and UK authorities are currently offering vaccinations to targeted parts of the population.
Similarly, at present, Polio is under a surveillance programme in the UK with no statutory measures in place for the general public. There is more specific guidance offered to clinicians and authorities.
How can I keep track of the latest news?
Public health officials are closely tracking all diseases of concern in the UK and globally, and will alert authorities and the media when necessary. For the most specific, up-to-date information, you can visit the UKHSA website or gov.uk, but any necessary and vital information should be communicated via public news channels and official social media channels.
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