Second New Zealand monkeypox case confirmed

A second case of monkeypox has been confirmed in New Zealand.

The person, who has a record of recent overseas travel, is isolating in the northern region.

"This case is not linked to the case reported on Saturday, and there is no evidence of any community transmission of monkeypox," the Ministry of Health said.

Public health advice had assessed the risk of transmission from this case as low.

"To protect the privacy of the case and contacts, we will be making no further comment on this case," the ministry said.

Health officials reported the first case of monkeypox in New Zealand at the weekend.

Ministry public health advice for those with monkeypox is to isolate at home until the scabs from lesions have fallen off.

Health officials also ask close contacts to monitor for symptoms for three weeks and isolate if symptoms develop.

The ministry said monkeypox does not easily spread between people so the risk to the public is low.

"Person to person spread may occur through intimate contact with an infected person, including kissing, direct contact with a person's infected lesions, contact with contaminated bed linen or clothes, and respiratory droplets from an individual with monkeypox."

A rash, which typically looks similar to chicken pox, appears after a few days.

Monkeypox in NZ 'inevitable'

Since a cluster of the viral disease was confirmed in the UK in May, the outbreak has grown to more than 8000 cases and spread to 57 countries as far-flung as Venezuela, Iceland, Latvia and South Korea.

"Once we reached that many cases in the world, and Australia was recording 20 of them, we were always going to see it in New Zealand. I don't think there was any ever question of that," Otago University epidemiologist Professor Michael Baker said.

How the global outbreak began remains unclear – and its emergence in the UK marked the first time that what was considered a reasonably rare, tropical disease had spread widely outside rainforest areas in central and west Africa.

Health officials reported the first case of monkeypox in New Zealand at the weekend. Photo / Supplied

With the World Health Organisation recording a 77 per cent jump in cases in the past week - and now considering whether the outbreak should be called a public health emergency - this global flare-up appeared to be only getting started.

More cases were likely to pop up in New Zealand, too - but experts nonetheless expect there's little danger to the public here.

"What would make it more important to New Zealand was if we had local transmission," Baker said.

"But at the moment, this is effectively an imported disease and we'd put it in the general category of tropical infection.

"For global health authorities, the main concern is that it becomes another disease of low and middle-income countries that they don't really need."

What is monkeypox?

Monkeypox is a virus that originates in wild animals such as rodents and primates and sometimes jumps to people - mostly in central and west Africa, where the disease is endemic.

Scientists first identified the disease in 1958 after two outbreaks of a "pox-like" disease in research monkeys. The first known human infection was in 1970, in a 9-year-old boy in Congo.

What are the symptoms and how is it treated?

Monkeypox belongs to the same virus family as smallpox but it has milder symptoms.
The Ministry of Health has said some smallpox vaccines can provide protection against the virus.

The ministry is working with Pharmac to explore options for access to smallpox vaccines that can be used as part of the targeted prevention of the spread of monkeypox in certain situations. Anti-viral drugs are also being developed.

The first symptoms of monkeypox include headache, acute onset of fever greater than 38C, chills, swollen lymph nodes, muscle and body aches, backache and tiredness. The characteristic rash, which typically looks similar to chickenpox, appears after a few days.

"Anyone with lesions that look like chickenpox who have been in contact with a case or have been to Africa should be wary," Baker said.

Monkeypox can be fatal for up to one in 10 people and is thought to be more severe in children.

The US Centres for Disease Control and Prevention said incubation - from infection to symptoms - usually lasted one week to a fortnight but could be as short as five days and as long as three weeks.

But most people recover within about two to four weeks without being hospitalised.
Belgium has introduced a compulsory three-week quarantine for anyone infected with monkeypox.

"We certainly have to be prepared for the scenario because it has been in other Western countries," associate health minister Ayesha Verrall said of New Zealand's response.

University of Canterbury Associate Professor of Epidemiology Arindam Basu believed protection measures will be necessary in New Zealand, as over the next few weeks more monkeypox cases will likely emerge.

"Monkeypox and Covid-19 are different diseases and spread through somewhat different pathways, but at a personal level, personal hygiene measures and protection with masks are super important for both diseases, especially as Covid-19 cases will continue to rise," Basu said.

"Being watchful about contacts, keeping a diary, and getting the tests at the first instances of common cold-like symptoms may be helpful."

The ministry has also provided advice to public health units, primary health organisations and sexual health clinics to assist with identifying potential cases.

Monkeypox cases around the world

The World Health Organisation estimates there are thousands of monkeypox infections in about a dozen African countries every year. Most are in Congo, which reports about 6000 cases annually, and Nigeria, with about 3000 cases a year.

However, many infected people are likely missed because of poor health monitoring systems in various countries.

Isolated cases of monkeypox are spotted outside Africa, including in the US and Britain, but have typically been associated with travel to Africa or contact with animals from areas where the disease is more common.

The Associated Press reported that in 2003, 47 people in six US states had confirmed or probable cases. They caught the virus from pet prairie dogs housed near imported small mammals from Ghana.

What is different about this outbreak?

It's the first time monkeypox appears to be spreading among people who didn't travel to Africa. Most of the cases involve men who have had sex with men.

In Europe, infections have been reported in Britain, Italy, Portugal, Spain and Sweden.
Britain's Health Security Agency said its cases are not all connected, suggesting that multiple chains of transmission are happening. The infections in Portugal were picked up at a sexual health clinic, where the men sought help for lesions on their genitals.

The Ministry of Health and the Autonomous Communities reviewed a "situation report" following the confirmation of 51 positive cases of monkeypox in Spain. Photo / Getty Images

Is monkeypox spread through sex?

The ministry said cases of monkeypox outside of endemic countries have primarily been identified among gay and bisexual men and men who have sex with men, and international cases have been clustered around events where this occurs.

Monkeypox had not previously been documented to have spread through sex, but it can be transmitted through close contact with infected people's body fluids and clothing.

Verrall said monkeypox lesions were distinctive but the disease could incubate undetected at first.

"It can be transmitted by close physical contact or by droplets. But the suspicion is that the cluster that's emerging in Europe has been spread by sexual contact," she said.

Michael Skinner, a virologist at Imperial College London, told the Associated Press in May it's still too early to determine how the men in the UK were infected.

"By nature, sexual activity involves intimate contact, which one would expect to increase the likelihood of transmission, whatever a person's sexual orientation and irrespective of the mode of transmission."