Cases of monkeypox are continuing to emerge in unexpected parts of the globe. With case numbers slowly creeping upward in parts of Europe and North America, some health authorities have started dishing out advice to people who may have come into contact with the rare disease. 

As of May 21, at least 92 lab-confirmed cases and 28 suspected cases in 12 different countries where the virus is not typically endemic have occurred, according to the World Health Organization (WHO).

Between 21 to 30 cases each have been found in the UK, Portugal, and Spain, while between one and five cases have been identified in Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, and the US. The past few months have also seen cases in Cameroon, the Democratic Republic of the Congo, Nigeria, and the Central African Republic, where the virus is naturally endemic.

The virus that causes monkeypox is part of the same family as smallpox. Symptoms of monkeypox are also similar to smallpox – albeit milder – with patients experiencing fever, achy muscles, swollen lymph nodes, exhaustion, and a rash, then later more visible symptoms like unusual rashes, lesions, and scabs on the skin. 

While typically most patients suffer from a mild illness and recover relatively quickly, the disease can be fatal, especially for younger people, and some people can develop more serious symptoms.

The United Nations AIDS agency has warned that some reporting on the monkeypox outbreaks has been used to “reinforce homophobic and racist stereotypes and exacerbate stigma,” stressing that the risk is not limited to men who have sex with men nor African people. 

Cases have mainly, although not exclusively, been seen in men who have sex with men (MSM). However, this is not to say that the virus is sexually transmitted or that MSM are more at risk, simply that it can be transmitted through close skin-to-skin contact or exposure to infected body fluids via sex. It can even be passed on by sharing clothes or bedsheets, although the virus is not considered to be extremely contagious. 

The cases are unusual because many patients have not recently traveled to parts of the world where the disease is naturally found in primates and rodents, such as Central and West Africa. Genetic analysis of the virus suggests that the unexpected cases belong to the West African clade, as opposed to the Congo Basin clade. It's also most closely related to the strains detected in the UK, Israel, and Singapore in 2018-19.

The UK Health Security Agency (UKHSA) first identified a monkeypox case outside of Africa on May 6. It recently posted an update on the outbreak, asking gay and bisexual men to be particularly aware of potential symptoms, including unusual rashes or lesions on any part of their body, especially their genitalia. 

Further advice from the UK government says that anyone who has had “unprotected direct contact or high-risk environmental contact” with a monkeypox case should isolate for three weeks. Before seeking medical advice in person, people have been asked to call clinics ahead of their visit so they can be prepared. The UK is continuing to offer the smallpox vaccine, which is effective against monkeypox because of its genetic similarity, to people who have been exposed. 

“We expect this increase to continue in the coming days and for more cases to be identified in the wider community. Alongside this, we are receiving reports of further cases being identified in other countries globally," Dr Susan Hopkins, Chief Medical Adviser at the UKHSA, said in a statement.