Image source, Science Photo Library

We're going to wrap up our live coverage now, but here's a recap what we've heard today:

• Another 36 cases of monkeypox have been detected in England, bringing the total number of confirmed cases to 56, the UK Health Security Agency says
• The UKHSA says the outbreak is "significant and concerning" but the risk to the UK population "remains low"

• The spread of monkeypox is "a containable situation", Dr Maria Van Kerkhove from the World Health Organization says, but warns "we can't take our eye off the ball"
• UK Prime Minister Boris Johnson says that so far the consequences "don't seem to be very serious but it's important that we keep an eye on it"
• The director of the EU disease control agency has said countries should review availability of the smallpox vaccine which is used for monkeypox
• Denmark and Scotland have recorded their first cases of monkeypox, meaning it's now been found in 16 countries outside Africa, including Spain, Portugal, the US and Australia

• In the UK, anyone at the highest risk of having caught monkeypox should isolate for 21 days.

Three facts to remember:

• Monkeypox doesn't tend to spread easily between people and the illness is usually mild
• Symptoms include a fever, aches, and a rash of raised spots that later turn into blisters. For most people it clears up within two to four weeks
• Unlike Covid, monkeypox is spread through close physical contact with somebody infected and we have tools – such as the smallpox vaccine – that can be used to help limit the spread.

Want more? Read up on what monkeypox is and how it spreads here.

Image source, EPA

Downing Street has said there are no plans to hold a meeting of the Cobra emergency committee over monkeypox, or to impose any travel bans.

Asked about travel restrictions from affected countries before the 36 new UK cases were announced, the prime minister's official spokesman said: "No, no considerations of that kind. What we're seeing at the moment is community transmission not linked to travel."

He said vaccines were being offered to close contacts but there were no plans for an "at scale" vaccination programme.

"We do have vaccines procured at significant numbers but given the nature of this and how we know it's spreading, it's thought to be no clinical requirement for that sort of at scale campaign," he said.

Why this is not like the early days of Covidpublished at 17:05 British Summer Time 23 May 2022

17:05 BST 23 May 2022

James Gallagher
Health and science correspondent, BBC News

It is tempting to treat this outbreak of monkeypox as though we’re in the early days of the Covid pandemic - but this is not Covid-Two.

We should expect cases to continue to rise beyond the 57 now recorded across the UK.

But remember monkeypox and coronavirus are different viruses that spread in a different ways and will need different tools to control them.

There are urgent questions that need answering:

• Why is the monkeypox virus spreading now?
• Has it mutated or did it just get a lucky break?
• Will it fizzle out like other outbreaks or will it take hard work to bring cases down?
• How many people are already infected?

Covid was a highly contagious disease that spread through the air we breathe and could spread even if you had no symptoms.

Monkeypox mainly spreads through close skin to skin contact and its blistering rash is hard to miss. We should have the tools to deal with it.

More now on the rise in monkeypox cases in the UK, with 36 new cases in England bringing the UK total to 57.

In a statement, the UKHSA said the outbreak is "significant and concerning" but the "risk to the UK population remains low".

Its chief medical adviser, Dr Susan Hopkins, urged people to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms, as the virus spreads through close contact.

“A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging these men to be alert to the symptoms.”

She thanked those who have come forward for monkeypox testing so far and who have supported contact tracing efforts.

"You are helping us limit the spread of this infection in the UK," she said.

The UK Health Security Agency (UKHSA) has said it has detected 36 additional cases of monkeypox in England.

The latest cases bring the total number of monkeypox cases confirmed in England since 7 May to 56.

Adding in the new case in Scotland, that brings the UK total to 57.

Laura Foster
BBC Scotland senior health reporter

Not much is known about Scotland's first monkeypox case, but some details are now starting to emerge.

We now know that the person is in isolation in a Scottish hospital in an area which specialises in infectious diseases.

They were exposed to the virus in the UK and their close contacts are already being contacted and offered the smallpox vaccine.

Dr Nick Phin from Public Health Scotland says you’d expect to have between 10 and 20 contacts for each case of monkeypox and says a "more than sufficient" number of vaccine doses have been ordered for this case "plus a buffer".

He could not confirm whether everyone who has been offered the vaccine has accepted the jab – but admits there has been some reluctance in England as can typically happen with vaccination programmes.

But Dr Phin stresses that "we’re not in a scenario like covid where we’re going to be vaccinating large swathes of the population".

Lauren Moss
LGBT+ & Identity Correspondent

Alex Sparrowhawk from Terrence Higgins Trust, the HIV and sexual health charity, says anyone with new symptoms – that can include a rash – should call their local sexual health clinic or 111 before going anywhere in person.

They’re also monitoring the cases alongside the NHS and UK Health Security Agency.

Alex said: “We absolutely don’t want to stigmatise gay and bisexual men and know the importance of being proactive in guarding against that.

"But we also know that to date a disproportionate number of monkeypox cases are among gay and bisexual men and want to play our role in reaching this community with the most up-to-date information including symptoms and what do."

Image source, Anadolu / Getty

Countries should review their availability of the smallpox vaccines used for monkeypox, as well as stocks of antivirals and personal protective equipment, an EU disease expert says.

Dr Andrea Ammon, the director of the EU's European Centre for Disease Prevention and Control, is also urging countries to swap their contact tracing mechanisms and their capacity to diagnose the disease.

She says those who are infected with monkeypox should remain isolated until their lesions heal completely.

"For the broader population, the likelihood of spread is very low," Dr Ammon says.

"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."

Philippa Roxby
Health reporter, BBC News

Experts at the World Health Organization know a huge amount about monkeypox already.

But there's a suggestion that perhaps not enough research has been carried out to keep pace with this current outbreak.

What's puzzling them is why it has spread so widely outside of Africa.

Is it simply the result of a 'superspreader event'? That would mean lots of people mixing closely together passing the virus on to others wherever they travel to next.

No one is sure what particular event could have been the cause.

There have been warnings that summer festivals could spread the virus even more.

Image source, CDC

Infection control experts from Europe have issued their advice and thoughts on the monkeypox situation.

They agree that while the disease is usually mild, some people can get more seriously ill.

That includes young children, pregnant women and people with weakened immune systems. Further investigations are needed to accurately estimate that level of threat, says the European Centre forDisease Prevention and Control, external.

And it warns that humans may be able to spread the virus to animals, including pets or wildlife. If so, there is a risk that the disease could become endemic in Europe.

Lauren Moss
LGBT and Identity Correspondent

Monkeypox is prompting questions among the gay community, with the latest health data indicating a proportion of the recent cases in the UK and Europe have been in gay and bisexual men.

It’s important to stress that this is not an illness that affects one community more than any other, and it’s not a sexually transmitted disease. It’s spread through close contact.

These latest infections are new and, as we learn more about them, more information will become clear about who is becoming infected.

WHO expert Andy Seale has suggested it could be due to an increased awareness of sexual health amongst the gay community; meaning more infections among that group are coming to light. For now though, it’s early days and too soon to say why.

UNAids has urged caution in the language used when we discuss monkeypox and to make sure that it doesn’t reinforce any homophobic or racist stereotypes. Any stigma around the disease could seriously undermine any response to the outbreak.

Getting the balance between informing groups who might need to be vigilant, but not stigmatising them, will be key to targeting the right public health message to the right people.

Image source, Reuters

US President Joe Biden has said the US has enough smallpox vaccine to deal with an outbreak of monkeypox. A smallpox jab offers some good protection against monkeypox since the two viruses are quite similar.

Biden urged people to be careful, but said the situation did not warrant the same emergency response seen worldwide during the coronavirus pandemic.

Shares of smallpox vaccine and drugmakers including SIGA Technologies and GeoVax Labs jumped between 7% and 40% after the US identified its third suspected case of monkeypox.

Philippa Roxby
Health reporter, BBC News

Image source, Getty Images

Sexual health doctors in the UK are warning monkeypox could have a major impact on access to sexual health services.

Staff at clinics who have seen patients infected with the virus are being told to stay at home and isolate for 21 days.

That means there are fewer doctors available to treat people coming in with other infections.

And in London, where most of the UK's 20 confirmed cases have been found, sexual health clinics want everyone to phone or email ahead, rather than walk in for an appointment.

The British Association for Sexual Health and HIV said it was concerned about the pressure this was already putting on the workforce.

It warned that sexually-transmitted infections could be missed while access to sexual health clinics is restricted.

Michelle Roberts
Health editor, BBC News online

We've just heard from experts at the World Health Organization and they say nations should be prepared to see more cases of monkeypox in the coming weeks.

That doesn't mean the situation is necessarily getting worse though, or that the disease is out of control. Health officials say they are confident that the spread can be contained.

Why? Although the outbreak we are seeing is unusual, the virus is not so easy to catch as some other diseases, such as Covid. We know it takes very close physical contact - often skin-on-skin - to spread monkeypox between people.

And unlike Covid, which is often asymptomatic, people with monkeypox will usually feel unwell and notice a rash.

Drugs and vaccines are already available that can help control and treat monkeypox.

As the WHO discussion draws to a close, one member of the public has shared concerns with the panel that the response to this virus could fuel discrimination.

Andy Seale, a WHO adviser on HIV, hepatitis and STIs programmes, says while some media reporting on monkeypox has been very good, sometimes it "does come sadly with some misinformation, stigma and discrimination".

He says has not just been the case for men who have sex with men, "but perhaps also unintentionally suggesting this is an African disease by only using images of black skin, for example".

Seale says the WHO wants to learn from the decades of experience tackling stigma and discrimination around HIV.

And he says they want to make sure communities are helping inform messaging and surveillance around monkeypox.

We're following experts from the World Health Organization answering questions from the public about monkeypox.On vaccines, Dr Rosamund Lewis says that, although smallpox has now been eradicated, studies from the time showed that smallpox vaccines were effective against monkeypox around 85% of the time.

The viruses, she says, are closely related to each other.

Monkeypox vaccines exist but are relatively new and not widely available. But the WHO experts said they were working to enhance availability.

"This is not something that everybody needs - it is only spreading between close contacts [of] those who are cases," Dr Maria Van Kerkhove adds.

A notable proportion of UK cases of monkeypox are in gay or bisexual men, which has prompted the UK Health Security Agency to encourage men who have sex with men to be aware of any unusual rashes or lesions.

The WHO's Andy Seale says it's early days, but this demographic is generally one which really takes care of health screening when it comes to potential STIs.

The fact this demographic has been proactive about responding to unusual symptoms might be part of the story, he says.

Image source, WHO

Some of the early symptoms are fever, headache, lethargy, backache and this usually lasts for a day or two, says Dr Rosamund Lewis.

Following this, a rash begins and it starts with red areas on the skin, then it progresses to papules which are raised, then to vesicles or blisters, and then to pustules.

After that they begin to dry and scab, and the scab falls off, she says.

In terms of the body, the classic progression is face, then to limbs, palms of the hands, soles of the feet and then to the body itself, the says.

Swollen lymph nodes are also a common symptom, and Dr Lewis says an important distinction between monkeypox and smallpox - which was eradicated in 1980 - was that if a child had swollen lymph nodes it was more likely to be monkeypox than smallpox.

Philippa Roxby
Health reporter, BBC News

Moving away from the WHO for a moment, UK Prime Minister Boris Johnson has said that monkeypox is "rare" and "so far the consequences don't seem to be very serious".

Speaking at a primary school in south-east London, the PM told reporters "it's important that we keep an eye on it and that's exactly what the new UK Health Security Agency is doing".

Johnson also said health officials were closely examining how the infection was being spread.

High-risk close contacts, such as doctors who've diagnosed people with the virus, are being advised to isolate for 21 days. Some are also being offered a smallpox vaccine which is known to provide good protection against the similar monkeypox virus.

We don't really know, says Dr Rosamund Lewis, the head of the WHO smallpox secretariat.

"It's a very stable virus," she says, explaining that smallpox is a DNA virus and the mutation rate is much lower than for RNA viruses, which include coronavirus.

We don't yet have evidence that there's a mutation in the virus itself, she says, but experts are beginning to collect information on this.

Virologists will soon begin discussing if the virus has changed based on the sequence of the genome of some of the cases that are being detected, she says.