Monkeypox: Reasons for Concern

A researcher, in the Indian laboratory that investigates monkeypox. / EFE

The WHO monitors a disease with more than 18,000 cases and which registers the first two deaths in Europe in Spain

Alvaro Soto

In mid-May, a health alert shook epidemiologists. The UK had just detected two cases of monkeypox, a disease that had never before been transmitted outside of Africa. Overcome the initial scare, the first news was relatively good. In young people, its symptoms were uncomfortable but not dangerous; and by avoiding contact between risk groups (particularly men who have sex with men), chains of transmission could be controlled within weeks.

However, everything has become complicated, to the point that the World Health Organization (WHO) – yes, with its divided experts – declared monkeypox a week ago as an international public health emergency of “worrying nature”. », the highest alert level you can set for a disease. How did we get to this?

What happened in London?

Scientists continue to investigate how monkeypox, until now confined to central or western Africa, was able to spread into the heart of Europe. "The most likely theory is that before the first two cases (unrelated to each other) were reported in the British capital, the virus was already circulating in the United Kingdom or on the continent," explains the Professor of Microbiology at the University of Salamanca Raúl Rivas, who has followed the spread of the outbreak from the outset.

What does the "concerning" emergency declaration mean?

“This is the seventh time that a statement of this type has been made in the last thirteen years,” Rivas underlines. In 2009 it was due to the H1N1 virus (swine flu) pandemic, in 2014 due to poliomyelitis, in the 2013-2016 period due to the Ebola outbreak in West Africa, in 2015 and 2016 due to the Zika virus epidemic, 2018 to 2020 due to the Ebola epidemic in Kivu and the penultimate one, due to the covid-19 pandemic. With this declaration, the WHO warns that a disease has become "a risk to the public health of other States through the international spread of the disease and that it potentially requires a coordinated international response," says Rivas.

How is monkeypox spread?

It does so by very close physical contact, mainly in the context of high-risk sexual relations. According to a report from the University Hospital of La Paz in Madrid published this week in 'The New England Journal of Medicine', 95% of infections have occurred through sexual activity between men. But health authorities warn: if transmission is not controlled, there is a high chance that it will spread to other groups and, if this happens, vulnerable people (immunosuppressed, transplant recipients, babies or the elderly) may be at risk.

new symptoms

The most common symptoms among patients are skin rash, fever, fatigue, muscle pain, vomiting, diarrhea, chills, sore throat, or headache. But experts have also detected anogenital lesions or mucosal lesions.

What is the WHO doing?

When it launched the alarm a week ago, the organization asked those infected, suspected cases and their close contacts not to travel to avoid spreading the virus. The health agency also asked countries to establish protocols for carrying out diagnostic tests. But this Wednesday the WHO went further. With 18,000 confirmed cases worldwide, he called on gays to reduce their sexual contacts and to "exchange information" about the possibility of being infected with the people with whom they have sex.

Treatments and vaccines

In Europe, the drug Tecovirimat SIGA, licensed for use in the treatment of smallpox, monkeypox, and cowpox, and the Imvanex vaccine, licensed to protect adults against smallpox and monkeypox, can be used.

Situation in Spain

Spain is the second country in the world with the most cases (4,298) only surpassed by the United States (4,907). In Europe, the other States with the most patients are Germany (2,540), the United Kingdom (2,367) and France (1,837). Spain was one of the first European countries to detect cases and an event, the Maspalomas Pride, and a place, the Paraíso sauna in Madrid, became outbreaks of the disease in May. It has also been the first to confirm two deaths – the first in the Old Continent – ​​in the Valencian Community and in Córdoba. Along with a patient in Brazil, they are the only deaths outside of Africa.

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