The two deaths with monkeypox in Spain show that the virus is still out of control

In the past week Two young people died with monkeypox in Spain. These two deaths, plus another in Brazil and another in India, released Monday, are the only four deaths from monkeypox that have occurred outside of Africa since the current outbreak was detected in the UK last month. May. The growing number of cases worldwide, the lack of antivirals and also the shortage of vaccines will mean that deaths with the infection continue to add up despite not being a particularly serious disease, according to infectologists.

Dr. Javier Membrillo, spokesman for the Spanish Society of Infections and Clinical Microbiology (SEIMC) and head of the Infectious Diseases section of the Gómez Ulla Central Defense Hospital, acknowledges that deaths in our country do not take specialists by surprise. "We don't have the data to find out about these cases, but we already knew that monkeypox is sometimes complicated and can lead to serious conditions, although it is a disease that is generally mild."

The Carlos III Health Institute is studying the samples of the two deceased in Spain to learn more about the death of these two people. The first case, registered in the Valencian Community last Friday, was caused by an encephalitis associated with the infection, indicated the Department of Health. In Andalusia they are studying whether the death of a 31-year-old man in Córdoba was caused by "meningoencephalitis or another pathology". In both cases they were young men, indicated the Ministry of Health, although the first has not transcended the age.

Before these two deaths were known, experts knew that the two complications of monkeypox to watch out for were pneumonia and meningoencephalitis. "It was something that could happen and the statistics play against us," acknowledges Membrillo, referring to the fact that, with a greater number of cases, "sooner or later" serious patients will continue to appear who, in some cases, may die.

To all this we must add, protests the doctor, that they are having "problems of access to antivirals, to tecovirimat treatment." “Right now we don't have it available in Spain. The doses obtained by the Ministry of Health at the beginning of the outbreak have been consumed and we do not know when we are going to receive more”, reported the SEIMC spokesperson, who attributes the lack of remittances to the fact that, due to the way in which the pharmaceutical industry, "there was no business model that included drugs for smallpox", a disease eradicated in the West. Now it's time to wait.

We will also have to wait for more vaccines to arrive so that a broader vaccination can be carried out, the specialist points out. After receiving the first consignment of vaccines from the EU, Health expanded the group of people who could receive the injection: from people who had been in contact with the virus and had a serious illness to people who maintain "high-risk practices".

"At this point in the epidemic, it would be interesting to intensify the campaign by making a ring vaccination model, that is, that all close contacts of any person with symptoms of the disease are vaccinated immediately." For Membrillo, the objective to be achieved is to vaccinate everyone who wants it within the subgroup with the highest incidence.

Normally, the virus responsible for the current outbreak does not cause serious illness. In Spain, only 120 people have had to be hospitalized, that is, 3.2% of the cases, and the most frequent complications during the clinical process, according to the Health bulletin, were secondary bacterial infections and mouth ulcers.

The variant currently circulating in the West is from the West African clade and is generally "minor." “In the data prior to this outbreak, we talked about a fatality rate of 1% and it is probably lower with the standard care measures of Western hospitals.” As a general rule, according to Membrillo, the disease will not be serious, "but in some people, especially in the immunocompromised", it can be fatal.

Not counting the two deceased from the Valencian Community and Andalusia, the complications seen in consultation had been derived from local reactions to the skin lesions that appear, such as proctitis or inflammation of the rectum, pharyngitis or bacterial infections in areas that , after being scratched, had become superinfected. “Meningoencephalitis is a rare complication of monkeypox”, Membrillo concluded. "They are more frequent in classic smallpox, but this is a disease that has been eradicated" de facto.

"Encephalitis is an inflammation of the brain and its adjoining tissues due to the presence of the virus in the cerebrospinal fluid, the fluid that surrounds the entire central nervous system, and in the brain itself," explains the doctor. Meningoencephalitis occurs when, in addition to the brain becoming inflamed, the meninges are also inflamed.

Globally, to date a total of 21,699 cases of monkeypox have been reported, of which 4,298 correspond to cases detected in Spain, which is the second country with the highest number of infections, only behind the 4,907 in the USA. . They are followed by Brazil with 978, Canada with 761, Peru with 269 and Israel, which adds up to 133.

Due to its expansion in more than 70 countries, The WHO decided just over a week ago to declare an international emergency for monkeypox. Although the decision did not have the consensus of the WHO expert committee, its director, Dr. Tedros Adhanom Ghebreyesus, decided to activate the mechanism in the face of the growing number of infections.

In Spain, during the months of May and June there has been an upward trend in reported cases that continues at the present time. By communities, those that continue to lead in terms of the number of cases are Madrid and Catalonia, with 1,656 and 1,406, respectively. They are followed by Andalusia, which has notified 498, the Valencian Community (213), the Canary Islands (102), the Basque Country (98), the Balearic Islands (89), Aragon (45), Galicia (37), Asturias (36), Castilla y León ( 31), Castilla-La Mancha (23), Extremadura (20), Murcia (19), Cantabria (15), Navarra (8) and La Rioja (2).

Specifically, of the total confirmed cases, more than 4,000 were men and only 64 were women, and the age ranges between 10 months and 88 years, with an average age of 37 years.

The WHO has shared a series of recommendations for four large groups of countries and, from here on, the governments will have to be in charge of adopting special preventive measures to stop an expansion that, although it has nothing to do with what was experienced during the COVID-19 pandemic, has proven to be constant and, in some cases, deadly.

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