What we know about the new outbreak of monkeypox

What happened?

United Kingdom detected on May 7 2022 a case of monkeypox or monkeypox in a patient who had recently traveled to Nigeria. Two other cases were announced on May 14, unrelated to the previous one and with no travel history.

On May 17, four additional cases were found, with no connection to the previous ones (although two of the four had common contacts) and no travel history.

At the time, the director of the United Kingdom Health Security Agency admitted that it was something "rare and unusual" and that the evidence suggested that there was community transmission.

Are there cases in Spain?

On Friday, May 20, the Ministry of Health reported that the Carlos III Health Institute had confirmed seven cases of monkeypox after partial sequencing of the virus. In addition, another 23 samples have tested positive for non-human smallpox by PCR and must also be sequenced to determine what type of smallpox it is, according to the Ministry of Health.

This May 23, the Madrid Minister of Health, Enrique Ruiz Escudero, has stated that the laboratory that confirms the cases has so far confirmed the positivity of 30 patients and the number of suspicions has increased to 45. In a previous statement, the Ministry pointed out that "in general its transmission occurs by respiratory route, but due to the characteristics of the 23 suspected cases of infection [en ese momento], points to the fact that it was due to contact with mucous membranes during sexual intercourse”. The people under study evolve positively and are isolated in their homes, although close surveillance must be maintained since they may require hospital admission, according to information provided by the Community of Madrid.

Following the protocol, an alert has been opened at the national level, the situation has been communicated to the Alerts Committee and all the key actors have been notified for a coordinated response. "The Ministry of Health is in permanent contact with the European Alert System to monitor this alert at a global level," the agency highlights.

Why are all the cases in men who have sex with men? Is it a sexually transmitted disease?

As you have advanced The country most suspected and confirmed cases have occurred in men who have sex with men. This does not mean that monkeypox is a sexually transmitted disease or that it only affects this group. “By nature, sexual activity involves intimate contact, which increases the chances of transmission, regardless of sexual orientation and mode of transmission,” explained to SCM British the virologist of Imperial College London (United Kingdom) Michael Skinner.

"The fact that several of the cases are among men who have sex with men does not imply that it is a sexually transmitted disease as such," warned the president of the Association of Foreign Health Doctors, Mar Faraco, in statements to SCM.

The researcher at the University of Southampton Michael Head assured that “this could be the first documented transmission through sexual contact”, although he clarified that it was something that had yet to be confirmed.

The UK Health Security Agency epidemiologist Mateo Prochazka considered that "This new transmission route will have implications for outbreak response and control." He also emphasized the importance of "addressing discourses that reinforce inequalities and stigmas."

But what is monkeypox?

The monkeypox virus belongs to the Orthopoxvirus genus, whose most famous member is smallpox (Variola virus), which was declared eradicated in 1980. Since then it has become the most important representative of this type of virus.

How is it transmitted?

Monkeypox has a somewhat misleading name, as it is actually usually transmitted by small mammals such as rodents (but also by apes). The name is due to the fact that it was detected for the first time in laboratory macaques in 1958. The contagion requires direct contact with the blood, fluids or injuries of the animals.

Human-to-human transmission is limited and requires close contact, either with respiratory secretions or skin lesions, a contaminated object, or prolonged face-to-face contact that allows infection from respiratory particles. The longest documented chain of transmission is six people.

Where does it come from?

It is an increasingly common disease in West and Central Africa. Since its discovery in 1970, it has been detected in 11 African countries. As is often the case on the mainland, the true burden of monkeypox is unknown.

The Democratic Republic of the Congo, for example, reported 704 cases in the first two months of 2022, of which 37 died. Since January 2020, the African country has reported more than 10,000 infections and 342 deaths. A 2010 study showed how cases had increased in this country after the cessation of smallpox vaccination campaigns.

Is it rare to find cases outside of Africa?

Although exports are rare, they have increased in recent years.

The first time cases were found outside of Africa was in 2003, when an outbreak occurred in the United States that affected 47 people. Its origin was found in prairie dogs that were sold as pets and that had lived with animals from Ghana.

Isolated cases were found in Israel and the UK in 2018. In 2019, in the United Kingdom and Singapore. In 2021, in the United States and the United Kingdom. All occurred in travelers from Africa or in toilets.

Why this increase in cases inside and outside Africa?

Studies like is published in Natural Medicine in 2005 suggest that people vaccinated against smallpox have some cross-immunity against monkeypox virus. Smallpox was declared eradicated in 1980 and vaccinations had already been slowing down in the previous decade: this implies that an increasing percentage of the population does not have protection against this virus or, by extension, against smallpox. monkeys.

It's dangerous?

There are two strains: West African and Congo. The first is the one that has been detected in the British cases, the first of which had traveled to Nigeria. It is the least lethal version, with a mortality of around 1%. The Congo strain has mortality of up to 10% and is probably better transmitted.

Case fatality has ranged from 0% to 11% in the general population, but is higher in young children and it is believed that the younger population, not vaccinated against smallpox, may be more susceptible. These figures come from developing countries with health systems with limited resources, so they cannot necessarily be extrapolated to other parts of the world.

What symptoms do you have?

Symptoms in humans are similar to smallpox, but milder. Incubation is usually between 6 and 13 days.

In the first phase there is fever, headaches, back and muscle aches, swollen lymph nodes, chills and tiredness. This lasts between 0 and 5 days.

Between 1 and 3 days after the onset of fever, itching begins (usually first on the face) that progresses to typical skin lesions. The illness lasts between 2 and 4 weeks.

The Ministry of Health reports that most people recover within several weeks, although serious illness may occur in some cases.

Is there a treatment or vaccine?

There is currently no specific treatment recommended for monkeypox, but there are tools to control outbreaks. smallpox vaccine is considered effective to prevent infection or make it milder, but these vaccines are no longer in circulation. A newer version against smallpox and monkey pox was approved in 2019, but is not yet available to the general public.

According to the Ministry of Health, treatment is symptomatic and supportive, including prevention and treatment of secondary bacterial infections.

Should we worry about the current outbreak?

Unlike previous outbreaks, with a few cases associated with travel or specific exposures (as happened with prairie dogs), in this case the health authorities fear that there is community transmission with undetected infections, both in the United Kingdom and in other countries.

“We are concerned that this is very different from what we typically associate with monkeypox. We have some concern that there may be spread outside of the UK." assured an official of the American CDC to Stat.

"The general public has no reason to worry, but doctors and public health authorities must be alert to detect infected cases early and limit transmission," reassured the virologist from Imperial College London (United Kingdom). speaking to the British SMC.

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