Monkeypox: What we know about a rare viral infection that’s putting health officials on high alert

Health officials around the world are on high alert over the spread of monkeypox, a rare viral infection that mainly occurs in West and Central Africa.

Great Britain, Portugal, Spain, the United States and Canada are among the countries with suspected or already identified cases.

The UK Health Safety Agency (UKHSA) has detected two new cases of the disease, one in London and one in south east England, bringing the total to nine since May 6, when the outbreak was initially reported. .

Five cases were also confirmed in Portugal and more than 20 are being analyzed in Spain. In the United States, a case has been confirmed in the state of Massachusetts in a man who recently traveled to Canada, but it is not yet known if it is linked to the outbreak in Europe.

According to the WHO (World Health Organization), the most recent cases were reported predominantly in gay, bisexual or men who have sex with men (MSM).

In Portugal, for example, all confirmed cases are in men, mainly young people.

But the US Centers for Disease Control and Prevention (CDC) emphasized in a statement that “anyone, regardless of sexual orientation, can spread monkeypox through contact with bodily fluids, injuries, or shared items (such as clothing and bed) contaminated”.

Why is the outbreak putting authorities on high alert?

The outbreaks are raising alarm because the viral disease, which spreads by close contact and was first identified in monkeys, occurs mainly in West and Central Africa, and only occasionally spreads elsewhere.

“Historically, there have been very few exported cases. This has only happened eight times in the past before this year,” Jimmy Whitworth, professor of international public health at the London School of Hygiene and Tropical Medicine, told Reuters news agency, describing the outbreak as ” highly unusual”.

The spread of the disease this time puzzles experts, because several cases in the UK have no known connection to each other, raising concerns that the infection was contracted through community transmission. Only the first case reported on May 6 has recently traveled to Nigeria.

The virus spreads through close contact and the UKHSA is advising individuals, particularly those who are gay, bisexual or MSM, to be alert to any unusual rashes or lesions on any part of the body, especially the genitals, and to contact a sexual health service in case of concern.

Monkeypox has never previously been described as a sexually transmitted infection, although it can be transmitted by direct contact during sex.

Most people recover within a few weeks.

“The UKHSA is working closely with the NHS and other stakeholders to urgently investigate where and how recent cases of monkeypox were acquired, including how they may be linked to one another.”

“The virus generally does not spread easily between people. The risk to the UK population remains low.”

“These most recent cases, together with case reports from countries across Europe, confirm our initial concerns that monkeypox could spread in our communities,” said Susan Hopkins, UKHSA’s Chief Medical Adviser.

“The UKHSA has identified cases quickly so far and we continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals,” he added.

“We are particularly asking gay and bisexual men to be aware of any unusual rashes or injuries and to contact a sexual health service without delay if they have concerns. Please contact the clinics prior to your visit.”

What is monkeypox and what are its symptoms?

Monkeypox is a relative of smallpox, a disease that was eradicated in the 1980s but is less communicable, causes milder symptoms and is less deadly.

It usually lasts for two to four weeks and symptoms can appear 5 to 21 days after infection.

Monkeypox symptoms usually start with a mixture of fever, headaches, muscle aches, backaches, chills, exhaustion, and swollen lymph nodes.

This last symptom is usually what helps doctors distinguish monkey pox from chickenpox or smallpox, according to the WHO.

Once the fever has passed, a rash may develop, which tends to develop one to three days later, usually starting on the face and then spreading to other parts of the body, including the genitals.

The number of injuries can range from a few to thousands.

The rash changes and goes through different stages, and may look like chickenpox or syphilis, before finally forming a crust, which then falls off.

Why is it called monkeypox?

Monkeypox virus belongs to the genus Orthopoxvirus in the family Poxviridae. It was first discovered in 1958 when two outbreaks of a smallpox-like disease occurred in laboratory monkeys kept for research, hence its name.

But monkeys may not be to blame, and the natural host of monkeypox remains unknown, although the WHO says rodents are the most likely.

“In Africa, evidence of monkeypox virus infection has been found in many animals, including rope squirrels, tree squirrels, rats hunted in The Gambia, voles and different species of monkeys,” says the WHO.

There are two main strains: the Congo strain, which is the most serious — with up to 10% mortality — and the West African strain, which has a mortality rate of around 1% of cases. The UK cases were reported as belonging to the West African strain.

Where is monkeypox normally found?

Human monkeypox mainly causes outbreaks in the rainforest regions of Central and West Africa and is not normally observed in Europe.

The Democratic Republic of Congo (DRC) had the first recorded human case of monkeypox in 1970.

Since then, cases have been reported in 11 African countries: Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ivory Coast, Liberia, Nigeria, Republic of Congo, Sierra Leone and South Sudan.

The first reported monkeypox outbreak outside Africa was linked to the importation of infected mammals in 2003 into the United States, according to the CDC (Centers for Disease Control and Prevention).

More recently, in 2018 and 2019, two travelers from the UK, one from Israel and one from Singapore, all with a history of travel to Nigeria, were diagnosed with the disease following a major outbreak in the country, according to the Europe Health Agency. the European Center for Disease Prevention and Control (ECDC).

How is monkeypox transmitted?

It is possible to contract the virus through biting or scratching an infected animal, eating bush meat, being in direct contact with an infected human, or touching contaminated bedding or clothing.

The virus enters the body through lesions on the skin, respiratory tract or mucous membranes (eyes, nose or mouth).

Human-to-human transmission is believed to occur primarily via large respiratory droplets, which usually cannot travel more than a few meters, so prolonged personal contact would be required.

“Recent cases suggest a potentially new means of spread,” Neil Mabbott, a disease specialist at the University of Edinburgh in Scotland, told the AP news agency.

Keith Neal, an infectious disease specialist at the University of Nottingham in England, raised the possibility that transmission might not occur through sex, but only “close contact associated with sexual intercourse.”

Should I be concerned?

Monkeypox “is usually a mild, self-limiting illness and most people recover within a few weeks,” the UKHSA said in its statement.

“It is important to emphasize that monkeypox does not spread easily between people and the overall risk to the general public is very low,” said Colin Brown, director of clinical and emerging infections at the British health agency.

Mortality is highest among children and young adults, and immunocompromised individuals are especially at risk of developing the most severe form of the disease.

Monkeypox during pregnancy can also lead to complications such as congenital smallpox or stillbirth, the WHO warned on Monday.

“Mild cases of smallpox may go unnoticed and pose a risk of person-to-person transmission,” the UN agency said in a statement.

Is there treatment? What is the best way to prevent yourself?

Currently, there is no specific treatment recommended for monkeypox, and it usually goes away on its own.

Common household disinfectants can kill the monkeypox virus, according to the CDC.

Smallpox vaccination is believed to be highly effective in preventing monkeypox, but as smallpox was declared eradicated over 40 years ago, first-generation smallpox vaccines are no longer available to the general public.

A more recent vaccine developed by Bavarian Nordic for the prevention of smallpox and monkeypox has been approved in the European Union, the United States and Canada (under the trade names Imvanex, Jynneos and Imvamune), and antivirals are also in development.

Because now?

One possible scenario behind the rise in cases is increased travel as Covid-19 restrictions are lifted.

“My working theory would be that there’s a lot of this in West and Central Africa, travel has resumed and that’s why we’re seeing more cases,” Whitworth told Reuters.

Anne Rimoin, professor of epidemiology at UCLA in California, reminded Reuters that as smallpox was eradicated, the ending of vaccination campaigns led to a jump in cases of the disease in areas where the disease is endemic.

She added that urgent investigation of new cases is important, as “they may suggest a new means of propagation or a change in the virus, but all of these must be determined.”

Experts urged people not to panic.

“This will not cause a national epidemic like Covid, but it is a serious outbreak of a serious disease — and we must take it seriously,” concluded Whitworth.