Monkeypox is “out of the box” and has Europe on edge

BARCELONA — For decades, experts thought monkeypox would simply stay put in Africa. Last May, the zoonotic virus proved that idea wrong, popping up in 23 countries – many of them in Europe – prompting the World Health Organization to declare on Sunday it was a “moderate” global risk. for public health.

“It’s an unusual situation,” said Dr Sylvie Briand, director of the department of pandemics and epidemics at WHO, during a webinar on Monday. “Before, we had [monkeypox] only in certain countries. Now it’s ready to use.

An electron microscope image from 2003 shows oval-shaped mature monkeypox virions and immature spherical virions obtained from a sample of human skin. (Cynthia S. Goldsmith, Russell Regner/CDC via AP)

The sudden rise in cases in Europe, where the UK and Spain have so far recorded 300, is prompting health authorities to issue alerts, warning sexually active populations, especially those who engage in high-risk activities, to be on the lookout for symptoms. The UK has also urged people with monkeypox to refrain from intimate relationships, have no contact with pets and not leave their homes for a month.

Officials in the UK, which confirmed 179 cases on Tuesday, and in Spain, where the Department of Health said on Monday it had 120 cases, are recommending smallpox vaccines for close contacts of those already infected, saying vaccine against the related virus given within four days of exposure can minimize the symptoms of monkeypox.

Click the image for more graphics from the World Health Organization.

Click the image for more graphics from the World Health Organization.

But Dr Daniel Lopez-Acuña, the former director of crisis management at the WHO, told Yahoo News that “we won’t need vaccinations from the general public” because the disease is unlikely to affect large sections of the population. This is encouraging, given that smallpox was eradicated in 1980 and stocks of smallpox vaccine are scarce. (The good news is that health officials say people over 45, most of whom have been vaccinated against smallpox, may be much less likely to get monkeypox.)

Beyond the number of cases in Europe, which is higher than in most African countries where monkeypox is endemic, what the recent outbreak highlights is that human-to-human transmission is indeed possible – and that human sexual contact is now what spreads the disease, as opposed to contact with wild animals.

According to Spanish health officials, two of the “amplifying events” believed to have contributed to the spread of monkeypox across Europe occurred in Spain. One was at a popular and now closed gay sauna in Madrid which is believed to have been linked to at least 20 infections. Another happened in the Canary Islands, the Spanish territory off Africa, which hosted a 10-day gay pride event in early May attended by 80,000 people, and which led to cases in other European countries, including Denmark and Slovenia.

Francesco Vaia speaks to journalists.

Francesco Vaia, director of the Spallanzani infectious diseases hospital in Rome, during a press conference on May 20. Vaia said three cases of monkeypox have been confirmed at the hospital. (Andrew Medichini/AP)

“But it’s not a gay disease – the transmission could have happened at a business conference or a political rally,” Dr. Roger Paredes, chief of the department of infectious diseases, told Yahoo News. the German Trias i Pujol hospital in Barcelona. It is transmitted by close skin contact, Paredes added, and is just as likely to be transmitted by heterosexuals.

In fact, close physical contact of any kind — including talking closely for an extended period and possibly even dancing — could transmit the disease, which can spread through respiratory droplets as well as skin touching skin, and via clothing and bedding.

Health experts now believe monkeypox may have been spreading for months or even years, previously going unrecognized and only now showing up in sufficient numbers to warrant global alerts.

“At first, some practitioners were confused, thinking it might be a manifestation of complicated syphilis [case]a manifestation of another new disease or even an extreme expression of genital herpes,” Lopez-Acuña said.

The fact that the disease makes itself known just before summer – with its music festivals, big parties and extended travels – makes the problem more difficult, as does the fear of stigmatizing those who show symptoms. “We need to identify cases, take good care of them and make sure they isolate themselves,” Paredes said, “and then do contact tracing,” which is critical to controlling the spread.

A patient's arms and torso covered in lesions and sores caused by monkeypox.

The arms and torso of a patient with monkeypox lesions in the Democratic Republic of Congo in 1997. (AP)

Moreover, since the lesions in this outbreak tend to appear in “the lower regions”, according to Dr. Rosamund Lewis, the WHO’s leading expert on monkeypox, some sufferers may not even know it. “You can have these lesions for two to four weeks [in the genital and perianal regions]so they may not be visible to others, but you can still be contagious,” she said Monday.

The recommended one-month quarantine period for infected people further complicates matters. “It’s hard to maintain,” Paredes said. “People don’t usually stay home for a month without leaving.”

Many believe, however, that this outbreak can be contained if people with monkeypox identify with medical professionals and commit to self-isolation, and if their contacts are quickly traced. “Collectively, the world has the opportunity to stop this epidemic,” Lewis said. “There is a window.”

But if not stopped soon, some experts, including Lopez-Acuña, believe monkeypox could be listed as a sexually transmitted infection, even though it is not, by definition, an infection. official sexually transmitted. sickness. It ignores “the whole debate of whether or not it’s an STD” for a matter of semantics. “The fact is that the dominant transmission mechanism in these recent outbreaks in Europe has been sexual,” he said.

The hands of a monkeypox patient with healing wounds.

The hands of a monkeypox patient who displayed the characteristic rash during his recovery phase in 1997. (AP)

That monkeypox is sexually transmitted is no big surprise to US epidemiologist Dr David Heymann, currently professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. The Centers for Disease Control and Prevention sent him to Africa as a principal investigator on monkeypox in the 1970s, when it was largely a disease seen in children. Three years ago he chaired a seminar at London’s Chatham House think tank that looked at the sharp acceleration in monkeypox rates in Africa – increases attributed in part to more frequent global travel, growing numbers of people who don’t hadn’t been vaccinated against smallpox, and even floods that brought humans and wild animals closer together.

A curious idea that emerged during the seminar was “an observation that some people with monkeypox have genital lesions,” he told Yahoo News. “And there was a hypothesis that they could transmit monkeypox if there was close contact in the genital area.” Now, this hypothetical mode of transmission appears to be exactly what spreads the disease, although it’s unclear if the exchange of bodily fluids is necessary for transmission, or if simple skin-to-skin contact is enough to spread it.

In fact, even though monkeypox has been seen in humans for over 40 years, there are still a number of unknowns in this current epidemic. “Pets,” Paredes said, “are pretty uncharted territory. There is potential transmission to pets, but our primary epidemiological concern is whether pets become infected and go outside and encounter other pets,” increasing the animal reservoir of potential carriers. The safety of places like public swimming pools is also “uncertain”, he said, although people with monkeypox should remain isolated at home regardless, he added.

A gloved hand points to a graph on a computer screen.

A computer screen at the Ramon y Cajal hospital in Madrid shows positive results for monkeypox. (Carlos Lujan/Europa Press via Getty Images)

But for now, at least, health officials are relieved that what is circulating widely is the West African strain of monkeypox and not the much more serious Central African strain, which is most likely to be shown on photographs accompanying the reports, according to Heymann, who noted that the Central African strain “is starting to spread from person to person. And that’s a real threat. This strain can prove fatal for 10% of those who acquire it, according to the WHO. Heymann attributes the absence of this strain in Europe to the fact that those who catch it are “extremely ill” and less likely to travel.

While emphasizing that monkeypox “won’t be like COVID – it won’t be a wide-spreading disease that anyone can catch anywhere,” Paredes said, which health authorities want to nip in the bud. . “The big question,” he added, “is whether monkeypox will become endemic in Western countries or not. It depends on the quality of our work in the coming weeks. »

While the risk to the general public may not be high, Lopez-Acuña suggests that the measures put in place to combat COVID can benefit those who want to absolutely minimize any risk of encountering monkeypox. These include wearing masks, social distancing and staying away from environments with crowds. Despite a renewed sense of freedom in Spain (where indoor COVID mask mandates were only lifted in late April), an attitude that may have fostered greater sexual activity, he noted that 4,000 Spaniards have died from the COVID in the past two months.

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