Portuguese health authorities on Wednesday confirmed five cases of monkeypox – a rare viral infection linked to smallpox – in young men, marking an unusual outbreak in Europe of a disease typically confined to Africa.
Portugal’s Directorate General of Health added that it was investigating 15 other suspected cases and all were identified this month around the capital Lisbon.
All of the Portuguese cases involve men, most of them young, authorities said.
They have skin lesions and are said to be in stable condition. Authorities did not say whether the men had a history of travel to Africa or links to recent cases in Britain or elsewhere.
British health authorities said on Monday they had identified four cases of monkeypox infections in London in gay and bisexual men, bringing the total to seven.
Spain’s health ministry said on Wednesday it had also detected eight suspected cases of monkeypox that have yet to be confirmed.
How did this epidemic start?
The UK Health Safety Agency (UKHSA) was the first health authority in Europe to publicly report a case of monkeypox on May 7, in a person who had recently flown to the UK from Nigeria.
He has since confirmed six more cases and said he is investigating links between four of them, all of whom appear to have been infected in London and all of whom identify as gay, bisexual or other men who have sex with men.
“We particularly urge gay and bisexual men to be aware of any unusual rashes or lesions and to contact a sexual health service without delay,” said Dr Susan Hopkins, the agency’s chief medical adviser.
The UKHSA has recommended looking particularly for lesions on the genitals.
Britain had previously reported three previous cases of monkeypox, two involving people who lived in the same household and the third someone who had traveled to Nigeria, where the disease commonly occurs in animals.
What are the symptoms of monkeypox?
Monkeypox is a relative of smallpox, a disease that was eradicated in 1980, but is less transmissible, causes milder symptoms and is less deadly.
The illness usually lasts two to four weeks and symptoms may appear five to 21 days after infection.
Symptoms of monkeypox usually begin with a mixture of fever, headache, muscle aches, back pain, chills, exhaustion, and swollen lymph nodes.
This last symptom is usually what helps doctors distinguish monkeypox from chickenpox or smallpox, according to the World Health Organization (WHO).
Once you have a fever, the main characteristic of monkeypox, a nasty rash, tends to develop one to three days later, often starting on the face and then spreading to other parts of the body.
The number of lesions can vary from a few to thousands.
The lesions will go through an ugly process of maturing, from macules (flat lesions) to papules (raised lesions), to vesicles (fluid filled lesions), then to pustules (pus filled lesions) and finally to scabs (crusty lesions) before falling off.
Why is it called monkeypox?
Monkeypox virus belongs to the genus Orthopoxvirus of the Poxviridae family. 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 responsible for the outbreaks, and the natural reservoir of monkeypox remains unknown, although the WHO says rodents are most likely.
“In Africa, evidence of monkeypox virus infection has been found in many animals including rope squirrels, tree squirrels, poached Gambian rats, dormice, different species of monkeys,” says the United Nations health agency.
Where is monkeypox usually found?
Human monkeypox mainly causes epidemics in tropical rainforest regions of central and western Africa and is not usually seen in Europe.
The Democratic Republic of Congo (DRC) recorded the first 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 outbreak of monkeypox reported outside of Africa was linked to the 2003 importation of infected mammals into the United States, according to the US Centers for Disease Control and Prevention (CDC).
More recently, in 2018 and 2019, two travelers from the UK, one from Israel and one from Singapore, all with travel history to Nigeria, were diagnosed with monkeypox following a major outbreak there. , according to Europe’s own health agency, the European Center for Disease Prevention and Control (ECDC),
How do you catch monkeypox?
You can catch the virus through a bite or scratch from an infected animal, by eating bushmeat, by being in direct contact with an infected human, or by touching contaminated bedding or clothing.
The virus enters the body through skin lesions, the respiratory tract or the mucous membranes (eyes, nose or mouth).
Human-to-human transmission is believed to occur primarily through large respiratory droplets, which generally cannot travel more than a few feet, so prolonged face-to-face contact would be required.
Some UK experts commenting on the recent outbreak in the UK said they would soon conclude that monkeypox was spread through sexual contact, but that was a possibility.
“Recent cases suggest a potentially new way of spread,” said Neil Mabbott, a disease expert at the University of Edinburgh, adding that related viruses were known to be spread sexually.
Keith Neal, an infectious disease expert at the University of Nottingham, said transmission may not have occurred through sexual activity, but simply “close contact associated with sexual intercourse”.
Should I be worried?
Monkeypox “is generally 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 Dr. Colin Brown, director of clinical and emerging infections at the agency.
Patients infected in England contracted the West African clade of the virus, which health officials say is mild compared to the Central African clade and has a case fatality rate of around 1%.
Although its symptoms are milder than those of smallpox, monkeypox has been shown to cause the death of 10% of patients infected with the Congo Basin clade, compared to about 30% for smallpox, according to data from the WHO.
Mortality is higher in children and young adults, and immunocompromised people are particularly at risk of severe disease.
Monkeypox during pregnancy can also lead to complications, congenital monkeypox or stillbirth, the WHO warned on Monday.
“Mild cases of monkeypox may go undetected and pose a risk of person-to-person transmission,” he said in a statement.
Treatment and prevention
There is currently no specific treatment recommended for monkeypox, and it usually goes away on its own.
Smallpox vaccination is thought to be very effective in preventing monkeypox, but because smallpox was declared eradicated more than 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, United States and Canada (under the trade names Imvanex, Jynneos and Imvamune), and antivirals are also in development.