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.

A 2003 electron microscope image shows oval-shaped mature monkeypox virions and spherical immature virions obtained from a human skin sample associated with a prairie dog outbreak. (Cynthia S. Goldsmith, Russell Regner/CDC via TAUT)

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 abstain 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, former director of crisis management at the WHO, told Yahoo News that “we won’t need vaccinations of the general public” because the disease is unlikely to affect large populations. sections of the population. This is encouraging given that smallpox was eradicated in 1980 and smallpox vaccine stocks 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.

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According to Spanish health officials, two of the “amplifying events” believed to have helped spread monkeypox across Europe occurred in Spain. One took place 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 has led to cases in other countries. European countries, including Denmark and Slovenia.

Francesco Vaia speaks to journalists.

Francesco Vaia, director of the Spallanzani infectious diseases hospital, speaks to reporters at the end of a press conference, in Rome on May 20. Vaia said three cases of monkeypox have been confirmed and isolated at Spallanzani Hospital in two patients who traveled to the Canary Islands and one to Vienna. (Andrew Medichini/TAUT)

“But it’s not a homosexual 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 of time and possibly even dancing — could transmit the disease, which can be spread through respiratory droplets as well as skin touching skin, as well as through 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 the cases, take good care of them and make sure they self-isolate,” Paredes said, “and then do contact tracing,” which is critical to controlling the spread.

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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. (TAUT)

Moreover, since the lesions in this outbreak tend to appear in “the lower regions” according to Dr. Rosamund Lewis, the WHO’s leading monkeypox expert, 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 this outbreak, however, can be contained if people with monkeypox identify themselves to 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 added.

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. (TAUT)

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.

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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,” he added, “but our main epidemiological concern is whether pets are infected, and they go outside and meet other pets.” – thus 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 shows positive test results for monkeypox, at the Ramon y Cajal hospital in Madrid. (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 people 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 health authorities want to nip it 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. »

Even though 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 absolutely want to 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 domestic 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 COVID over the past two months.


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