At least 160 cases of monkeypox have been reported in 16 countries, most of which are in Europe — a rare event for a virus largely confined to central and western Africa.
The United States confirmed its first two monkeypox cases of the year last week, one in Massachusetts and the other in New York.
On Monday, 12 European countries – Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom – have reported cases, according to Global.health, a group that collates infectious disease data on the disease.
Dr David Heymann, a top adviser to the World Health Organization, said Friday that two raves in Spain and Belgium may have fueled the transmission. Public health authorities in Madrid have also linked the Spanish infections to an outbreak in a sauna.
Outside Europe and the United States, cases have been reported in Australia, Canada and Israel. Several countries have more suspected cases awaiting confirmation. No deaths have been reported.
“This is the largest outbreak in history of monkeypox in the Western Hemisphere,” said Anne Rimoin, professor of epidemiology at the UCLA Fielding School of Public Health.
The last time the Western Hemisphere saw a monkeypox outbreak of this magnitude was in 2003, she said, when the United States identified 47 cases.
These patients had contact with infected prairie dogs and none died. But disease experts have not pinpointed exactly how the virus is currently spreading.
“What we are facing right now appears to be at least a subset of cases that have no travel history to any of these countries in Africa where monkeypox virus naturally occurs, and who also report no exposure to anyone who has been diagnosed with monkeypox. So what we’re seeing right now is unusual,” said Dr Agam Rao, a physician in the Division of High Consequence Pathogens and Pathologies. from the Centers for Disease Control and Prevention.
Although monkeypox doesn’t spread easily between people, the CDC is preparing for additional cases in the United States, Rao said.
“We tell people this is an emerging issue,” she said. “Some emerging issues eventually become mild. Others get worse. As an emerging issue, we ask people to keep it in mind for now.”
What is monkeypox and where does its name come from?
Monkeypox belongs to the poxvirus family, which includes smallpox. The disease got its name after scientists discovered it in laboratory monkeys in 1958. The first human case of monkeypox was diagnosed in 1970.
Since then, most infections have been concentrated in the Democratic Republic of Congo and Nigeria. DRC reports thousands of cases each year and Nigeria has reported over 200 confirmed cases and over 500 suspected cases since 2017.
The type of monkeypox identified in recent cases in the United States and Europe tends to produce milder disease than the other common branch of the virus.
“All of the virus strains that we know of among all of these cases that have occurred in the past two weeks are the West African clade. The West African monkeypox clade is much milder than the Congo Basin clade,” Rao said. . “That’s good news in that hopefully there won’t be a lot of clinically bad things happening to people who might be infected.”
According to the World Health Organization, approximately 1% of people who contract the West African clade die, compared to up to 10% of people who contract the Congo Basin clade.
Rao said people who contract the West African clade “usually recover quite well” and go back to “normal life when it’s over.”
How do you catch monkey pox?
According to the CDC, humans can catch monkeypox from animals, either through bites or scratches, or by preparing wild game meat.
Person-to-person transmission can occur through the exchange of large respiratory droplets during prolonged face-to-face contact. People can also be exposed through direct contact with bodily fluids, lesions that form during infection, or contaminated items such as clothing or bedding.
Many newly identified cases in Europe involve men who have sex with men, but monkeypox is not considered a sexually transmitted infection.
“It is probably premature and potentially even dangerous to assume that there are only cases within this community,” Rao said.
She added that the overrepresentation of this group may simply be a product of skin-to-skin contact within a tight-knit community.
“It’s going to take studies to try to isolate the virus from seminal fluid or vaginal fluid. There really is a lot of work to do before it can be said to be sexually transmitted,” she said.
WHO officials said on Monday that monkeypox could be spread through exposure to rashes and lesions during sexual activity.
“Many diseases can be spread through sexual contact. You can catch a cough or a cold through sexual contact, but that doesn’t mean it’s a sexually transmitted disease,” said Andy Seale, adviser to WHO for HIV, Hepatitis and STIs. Program.
What are the symptoms of monkeypox?
Symptoms of monkeypox can develop anywhere from five to 21 days after a person becomes infected. Most people recover after two to four weeks.
The illness usually begins with flu-like symptoms such as fever, headache, muscle aches and exhaustion, which can last for a day or two. A rash often follows one to three days after the fever, progressing from red areas to small bumps on the skin. These may then turn into blisters which may fill with whitish fluid.
The rash sometimes resembles chickenpox, syphilis, or herpes. It usually spreads from the face to the limbs, hands, feet and then to the rest of the body, WHO officials said. But disease experts have identified a trend among recent cases.
“We’re seeing more cases where the rash starts in the genital area – which isn’t new, it’s always been there – but it’s more common now and sometimes it tends to stay there,” Dr. Rosamund Lewis, head of the Smallpox Secretariat at WHO.
This could make the rash less noticeable, she added.
Following the identification of the first U.S. case, the CDC asked health care providers to look for patients with the characteristic monkeypox rash.
“We recommend all clinicians do this, but especially those caring for patients in STD clinics,” Rao said, referring to sexually transmitted diseases.
So far, Rimoin said, the recent infections “appear to be reasonably mild cases that were discovered in clinics, and not because people are showing up seriously ill at the emergency room.”
What treatments are available?
Rimoin said it made sense that new cases of monkeypox would continue to appear because there is less immunity to poxviruses than before 1980, when people were still getting smallpox vaccines.
“It is not surprising that we see infections following exposures, given that we no longer have that immunity that we relied on during the eradication of smallpox,” she said.
There is no proven treatment for monkeypox, but doctors can treat its symptoms. Rimoin said supportive care is quite effective for the West African clade. Beyond that, she said, there are experimental drugs that have not been widely tested in humans.
Physicians who identify a suspected case of monkeypox should report it to the CDC, Rao said, because “any potential treatments that might be provided to the patient are really only available in consultation with public health authorities.”
Older smallpox vaccines are about 85% effective in preventing monkeypox, but the United States stopped vaccinating the public against smallpox in 1972. In 2019, the Food and Drug Administration approved a vaccine for smallpox. which also protects people from monkeypox, but it is not widely available. Experts believe the vaccine could help reduce symptoms or prevent disease if given soon after a person is infected.
The CDC’s website states that “in the event of a new outbreak of monkeypox in the United States, the CDC will establish guidelines explaining who should be vaccinated.”
For now, Rao said, the risk to the general population is low.
“I wouldn’t want people to be too terribly alarmed right now and change their behavior too much,” she said.