Monkeypox is ‘out of the box’ and has Europe on edge

BARCELONA – For decades, experts believed that monkeypox would simply remain in Africa. In May, the zoonotic virus proved that idea wrong. a “moderate” global public health risk

“It’s an unusual situation”, dr. Sylvie Briand, director of the WHO’s Division of Pandemic and Epidemic Diseases said during a webinar on Monday. “We used to have [monkeypox] only in certain countries. Now it is out of the box.”

An electron microscope image showing both oval and round virions of monkeypox.

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

The sudden increase in the number of cases in Europe, where the UK and Spain have registered 300 so far, is prompting health authorities to issue warnings and warn sexually active populations, especially those engaging in risky activities, to be wary. are for symptoms. The UK has also urged those who are sick with monkey pox to refrain from intimate relationships, have no contact with pets and do not leave their home for a month.

officials in the UK, who confirmed 179 cases on Tuesdayand Spain, where the Ministry of Health on Monday announced it has 120 casesrecommend smallpox vaccines for close contacts of those already infected, believing that a vaccine for the related virus given within four days of exposure can minimize monkeypox symptoms.

Click on the image for more images from the World Health Organization.

Click on the image for more images from the World Health Organization.

But dr. Daniel Lopez-Acuña, the former director of crisis management at WHO, told Yahoo News that “we will not need vaccinations from the general public” as the disease is unlikely to affect large segments of the population. This is encouraging given that smallpox was eradicated in 1980 and supplies of smallpox vaccines are scarce. (The good news is that health officials say people over the age of 45, most of whom have been vaccinated against smallpox, are much less likely to contract monkeypox.)

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

According to Spanish health officials, two of the supposed “reinforcement events” that contributed to the spread of monkeypox across Europe took place in Spain. One was in a popular, and now closed, gay sauna in Madrid that was reportedly linked to at least 20 infections. Another took place in the Canary Islands, the Spanish territory off the coast of Africa, where a 10-day gay pride event was held in early May that attracted 80,000 people, resulting in cases in other European countries, including Denmark and Slovenia. .

Francesco Vaia talks to reporters.

Francesco Vaia, director of the Spallanzani Infectious Disease Hospital in Rome, at a press conference on May 20. Vaia said three cases of monkey pox 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 meeting,” Dr. Roger Paredes, head of the Infectious Diseases Division at Germany’s Trias i Pujol Hospital in Barcelona, ​​told Yahoo News. It’s transmitted through close skin contact, Paredes added, and it’s equally likely to be passed on through heterosexuals.

In fact, close physical contact of many kinds — including prolonged talking and perhaps even dancing — can transmit the disease, which can spread through respiratory droplets and skin touching the skin, and through clothing and bedding.

Health experts now believe monkeypox can spread for months or even years, previously unrecognized and only now presenting in large enough numbers to warrant global warnings.

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

That the disease makes itself known just before the summer — with its music festivals, major bashes and extensive travel — complicates the issue, 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,” Paredes said, “and then do contact tracing,” which is key to controlling the spread.

A patient's arms and torso covered in lesions and ulcers caused by monkey pox.

The arms and trunk of a patient with monkey pox lesions in the Democratic Republic of Congo in 1997. (AP)

In addition, as lesions from this outbreak are spreading, according to Dr. Rosamund Lewis, WHO’s leading monkeypox expert, usually occurs in “the lower echelons”, some people who have it may not even know. “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.

Complicating matters even more is the recommended one-month quarantine period for those infected. “That’s hard to sustain,” Paredes said. “People usually don’t stay home for a month without leaving.”

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

But if it’s not stopped soon, some experts, including Lopez-Acuña, believe monkeypox could make it onto the list of sexually transmitted infections, even though it’s not necessarily an official sexually transmitted disease. disease. He shrugs off the “whole debate about whether it’s an STD or not” as 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 ulcers.

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

That monkeypox is transmitted through sex is no great surprise to American 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 the chief investigator of monkeypox in the 1970s, when it was largely a disease seen in children. Three years ago, he chaired a seminar at the London think tank Chatham House examining the soaring rates of monkeypox in Africa – increases attributed in part to more frequent travel around the world, a growing number of people who had not been vaccinated against smallpox, and even floods that brought people and wildlife closer together.

One 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 that supposed mode of transmission appears to be exactly what spreads the disease through skin-to-skin contact, although it’s unclear whether the exchange of bodily fluids can also transmit it.

Although monkeypox has been seen in humans for over 40 years, there are still some unknowns in this current outbreak. “Pets,” Paredes said, for example, “are rather uncharted territory. There is potential transmission to pets, but our main epidemiological concern is whether pets become infected and they go out and meet other pets” – increasing the animal reservoir of potential carriers. The safety of places such as public swimming pools is also “uncertain,” he said, although people with monkey pox 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 test results for monkey pox. (Carlos Lujan/Europa Press via Getty Images)

But for now, health officials are relieved that what’s circulating far and wide is the West African species of monkeypox and not the much more serious Central African species, most likely shown in photos on reports, according to Heymann, who noted that the Central African species “person to person begins to spread. And it is quite a threat.” That tension can prove fatal to 10% of those who acquire it, according to the WHO. Heymann attributes the absence of that species in Europe to the fact that those who get it are “extremely ill” and less likely to travel.

While stressing that monkey pox “will not be like COVID — it won’t be a super-spreading disease that anyone anywhere can get,” 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. That depends on how well we do our job in the coming weeks.”

While the risk to the general public may not be great, Lopez-Acuña suggests that measures taken to combat COVID could benefit those who absolutely want to minimize all monkey pox risks. These include wearing masks, social distancing, and staying away from crowded environments. Despite a newfound sense of freedom in Spain (where mandates for indoor COVID masks were not lifted until late April), an attitude that may have fostered more sexual activity, he noted that 4,000 Spaniards died from COVID in the past two months.

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