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LONDON – Scientists who have observed numerous outbreaks of monkeypox in Africa say they are puzzled by the recent spread of the disease in Europe and North America.
Cases of the smallpox-related illness have so far only been observed in people with connections to Central and West Africa. But in the past week, the UK, Spain, Portugal, Italy, the US, Sweden and Canada all reported infections, mostly among young men who had not previously traveled to Africa.
According to the World Health Organization, there are about 80 confirmed cases and 50 other suspected cases worldwide. France, Germany, Belgium and Australia reported their first cases on Friday.
“I’m stunned by this. Every day I wake up and more countries are getting infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Sciences and sits on several WHO advisory boards.
“This isn’t the type of spread that we’ve seen in West Africa, so something new could be happening in the West,” he said.
To date, no one has died in the eruption. Monkeypox typically causes fever, chills, a rash, and lesions on the face or genitals. The WHO estimates the disease kills up to one in 10 people, but smallpox vaccines protect and some antiviral drugs are being developed.
British health authorities are investigating whether the disease is sexually transmitted. Health officials have asked doctors and nurses to be alert to potential cases but said the risk to the general population is low. The European Center for Disease Control and Prevention recommended isolating all suspected cases and offering smallpox vaccination to high-risk contacts.
Nigeria reports about 3,000 cases of monkeypox a year, the WHO said. Outbreaks usually occur in rural areas when people have close contact with infected rats and squirrels, Tomori said. He said many cases are likely to be overlooked.
dr Ifedayo Adetifa, head of the country’s Center for Disease Control, said none of the British patients’ Nigerian contacts had developed symptoms and investigations were ongoing.
WHO Europe Director Dr. Hans Kluge, described the outbreak as “atypical” and said the occurrence of the disease in so many countries on the continent suggested “transmission has been going on for some time”. He said most European cases are mild.
On Friday, Britain’s Health Security Agency reported 11 new cases of monkeypox and said “a significant proportion” of infections in the UK and Europe occurred in young men with no history of travel to Africa who were gay, bisexual or who had had sex with men .
Authorities in Spain and Portugal also said their cases involved young men who primarily had sex with other men and said those cases were picked up when the men with lesions showed up at sexual health clinics.
Experts have stressed that they don’t know if the disease is spread through sex or other close sex-related contacts.
Nigeria has not seen sexual transmission, Tomori said, but he noted that viruses not initially known to be transmitted through sex, such as Ebola, were later shown to be the case after larger epidemics exhibited different patterns of spread showed.
The same could be true for monkeypox, Tomori said.
In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus is being sequenced to see if there have been genetic changes that might have made it more contagious.
Rolf Gustafson, a professor of infectious diseases, told Swedish broadcaster SVT it was “very difficult” to imagine the situation could get worse.
“We will certainly find some more cases in Sweden, but I don’t think it will become an epidemic in any way,” Gustafson said. “There is nothing to suggest that at the moment.”
Scientists said that while it’s possible that the first patient in the outbreak contracted the disease in Africa, what’s happening now is extraordinary.
“We have never experienced anything like what is happening in Europe,” said Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases. “We have seen nothing to suggest that monkeypox transmission patterns have changed in Africa. So if something else happens in Europe, then Europe needs to investigate that.”
Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 could inadvertently contribute to the spread of monkeypox. Smallpox vaccines also protect against monkeypox, but mass immunization stopped decades ago.
“Apart from people in west and central Africa, who may have some immunity to monkeypox due to past exposure, the lack of smallpox vaccination means that nobody has any type of immunity to monkeypox,” Happi said.
Shabir Mahdi, a professor of vaccinology at the University of the Witwatersrand in Johannesburg, said a detailed investigation into the outbreak in Europe, including determining who the first patients were, is now crucial.
“We really need to understand how this started and why the virus is gaining momentum now,” he said. “Africa has had very controlled and infrequent outbreaks of monkeypox. If that changes now, we really need to understand why.”
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Geir Moulson in Berlin, Jan M. Olsen in Copenhagen, Chinedu Asadu in Lagos, Nigeria, and AP reporters across Europe contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
