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BARCELONA — For decades, experts believed monkeypox would simply stay in Africa. This May, the zoonotic virus proved the fallacy of that idea, popping up in 23 countries — many in Europe — prompting the World Health Organization to declare on Sunday that it was a “moderate” global public health risk.
“It’s an unusual situation,” said Dr. Sylvie Briand, Director of the Division for Pandemics and Epidemic Diseases at WHO, during a webinar on Monday. “We used to have [monkeypox] only in certain countries. Now it’s out of the box.”
The sudden spike in cases in Europe, where the UK and Spain have registered 300 so far, is prompting health authorities to issue alerts and warn sexually active populations, particularly those engaging in high-risk activities, to be on the lookout for symptoms. The UK has also urged those suffering from monkeypox to refrain from intimate relationships, refrain from contact with pets and not leave their homes for a month.
Officials in the UK, which confirmed 179 cases on Tuesday, and Spain, where the Health Ministry said Monday there were 120 cases, are recommending smallpox vaccines for close contacts of those already infected, as they believe a vaccine for the related virus can be released within Four days of exposure can minimize monkeypox symptoms.
But dr Daniel Lopez-Acuña, the former director of crisis management at the WHO, told Yahoo News that “we will not need vaccinations of the general public” because the disease is not likely to affect large sections of the population. That’s encouraging given that smallpox was eradicated in 1980 and supplies of smallpox vaccine are scarce. (The good news is that health officials say people over 45, most of whom have been vaccinated against smallpox, are far less likely to get monkeypox.)
With case numbers in Europe skyrocketing than most African countries where monkeypox is endemic, the recent outbreak underscores that human-to-human transmission is indeed possible — and that human-to-human sexual contact is now spreading the disease , as opposed to contact with wild animals.
According to Spanish health officials, two of the suspected “amplification events” that helped spread monkeypox across Europe took place in Spain. One was at a popular and now closed gay sauna in Madrid, which has reportedly been linked to at least 20 infections. Another occurred in the Canary Islands, Spain’s territory off Africa, where a 10-day gay pride event was held in early May that drew 80,000 people and sparked cases in other European countries, including Denmark and Slovenia.
“But it’s not a gay disease — the transmission could have happened at a business conference or a political rally,” said Dr. Roger Paredes, head of the infectious diseases unit at the Germans Trias i Pujol Hospital in Barcelona, told Yahoo News. It’s transmitted through close skin-to-skin contact, Paredes added, and is just as likely to be passed on by heterosexuals.
Indeed, close physical contact of all kinds – including close conversations for long periods of time and perhaps even dancing – could transmit the disease, which can spread through respiratory droplets as well as through skin-to-skin contact and through clothing and bedding.
Health experts now believe that monkeypox may have been spreading for months or even years, previously going undetected and only now presenting itself in sufficient numbers to warrant global alerts.
“In the beginning, some doctors were confused and thought this could be a manifestation of complicated syphilis [case]a manifestation of another novel disease or even an extreme form of genital herpes,” said Lopez-Acuña.
That the disease will become well known just before summer – with its music festivals, big parties and extensive travel – complicates the problem, as does the fear of stigmatizing those showing symptoms. “We need to identify cases, take good care of them and make sure they’re isolated,” Paredes said, “and then do contact tracing,” which is key to controlling the spread.
Because lesions from this outbreak tend to spread, according to Dr. Showing Rosamund Lewis, the WHO’s top monkeypox expert, in “the lower regions” 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.
To make matters worse, the recommended one-month quarantine period applies to infected people. “It’s hard to sustain,” Paredes said. “People don’t usually stay home for a month without leaving.”
However, many believe that if people with monkeypox identify with medical professionals and commit to self-isolation, and if their contacts are quickly traced, this outbreak can be contained. “Together, the world has an opportunity to stop this outbreak,” Lewis said. “There is a window.”
But if it’s not stopped soon, some experts, including Lopez-Acuña, believe monkeypox could make its way onto the STI list, despite not being an official STI by definition Illness. He shrugs off the “whole debate about whether it’s an STD or not,” for semantic reasons. “The fact is that the dominant mechanism of transmission in these recent outbreaks in Europe has been sexual,” he said.
The American epidemiologist Dr. David Heymann, currently Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine, no great surprise. The Centers for Disease Control and Prevention sent him to Africa in the 1970s as the principal investigator for monkeypox, when it was a disease primarily found in children. Three years ago, he led a seminar at London think-tank Chatham House that examined skyrocketing rates of monkeypox in Africa — increases attributed in part to more frequent global travel, growing numbers of the population unvaccinated against smallpox, and even flooding that brought people and wildlife closer together.
One curious idea that emerged at 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 genital contact.” Now, this hypothetical transmission route appears to be exactly what spreads the disease, although it’s unclear whether the exchange of bodily fluids is necessary for transmission or whether mere skin-to-skin contact is sufficient to spread it.
Although monkeypox has been observed in humans for over 40 years, there are still a number of unknowns in this current outbreak. “Pets,” Paredes said, “is pretty much uncharted territory. There is potential transmission to pets, but our biggest epidemiological concern is when pets become infected and they go outside and socialize with other pets” – increasing the pet reservoir of potential carriers. The safety of places like public pools is also “unsafe,” he said, although people with monkeypox should stay home anyway, he added.
But for now, at least, health officials are relieved that what is rife is the West African strain of monkeypox, and not the much more serious Central African strain that is most likely to be seen in photos, according to Heymann, who noted that the Central African strain “is beginning.” to spread from person to person. And it’s quite a menace.” According to the WHO, this strain can prove fatal to 10% of those who acquire it. Heymann attributes the absence of this strain in Europe to the fact that those who get it are “extremely ill” and less likely to travel.
While stressing that monkeypox “isn’t going to be like COVID — it’s not going to be a superspreader disease that anyone, anywhere can get,” Paredes said health officials want to nip it in the bud. “The big question,” he added, “is whether or not monkeypox will become endemic in western countries. That depends on how well we do our job in the coming weeks.”
Although the risk to the general public may not be high, Lopez-Acuña suggests that measures to combat COVID could benefit those who absolutely want to minimize the risk of contracting monkeypox. These include wearing masks, social distancing and avoiding crowded environments. Despite a renewed sense of freedom in Spain (where regulations on indoor COVID masks were only lifted at the end of April), a sentiment that may have encouraged more sexual activity, he noted that 4,000 Spaniards have died from COVID in the past two months .
