Two other European countries reported unusual cases of monkeypox on Wednesday, a development that suggests the outbreak, first spotted in the UK, is more widespread than originally thought.
News of cases in other countries has prompted a senior official at the Centers for Disease Control and Prevention to warn that the cases are likely to be spotted in the United States.
“I think we have concerns that there may be cases in the United States. “I don’t know that we have strong visibility for people who may report something that looks like a mild rash in a STI clinic or something,” said Jennifer McQueston, deputy director of the CDC’s Highly Consecrative Pathogens and Pathogens Division. and pathology.
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“Given that we have already seen confirmed cases outside Portugal, alleged cases outside Spain, we see this expansion of confirmed and suspicious cases worldwide, we have the feeling that no one is catching on to understand how big and It can be large-scale. And given how many trips there are between the United States and Europe, I am very confident that we will see cases in the United States.
Spain has said it is investigating eight suspected cases, and Portugal has said it is investigating more than 20 suspected cases, five of which have already been confirmed. It is not clear at this time whether the outbreaks are interconnected or related to the one in the United Kingdom, where seven confirmed and one probable cases have been reported.
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If they are related, it is not yet clear whether the virus has spread from the United Kingdom to Europe or vice versa. It is not known when the virus spread to these countries.
Some of the cases have been found in men who have sex with men, which increases the chance of being more prevalent than is currently found, said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
“There may be a dynamic broadcast here that we just haven’t appreciated because of the potential number of contacts,” he said.
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Tom Inglesby, director of the Johns Hopkins School of Public Health’s Center for Public Safety, said a number of countries outside Central and West Africa where monkeypox is more common have experience in dealing with the virus, so there is a chance outbreaks should be “relatively small”.
“I think that’s still likely, given the past,” Inglesby told STAT. “But on the other hand, it starts with a lot more support, in a much more distributed way, and we don’t understand how it got … into these networks.”
“This can have the potential to move and will require quite a lot of effort for public education in the affected communities, and perhaps even more widely, so that people recognize the possibility” of contracting monkeypox, he said.
UK health authorities said earlier this week that four of the seven cases found there this month were men who identify as gay, bisexual or have sex with men, and it appears that in at least some European cases to have the same dynamics be in play. The Spanish Ministry of Health said the eight alleged cases there had been discovered by a sexual health clinic in Madrid, according to news reports.
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Portuguese authorities did not reveal how the cases were found there, but said they were all men and most were young.
The rapid accumulation of cases is the ringing of alarms.
On Tuesday, the CDC said it was concerned about the state of the outbreak in the UK and the potential for cases to be found in other countries.
“We have a certain level of concern that this is very different from what we usually think of monkeypox,” McQueston said.
“We do not understand how many other cases there may be in the United Kingdom, for example, with unspecified transmission chains. We have a feeling that there may be some unusual methods of transmission, through intimate contact or some form of close personal contact that we have not previously associated with monkeypox. And I think there are a lot of trips between the United Kingdom and the United States and other global areas, “she said in an interview.
The World Health Organization has also expressed its concern, saying that the change in the epidemiology of the disease in countries where the virus is endemic, which has occurred in recent years, must be investigated.
“We see a change in the age distribution of cases. We see a change in the geographical distribution of cases, “said Michael Ryan, executive director of the WHO Emergency Health Program.
“We really need to understand this deep ecology. We really need to understand human behavior in these regions, and we must first try to prevent the disease from reaching people. “
The smallpox virus is associated with the smallpox virus, which causes smallpox, once a terrible disease that was declared eradicated in 1980. The symptoms of smallpox are similar but milder than smallpox.
Infected people develop flu-like symptoms – fever, body aches, chills – but also swollen lymph nodes. One to three days after the onset of fever, a characteristic rash appears, often starting on the face. Many conditions can cause rashes, but smallpox rash has some unusual features, especially the fact that vesicles can form on the palms of the hands.
In countries where it is endemic, the virus is thought to be spread mainly by humans from infected animals when people kill or prepare bush meat for consumption.
Once the virus is transmitted to humans, human-to-human transmission can occur through respiratory droplets – saliva with a viral link that can infect the mucous membranes of the eyes, nose and throat – or through contact with monkeypox lesions or body fluids. penetration of the virus through small cuts in the skin. It can also be infected by contact with clothing or bedding contaminated with material from monkeypox lesions.
Cases outside Africa were rare, although there was a major outbreak in the United States in 2003, involving 47 confirmed and probable cases in six states. This outbreak, first reported outside Africa, was traced to small mammals imported from Ghana.
However, in the last few years there has been a small increase in the incidence of monkeypox. The United States found two in 2021, both with passengers returning from Nigeria. The United Kingdom has seen a number of imports in the last few years, and Israel and Singapore have also found cases.
McQueston said the number of cases reported, in particular from Nigeria, seemed to contradict the reported number of cases in the country itself.
“I think we are concerned about the number of reported cases of passengers we have seen. And having so many of them in the last few years is just a flag for us that there is a lot more monkeypox transmission going on in Nigeria than maybe [official] the numbers suggest it, “she said.
“And I also think it’s a banner for us that the more traditional ways of transmission that we think of, such as wildlife hunting, contact with bush meat, living on this interface between the jungle and small communities, don’t seem to be the engine. of transmission in terms of what we see happening. And so that makes us throw in a wider network of what the risk factors may be. “
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