Monkeypox Cases Spreading In Europe, North America
A handful of cases of monkeypox have now been reported or are suspected in Britain, Portugal, Spain, Italy, Sweden and the United States. The outbreaks are raising alarms because this viral disease normally mostly occurs in west and central Africa, and only very occasionally spreads elsewhere.
Monkeypox is a virus that causes fever symptoms as well as a distinctive bumpy rash, similarly looking to chickenpox. It is usually a mild and self-limiting disease, with a case fatality ratio (CFR) in Africa of 1% for the West African strain and 10% mortality for the Congo strain. The UK cases have been reported to be the milder West African strain. It is likely that the fatality rates would be much lower in countries with good access to healthcare. Normally monkeypox is not particularly contagious between people, with a reproduction number (R0) of around 2. Most people who contract the virus will recover within weeks.
So far, the UK has reported a total of 7 cases with 3 of these belonging to the same family with cases concentrated around London. Portugal has confirmed 5 cases out of 20 suspected cases, mostly in Lisbon. Spain had initially 23 suspected cases who still need to be laboratory confirmed, but meanwhile between 40 and 50 suspected cases have been identified. One was confirmed in the United States, Sweden and Italy.
Some of the cases detected in Britain and Spain self-identified as gay, bi-sexual or other men who have sex with men, indicating transmission in this community. Not too much attention should be drawn to this fact as the main transmission mode of this disease is through respiratory droplets and close contact.
The increased number of cases is worrying and could be indicative of wider transmission and potentially a mutation that makes the virus more transmissible. Immunity in developed countries against the disease is very low. While the smallpox vaccine offers some protection against monkeypox, vaccinations were phased out after the eradication of smallpox in the 1980s.
The monkeypox virus has long been ignored as a potential threat. There are no standard guidelines for clinical management, nor therapeutics or specific vaccines. It is known that the disease is endemic in the Democratic Republic of the Congo but surveillance information comes mostly from unofficial sources. The WoIDMo runs a surveillance system that indexes these unofficial reports. The first report of the disease in Europe can be found as IDMO id #d1348a5c6277e908.
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