Wednesday, May 18, 2022

Media Reports Of Suspected Monkeypox Cases In Portugal & Spain



Thirty-six hours ago, in UKHSA Reports 4 More Monkeypox Cases, we saw the first evidence of a community outbreak of Monkeypox - a virus endemic in parts of West and Central Africa - in the UK.  At that time, it seemed reasonable to expect more cases, both in the UK, and beyond.

Now that the alert has gone out, and doctors and public health officials are actively looking for cases, we are starting to get media reports of more cases being reported in Europe.   

Many of these cases are only `suspected' -  with confirmatory tests still pending - but this outbreak appears to have more `legs' than initially suspected.  Hopefully we'll be getting some official statements from MOHs later today. 

The name `monkeypox’ is a bit of a misnomer. It was first detected (in 1958) in laboratory monkeys, but further research has revealed its primary hosts to be rodents or possibly squirrels. Human monkeypox was first identified in 1970 in the DRC, and since then has sparked small, sporadic outbreaks in the Congo Basin and Western Africa.

Monkeypox produces a remarkably `smallpox looking' illness in humans, albeit not nearly as deadly. The CDC's Monkeypox website states:

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.

Human-to-human transmission is also possible.  This from the CDC’s Factsheet on Monkeypox:

The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.

Over the past decade we've seen signs that Monkeypox has been causing larger, and more frequent, outbreaks in Africa sparking concerns that it may eventually pose a bigger public health problem (see WHO: Modelling Human-to-Human Transmission of Monkeypox).

Routine smallpox vaccination - which was discontinued 40 years ago - provided significant protection against Monkeypox infection. The increased number of unvaccinated people in the world, and the waning protection among older vaccine recipients, has likely helped increase transmission of the virus.

While I've not found any official confirmation posted on Portugal's MOH website, overnight CNN International is reporting Portugal has five confirmed cases of monkeypox, more than 20 suspects

Similarly, in Spain, there are multiple media reports citing `informed sources' that the Health Ministry is investigating 8 suspected cases of Monkeypox in the Madrid region.  Again, I've found nothing official posted on their MOH website

Typical is this report from Diario ABC.

Although there are reports suggesting that most of these cases involve individuals who identify as gay, bisexual, or men who have sex with men (MSN), it isn't at all clear whether this virus is being transmitted sexually, or simply by close, intimate contact. 

While we remain focused on our COVID pandemic there are plenty of other public health threats out there that deserve our attention.

Viruses with epidemic (or even pandemic) potential - like Lassa Fever, MERS-CoV,  Monkeypox,  Nipah, and multiple subtypes of avian influenzastill circulate, and evolutionary processes continue to propel them, and others, towards greater human impact.

One of the realities of life in this highly mobile, interconnected, 21st century is that oceans and vast distances no longer afford protection against exotic diseases.

Photo Credit- CDC

Ten months ago, in PNAS Research: Intensity and Frequency of Extreme Novel Epidemics, researchers suggested that the probability of novel disease outbreaks will likely grow three-fold in the next few decades.

Which suggests the next global public health crisis may be much closer than we think.