JTwo other European countries reported unusual cases of monkeypox on Wednesday, a development that suggests an outbreak first spotted in the UK is more widespread than initially thought.
News of cases in other countries has led a senior Centers for Disease Control and Prevention official to warn that cases will likely be spotted in the United States.
“I think we are concerned that there may be cases in the United States. I don’t know if we have strong visibility on people who might report what appears to be a minor rash at an STI clinic. or something like that,” said Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology.
“Given that we have now seen confirmed cases from Portugal, suspected cases from Spain, we are seeing this expansion of confirmed and suspected cases around the world, we feel that no one has the arms around that to find out how big and expansive it could be. And given the amount of travel between the United States and Europe, I’m very confident that we’re going to see cases in the United States.
Spain announced it was investigating eight suspected cases, and Portugal said it was investigating more than 20 suspected cases, five of which have already been confirmed. It is currently unclear whether the outbreaks are linked to each other or to that of the UK, where seven confirmed cases and one probable case have been reported.
If they are connected, it is not yet clear whether the virus has spread from the UK to Europe, or vice versa. It is also not known how long the virus has been spreading in these countries.
Some of the cases were detected in men who have sex with men, raising the possibility that there is more spread than currently detected, said Michael Osterholm, director of the Center for Infectious Diseases Research. and Policy from the University of Minnesota.
“There could be a dynamic transmission here that we just didn’t appreciate because of the potential number of contacts,” he said.
Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said a number of countries outside of central and west Africa, where monkeypox is more common, have experience to deal with introductions of the virus, so there is a possibility that outbreaks will be “relatively small”.
“I think it’s still likely, given the past,” Inglesby told STAT. “But on the other hand, it starts with a lot more anchoring, in a much more distributed way, and we don’t understand how it happened… in these networks.”
“This could have the potential to shift and will require quite a significant public education effort in affected communities and perhaps even more broadly, so that people recognize the possibility” of monkeypox infection, he said. -he declares.
British health authorities said earlier this week that four of the seven cases detected there this month are men who identify as gay, bisexual or have sex with men, and it appears that in at least some of the European cases, the same dynamic may be at play. The Spanish Ministry of Health said the eight suspected cases were detected by a sexual health clinic in Madrid, according to news reports.
Portuguese authorities did not reveal how the cases were detected there, but said they were all male and most were young.
The rapid accumulation of cases is ringing the alarm bells.
On Tuesday, the CDC signaled that it was concerned about the state of the outbreak in the UK and the possibility of cases being discovered in other countries.
“We’re concerned that this is very different from what we typically think of monkeypox,” McQuiston said.
“We don’t understand how many more cases could exist in the UK, for example, with undefined chains of transmission. We have a feeling there may be unusual methods of transmission, through intimate contact or some form of close personal contact, that we have not yet associated with monkeypox. And I think there’s a lot of travel between the UK and the US and other parts of the world,” she said in an interview.
The World Health Organization has also expressed concern, saying a change in the epidemiology of the disease in countries where the virus is endemic that has occurred in recent years needs to be investigated.
“We are seeing a change in the age distribution of cases. We are seeing a shift in the geographic distribution of cases,” said Michael Ryan, executive director of WHO’s Health Emergencies Programme.
“We really need to understand this deep ecology. We really need to understand human behavior in these regions and we need to try to prevent disease from reaching humans in the first place. »
The monkeypox virus is related to the smallpox virus, which caused smallpox, a once dreaded disease that was declared eradicated in 1980. Symptoms of monkeypox are similar to but milder than smallpox.
Those infected 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 the monkeypox rash has some unusual features, including the fact that blisters can form on the palms of the hands.
In countries where it is endemic, the virus is believed to spread to people primarily from infected animals when people kill or prepare bushmeat for consumption.
Once the virus has reached humans, human-to-human transmission can occur via respiratory droplets – virus-laden saliva that can infect the mucous membranes of the eyes, nose and throat – or through contact with lesions of the monkeypox or bodily fluids, with the virus entering through small cuts in the skin. It can also be contracted through contact with clothing or linens contaminated with material from monkeypox lesions.
Cases outside of Africa have been rare, although there was a large outbreak in the United States in 2003 that involved 47 confirmed and probable cases in six states. This outbreak, the first reported outside of Africa, has been attributed to the importation of small mammals from Ghana.
However, in recent years there have been slight increases in exported cases of monkeypox. The United States detected two in 2021, both in travelers returning from Nigeria. The UK has seen multiple importations in recent years and Israel and Singapore have also detected cases.
McQuiston said the number of cases exported from Nigeria in particular appears to be at odds with the number of cases reported in the country itself.
“I think we are concerned about the number of exported cases in travelers that we have seen. And to have so many over the past few years is just a sign to us that there is far more transmission of monkeypox in Nigeria than perhaps the [official] the numbers suggest,” she said.
“And I think it’s also a sign for us that the more traditional routes of transmission that we think of, like hunting wild animals, contact with bushmeat, living at this interface between the jungle and the small communities don’t seem to be a transmission driver in terms of what we see happening, and so that makes us cast a wider net on potential risk factors.