Monkeypox: What we know about the smallpox-like virus spreading in Europe, the US and Canada
Germany, France and Belgium confirmed their first cases of monkeypox on Friday, becoming the latest European countries confronted with a smallpox-related virus typically limited to Africa.
The German case was regis-tered in Bavaria on Thursday, according to the Bundeswehr Institute of Microbiology in Munich.
The French case is a 29-year-old man in the Paris region, who had no recent travel history to a country where the virus is circulating. Authorities said his case is mild and he is isolating at home.
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Belgium reported two cases in the northern Dutch-speaking region of Flanders.
Dozens of suspected or con-firmed cases have so far been reported in the United States, Canada, Australia and several other European countries: the UK, Portugal, Spain, Italy and Sweden.
The World Health Organization (WHO) says many cases have been in people identifying as gay, bisexual or men who have sex with men.
Monkeypox has not previously been documented to have spread through sex, but can be transmitted through close contact with infected people, their clothing, or bedsheets.
How did this outbreak start?
The UK Health Security Agency (UKHSA) was the first health authority in Europe to publicly report a case of monkeypox on May 7, in a person who had recently flown into the UK from Nigeria.
On Friday, the agency reported 11 new cases, bringing the country's total to 20.
"A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging them to be alert to the symptoms and seek help if concerned," Dr Susan Hopkins, the agency's chief medical adviser, said in a statement.
The UKHSA has recommended particularly looking out for lesions on genitalia.
Authorities in Spain and Portu-gal also said their cases were in young men who mostly had sex with other men and that those cases were picked up when the men turned up with lesions at sexual health clinics.
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On Wednesday, US officials re-ported a case of monkeypox in a man who had recently travelled to Canada. Canadian health authorities have since confirmed two infections related to that positive test, and 17 suspected cases are being investigated around Montreal.
As of Friday, Spain and Portu-gal had spotted more than 40 possible and confirmed infections, while Australia, Italy and Sweden had each confirmed one case.
In total, more than 100 cases have been confirmed outside Africa, according to a tracker by a University of Oxford academic.
What are the symptoms of monkeypox?
Monkeypox is a relative of smallpox, a disease that was eradicated in 1980, but is less transmissible, causes milder symptoms and is less deadly.
The illness typically lasts for two to four weeks and symptoms can appear anywhere from five to 21 days after infection.
Monkeypox symptoms usually begin with a mix of fever, headaches, muscle aches, backache, chills, exhaustion, and swollen lymph nodes.
This latter symptom is typically what helps doctors distinguish monkeypox from chickenpox or smallpox, according to the WHO.
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Once you have a fever, the key feature of monkeypox, a nasty rash, tends to develop one to three days later, often starting on the face and then spreading to other parts of the body.
The number of lesions may range from a few to thousands.
The lesions will go through an ugly ripening process, from macules (flat lesions) to papules (raised lesions), vesicles (fluid-filled lesions), then pustules (pus-filled lesions) and then finally scabs (crusty lesions) before eventually falling off.
Why is it called monkeypox?
Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae. It was first discovered in 1958 when two outbreaks of a pox-like disease occurred in lab monkeys kept for research, hence the name.
But monkeys might not be the ones to blame for outbreaks, and the natural reservoir of monkeypox remains unknown, though the WHO says rodents are the most likely.
“In Africa, evidence of monkey-pox virus infection has been found in many animals including rope squirrels, tree squirrels, Gambian poached rats, dormice, different species of monkeys,” says the UN health agency.
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Where is monkeypox typically found?
Human monkeypox primarily causes outbreaks in the tropical rainforest regions of Central and West Africa and is not typically seen in Europe.
The Democratic Republic of the Congo (DRC) had the first recorded human case of monkeypox in 1970.
The first outbreak of monkey-pox reported outside of Africa was linked to the importation of infected mammals in 2003 in the United States, according to the US Centers for Disease Control and Prevention (CDC).
More recently, in 2018 and 2019, two travellers from the United Kingdom, one from Israel, and one from Singapore, all with travel history in Nigeria, were diagnosed with monkeypox following a large outbreak there, according to Europe’s own health agency, the European Centre for Disease Prevention and Control (ECDC),
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How do you catch monkeypox?
You can catch the virus from the bite or scratch of an infected animal, by eating bush meat, being in direct contact with an infected human or touching contaminated bedding or clothing.
The virus enters the body through skin lesions, the respiratory tract, or the mucous membranes (the eyes, nose, or mouth).
Human-to-human transmis-sion is thought to occur primarily through large respiratory droplets, which generally cannot travel more than a few feet, so prolonged face-to-face contact would be needed.
Some British experts com-menting on the recent UK outbreak said it was soon to conclude that monkeypox had spread through sexual contact, but that it was a possibility.
"The recent cases suggest a po-tentially novel means of spread," said Neil Mabbott, a disease expert at the University of Edinburgh, adding that related viruses were known to spread via sex.
Keith Neal, an infectious dis-eases expert at the University of Nottingham, said the transmission might not have occurred through sexual activity but just “the close contact associated with sexual intercourse".
The US Centres for Disease Control and Prevention (CDC) stressed in a statement that "anyone, regardless of sexual orientation, can spread monkeypox through contact with body fluids, monkeypox sores, or shared items (such as clothing and bedding) that have been contaminated".
Should I be worried?
Monkeypox “is usually a mild selflimiting illness and most people recover within a few weeks,” the UKHSA said.
“It is important to emphasise that monkeypox does not spread easily between people and the overall risk to the general public is very low,” said Dr Colin Brown, the agency’s director of clinical and emerging infections.
The patients infected in Eng-land contracted the West African clade of the virus, which health officials say is mild compared to the Central African clade and has a case fatality ratio of around 1 per cent.
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Although its symptoms are milder than those of smallpox, monkeypox has been shown to cause death in as many as 10 per cent of patients infected with the Congo Basin clade, compared to about 30 per cent for smallpox, according to WHO data.
Mortality is higher among chil-dren and young adults, and immunocompromised individuals are especially at risk of severe disease.
Monkeypox during pregnancy may also lead to complications, congenital monkeypox, or stillbirth, the WHO warned on Monday.
"Milder cases of monkeypox may go undetected and represent a risk of person-to-person transmission," it said in a statement.
Treatment and prevention
Monkeypox usually goes away on its own, but an oral antiviral drug called Tecovirimat was approved earlier this year in the European Union to treat smallpox, monkeypox and cowpox and it can limit the spread of the virus and the severity of the infection.
Vaccination against smallpox is believed to be highly effective in preventing monkeypox, but because smallpox was declared eradicated more than 40 years ago, younger populations "no longer benefit from the protection afforded by prior smallpox vaccination programmes," says the WHO.
A newer vaccine developed by Bavarian Nordic for the prevention of both smallpox and monkeypox has been approved in the European Union, the United States, and Canada (under the trade names Imvanex, Jynneos and Imvamune), but it's not yet widely available.
Common household disinfec-tants can kill the monkeypox virus, says the CDC.