Cases of the smallpox-related disease have previously been
seen only among people with links to central and West Africa. But in the past
week, Britain, Spain, Portugal, Italy, U.S., Sweden and Canada all reported
infections, mostly in young men who hadn’t previously traveled to Africa.
France, Germany, Belgium and Australia confirmed their first
cases Friday.
“I’m stunned by this. Every day I wake up and there are more
countries infected,” said Oyewale Tomori, a virologist who formerly headed the
Nigerian Academy of Science and who sits on several World Health Organization
advisory boards.
“This is not the kind of spread we’ve seen in West Africa,
so there may be something new happening in the West,” he said.
To date, no one has died in the outbreak. Monkeypox
typically causes fever, chills, a rash and lesions on the face or genitals. WHO
estimates the disease is fatal for up to one in 10 people, but smallpox
vaccines are protective and some antiviral drugs are being developed.
British health officials are exploring whether the disease
is being sexually transmitted. Health officials have asked doctors and nurses
to be on alert for potential cases, but said the risk to the general population
is low. The European Center for Disease Control and Prevention recommended all
suspected cases be isolated and that high-risk contacts be offered smallpox
vaccine.
Nigeria reports about 3,000 monkeypox cases a year, WHO
said. Outbreaks are usually in rural areas, when people have close contact with
infected rats and squirrels, Tomori said. He said many cases are likely missed.
Dr. Ifedayo Adetifa, head of the country’s Center for
Disease Control, said none of the Nigerian contacts of the British patients
have developed symptoms and that investigations were ongoing.
WHO’s Europe director, Dr. Hans Kluge, described the
outbreak as “atypical,” saying the appearance of the disease in so many
countries across the continent suggested that “transmission has been ongoing
for some time.” He said most of the European cases are mild.
On Friday, Britain’s Health Security Agency reported 11 new
monkeypox cases, saying that “a notable proportion” of the most recent
infections in the U.K. and Europe have been in young men with no history of
travel to Africa who were gay, bisexual or had sex with men.
Authorities in Spain and Portugal also said their cases were
in young men who mostly had sex with other men and said those cases were picked
up when the men turned up with lesions at sexual health clinics.
Experts have stressed they do not know if the disease is
being spread through sex or other close contact related to sex.
Nigeria hasn’t seen sexual transmission, Tomori said, but he
noted that viruses that hadn’t initially been known to transmit via sex, like
Ebola, were later proven to do so after bigger epidemics showed different
patterns of spread.
The same could be true of monkeypox, Tomori said.
In Germany, Health Minister Karl Lauterbach said the
government was confident the outbreak could be contained. He said the virus was
being sequenced to see if there were any genetic changes that might have made
it more infectious.
Rolf Gustafson, an infectious diseases professor, told
Swedish broadcaster SVT that it was “very difficult” to imagine the situation
might worsen.
“We will certainly find some further cases in Sweden, but I
do not think there will be an epidemic in any way,” Gustafson said. “There is
nothing to suggest that at present.”
Scientists said that while it’s possible the outbreak’s
first patient caught the disease while in Africa, what’s happening now is
exceptional.
“We’ve never seen anything like what’s happening in Europe,”
said Christian Happi, director of the African Centre of Excellence for Genomics
of Infectious Diseases. “We haven’t seen anything to say that the transmission
patterns of monkeypox have been changing in Africa. So if something different
is happening in Europe, then Europe needs to investigate that.”
Happi also pointed out that the suspension of smallpox
vaccination campaigns after the disease was eradicated in 1980 might
inadvertently be helping monkeypox spread. Smallpox vaccines also protect
against monkeypox, but mass immunization was stopped decades ago.
“Aside from people in west and Central Africa who may have
some immunity to monkeypox from past exposure, not having any smallpox
vaccination means nobody has any kind of immunity to monkeypox,” Happi said.
Shabir Mahdi, a professor of vaccinology at the University
of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak
in Europe, including determining who the first patients were, was now critical.
“We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.” -AP