UNDERSTAND IT ALL – What is monkeypox, of which several cases have been detected in Europe?

Several dozen cases of this rare disease originating in Africa have been identified in Europe since the beginning of May. Spain has launched a health alert, and the Kingdom fears a community infection.

After the United Kingdom, Portugal and Spain, it is Canada and the United States which indicated on Wednesday that they had detected on their soil people suffering from monkey pox, a rare disease normally confined to the African continent. Characterized by its impressive pustules, this infection is transmitted during close contact, or exchange of bodily fluids.

The United Kingdom has warned that all of the carriers of the disease on its soil are men who have had homosexual relations. The World Health Organization (WHO) said on Tuesday that it wanted to shed light on these cases.

• Where does monkeypox come from?

Monkeypox, or simian orthopoxvirus, is a rare viral zoonosis, as indicated by the WHO on its website, that is to say a virus transmitted to humans by animals. The disease was first detected in humans in 1970, in the Democratic Republic of Congo. Since then, the majority of cases have been recorded in rural regions and areas of humid tropical forests in the Congo Basin as well as in West Africa, where the virus is endemic, according to the WHO.

Infection from animals to humans results from direct contact with blood, biological fluids, or skin lesions or mucous membranes of animals that are carriers of the disease. The WHO cites monkeys, Gambian giant rats and squirrels as species at risk. Eating meat infected with the virus may also be at risk.

Note that two different versions of the virus exist, that of the Congo Basin and that of West Africa. It is the first version which is the most virulent.

A child infected with monkeypox, in Zomea Kaka, Central African Republic on October 18, 2018.
A child infected with monkeypox, in Zomea Kaka, Central African Republic on October 18, 2018. © CHARLES BOUESSEL / AFP

• How is this disease transmitted?

Human-to-human transmission is the result of close contact with a carrier of the disease. Either by coming into contact with its respiratory secretions, or by touching infected lesions, as well as biological fluids.

“Transmission occurs primarily through respiratory droplet particles and usually requires prolonged face-to-face contact,” the WHO adds.

• What are the symptoms?

Infection of humans with monkeypox – monkeypox in English – is divided into two periods. A first described as “invasive”, with fever, headaches, swollen glands and muscle pain.

This is then followed by a period of rash, which begins on the face, before spreading to other parts of the body. The face is the most affected, followed by the palms of the hands and the soles of the feet.

“The skin rash evolves in about ten days from maculo-papules (flattened base lesions) to vesicles (small fluid-filled blisters), then pustules and finally crusts. The complete disappearance of the latter can take up to ‘at three weeks,’ says the World Health Organization.

The arm and leg of a girl with monkeypox.
The arm and leg of a girl with monkeypox. © Wikimedia

• Can monkeypox be cured?

Monkeypox is not a particularly dangerous disease for humans, although bothersome due to the pustules it causes. The WHO thus ensures that in the vast majority of cases, it heals itself. Symptoms can last 14 to 21 days.

The disease can nevertheless be fatal, but the fatality rate remains below 10%. It is especially the youngest children who are likely to develop a severe form.

There is currently no vaccine or treatment for the disease, although the smallpox vaccine has shown some effectiveness in preventing its development. However, the latter is no longer produced since the eradication of the disease.

• Where were the last cases identified?

If this relatively rare infection is attracting attention today, it is because since the beginning of May, many European and North American countries have indicated that they have spotted cases of this disease on their soil.

It was first in the United Kingdom that the alert was launched, from May 6. A total of nine cases in total have been detected across the Channel. With the exception of a first individual who recently traveled to Nigeria, all the other people were infected on British soil, as indicated by the British health security agency (UKHSA).

At the start of the week, Spain and Portugal in turn announced that they had detected around forty suspected cases on their territory, prompting the two countries to trigger a health alert.

Across the Atlantic, Canada said on Wednesday it was looking into more than a dozen suspected cases, being examined in Montreal. As for the United States, a man who had recently traveled to Canada tested positive for monkeypox in the state of Massachusetts.

Since the detection of this disease in humans in 1970, cases of contamination outside the African continent have been very rare. It was not until 2003 that the disease was detected outside the continent, in the United States. The patients had been in contact with domestic prairie dogs, which had been infected with imported African rodents.

• Is there a risk of community contamination among homosexual men?

This outbreak of contaminations in Europe is accompanied by a fear that they result from sexual relations between men. Indeed, London reported that patients identified as carriers of monkeypox all had sex with other men.

In Geneva, Ibrahima Socé Fall, WHO Deputy Director General for Emergency Response, said:

“We are seeing transmissions among men who have sex with men,” which is “new information that we need to study properly to better understand the dynamics of ‘transmission’.”

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