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What is monkeypox and why are cases spreading in the UK and Europe?

The virus usually spreads only in Central and West Africa.

Image: Alamy Stock Photo

DOZENS OF CASES of monkeypox have recently been confirmed or are suspected in parts of Europe and North America.

The viral disease is usually confined to Central and Western Africa, but its emergence in countries that rarely experience outbreaks has raised concerns about how it is spreading.

No cases have yet been confirmed in Ireland, but authorities are preparing health services for its possible arrival following confirmed cases in the UK, Portugal and Sweden.

Although the virus is only fatal in a small number of cases, it can cause uncomfortable symptoms for weeks and there is no cure for it.

Here’s what we know about the virus and its spread outside of Africa so far. 

What is monkeypox?

Monkeypox is a viral zoonotic illness (that is, a virus which has transmitted to humans from animals – like Covid-19) with symptoms like those experienced by those who contract smallpox.

It mainly spreads in remote parts of Central and West Africa, and there are two strains of the virus: West African monkeypox and Congo Basin monkeypox.

Of these, the Congo Basin strain is more severe with a fatality rate of up to 10%, but it is the milder West African strain (with a fatality rate of around 1%) which is currently spreading in Europe and North America.

The virus is usually passed to people when they come into very close contact with rodents and primates, or if they eat infected bushmeat.

However, there are also cases of human-to-human transmission, particularly among those who come into close physical contact with infected lesions, bodily fluids or recently contaminated materials like clothes or bedding. 

Transmission can also occur via respiratory droplets – again, like Covid-19 – though this usually requires prolonged face-to-face contact.

Person-to-person transmission generally happens among close family members and through sexual contact, and the risk of community transmission is deemed to be very low.

portugal-monkeypox An electron microscopic image depicted a monkeypox virion Source: AP/PA Images

What are the symptoms?

Cases of monkeypox resemble smallpox, a related virus that was declared eradicated worldwide in 1980 following years of vaccination campaigns.

Initial symptoms of monkeypox infection include a fever (of 38 Celsius or higher), headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion.

Patients will also develop a rash, which starts on their face and spreads to the mouth, and raised red spots that develop into blisters within three days. If the virus has been transmitted via sexual contact, this rash may also begin to develop in the genital areas.

The rash will go through a number of different stages before finally forming scabs and falling off. Symptoms tend to last from two to four weeks.

The most severe cases tend to occur in children and those with weaker immune systems, and are related to the extent of virus exposure, a patient’s health status and the nature of any complications they develop.

These complications can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea which could result in loss of vision.

There is no cure for monkeypox, and any treatment is simply for the relief of uncomfortable symptoms, like pain or itchiness, keeping patients warm and comfortable, and making sure they get plenty of fluids.

monkeypox-patient Patients will develop red spots that turn into blisters Source: Alamy Stock Photo/US Centers of Disease Control

Where is monkeypox spreading and why?

According to the US Centres for Disease Control, there were no reported cases of monkeypox for 40 years before it re-emerged in Nigeria in 2017.

However, the virus has recently started spreading between people in places where this has not previously happened – namely in Europe and North America. 

Since the beginning of May, health authorities on both continents have detected dozens of suspected or confirmed cases of monkeypox.

The current outbreak has seen transmission between humans reported for the first time in Europe, where there is no known epidemiological links to West and Central Africa.

In continental Europe, Spain and Portugal have detected more than 40 possible and verified cases. Closer to home, the UK has confirmed nine cases since 6 May. Sweden also reported its first case of the virus today.

For context, seven cases of monkeypox have been reported in total in the UK in the three years before 2022, which were mainly associated with travel to countries where the virus tends to circulate.

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The first case this year was reported by the UK Health Security Agency on 7 May, and is believed to have been imported. Two more cases – both people living in the same house who had no history of travel or contact with the first case – followed on 14 May.

Another four cases were then confirmed by the UK’s Health and Safety Authority (UKHSA) on 16 May, all without a history of travel to Central or West Africa or contact with the cases reported on 7 and 14 May.

All of the latter four those cases involved men who have sex with men – the first time this has happened in the world.

Then on 18 May, Portugal reported five confirmed and another 20 suspected cases of monkeypox, all of whom were young men. Spain has also reported eight suspected cases.

The extent of community transmission in Europe is currently unknown, but targeted testing of those with symptoms of the virus is beginning in affected countries.

As of yet, there are no cases reported in Ireland, but the HSE has co-ordinated a team to actively monitor the situation and prepare services in Ireland for the possibility of cases arising here. 

Yesterday, the US also confirmed its first case of monkeypox in a man who had recently travelled to Canada, where no cases have yet been reported but where the situation is being monitored.

What is the current public health advice?

In Ireland, the HPSC says that the risk of spread in the wider community is low.

However, they also warn that recent cases in the UK among gay, bisexual and other men who have sex with men (gbMSM) suggest that there may be a higher risk among this group in Ireland.

The HSE is advising those who self-identify as gbMSM, especially those who have travelled to London, the UK or Portugal in the past month, to be alert to any unusual rashes or lesions on any part of their or their partner’s body, especially their genitalia.

If any such changes are noticed, affected people are told to contact their GP or local STI clinic for advice.

Meanwhile, the WHO has urged intensive public health measures to continue in the UK, and for contact tracing and source tracing, case searching, and local rash-illness surveillance to be strengthened among gbMSM and in the wider community.

They also say that anyone who is sick during travel or after return from Central or West Africa should report their symptoms to a healthcare professional, including information about all recent travel and immunisation history.

Those travelling to these areas are told to avoid contact with sick or dead animals that could harbour monkeypox, such as rodents, marsupials and primates, and refrain from eating or handling bush meat.

- Contains reporting from © AFP 2022.

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