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Thursday, June 30, 2022

The monkeypox virus is widespread in five major European capitals

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Monkeypox continues its upward trend across most of Europe five weeks after the international alert that uncovered the largest outbreak of the disease ever recorded outside endemic areas of Africa. With more than 2,000 confirmed cases in 28 countries on the continent, chains of infection remain unchecked in the three first-hit capitals – London, Madrid and Lisbon – and the spread of the virus is accelerating in two other major cities, Berlin and Paris, but also growing in Countries like Belgium, the Netherlands and Italy.

Spain has overtaken the United Kingdom as the country with the most diagnoses in the world in recent days, with almost 700 cases detected by the Autonomous Communities. The hardest-hit area remains Madrid, with 510. “We are consistently diagnosing cases, a stable number [26 diarios de media en la última semana], suggesting that there are undetected sources of exposure, likely cases with few undiagnosed symptoms,” explains a spokesman for the Autonomous Community of Madrid. In the last week, reports have also risen sharply in Catalonia, where they have gone from 14 to 71 in seven days, and in the province of Malaga (from 9 to 24).

Monkeypox is a zoonotic disease whose reservoir is in small rodents from Central and West Africa. From there it jumps sporadically to humans via liquids and triggers transmission chains that have been limited so far, because in order to infect a human being, close contact is required, such as that which takes place during sexual intercourse, but not only into you. The main novelty of the current outbreak is the ongoing transmission of the virus between men who have sex with other men, a route of infection that accounts for more than 98% of confirmed cases.

The disease is not considered sexually transmitted, although there are several lines of research that suggest it can. A study conducted in Italy found the virus in the semen of the first four cases diagnosed in the country. “This is not definitive as there are other viruses that cannot be transmitted. However, we have also found it in the rectal exudate of patients with proctitis [inflamación de la mucosa de la zona] They didn’t even have lesions on other parts of their bodies. We were not aware of this and lead us to believe that we may be facing a transmission route that is not described in the scientific literature,” explains Santiago Moreno, Head of the Infectious Diseases Service at the Ramón y Cajal Hospital (Madrid). puts forward this hypothesis in an as yet unpublished study.

Carlos Maluquer de Motes, professor of molecular virology at the University of Surrey (UK) and an expert on smallpox, believes that “this outbreak will be difficult to eradicate”. “The virus has reached many countries, the spread continues to increase and detection and tracking systems are limited. At the moment, the confirmed cases are people who go to health centers because they have found injuries, but not all do so because of the social stigma that exists. For the same reason, contact tracing is very complicated,” explains this researcher.

Recent studies and communications from United Kingdom, Portugal Y France They have warned that a majority of the confirmed cases cannot identify many of their high-risk contacts because they have had relationships with unknown individuals or have refused to provide data on them.

“At least there is something positive about what we know so far. There is very little contagion outside of risk practices, and that means the virus hasn’t adapted to other modes of transmission. This explains why the increase in cases is sustained but not exponential. But you have to be vigilant because the longer the virus circulates, the more time it has to adapt,” explains Carlos Maluquer de Motes.

Smallpox viruses are DNA, much less prone to sudden mutations that can make them more contagious than RNA, like the coronavirus. “Genetic studies comparing the current virus to that of 2018 [cuando fueron diagnosticados en Reino Unido tres casos con origen en Nigeria] show a higher number of mutations than expected. They’re small mutations that don’t seem to make the virus more dangerous on their own, but what we don’t know is whether the combined effect of all of them gives it an advantage in transmission,” explains this researcher.

The current outbreak was detected in the UK in early May, although later investigations found the virus had been circulating in London, Madrid and Lisbon for at least a few weeks. The alert launched by British authorities was confirmed on the 17th of last month, when Portugal confirmed the first three cases and Spain discovered the first suspected patients.

Since then, Spain and the United Kingdom have alternated as the countries with the most diagnoses. This Monday, British authorities have confirmed 574 compared to the 688 reported by local authorities, more than 80% of whom are residents of the capital. In Portugal, the number of new cases seems to have slowed down somewhat in recent days and currently stands at 276 (85% in Lisbon).

Germany has been the country where diagnoses have grown the most in recent days, already exceeding 400, more than 250 in Berlin. In France, cases have gone from 91 to 183 in a week (129 of them in Paris). In the Netherlands from 60 to 95, in Belgium from 24 to 62, in Italy from 31 to 71 and in Switzerland from 14 to 40. However, these data are not fully comparable as some governments report new screenings every day while others report the two – up to three times a week.

Outside of Europe, Canada has been the hardest-hit country since the outbreak began. It’s 168 this Friday and Quebec authorities, the hardest-hit province, have opened up vaccination to those who request it in a bid to halt the outbreak. In the United States, where several experts have criticized the fact that far fewer cases are detected than those that exist, the number of diagnoses has exceeded the hundred.

About twenty cases have been reported in Latin America: eight in Brazil, five in Mexico, three in Argentina and one in Venezuela and Chile. In Mexico, authorities are trying to contain the outbreak, which emerged at a festival in Puerto Vallarta, and in Argentina, the first outbreak detected with no travel history is worrying, meaning there is an undetected chain of transmission in the country.

A nurse at the Ramón y Cajal hospital in Madrid prepared a PCR test to detect monkeypox on May 30.Carlos Lujan (European press)

International Coordination

The magnitude of these numbers and the need for strong coordination between countries to contain the virus – which could be eradicated in most countries and spread again and again through travel if measures are not taken to stop its spread – are being debated within the World Health Organization (WHO) to decide whether monkeypox constitutes a “public health emergency of international concern,” which a growing number of analysts say is likely, and that means giving it the same attention as the coronavirus and polio.

“The virus shouldn’t become endemic in Europe unless it jumps into an animal reservoir, but the truth is that this outbreak will last longer than we anticipated with the first cases. So far it does not seem that the known data have led to a change in the pattern of relationships that facilitates contagion, although it should be erased if nothing happens over a period of more or less length, “says Santiago Moreno.

Carlos Maluquer de Motes believes that given the difficulties of contact tracing and the lack of availability of vaccines – Spain has only received 200 so far and will not receive the first 5,000 doses of the joint purchase from the EU before the end of the month – “it should.” focus on rapid diagnosis, through a system that would allow patients in primary care to know if they are carriers of the virus.

Experts and authorities fear that the arrival of summer and the increase in festivals and events will lead to an even greater spread of the virus. But, as has happened since the outbreak began, the complexity of informing and preventing groups engaged in risky practices arises without implying “stigma based on sexual orientation and sexual practices,” as stated in the latest risk assessment report published by the Ministry of Health.

For this reason, “meetings were held with the representatives of the Advisory and Advisory Board of NGOs, LGTBIQ+ organizations and various scientific societies” to get their position and engage them to “pass preventive messages to the LGTBIQ+ community and society in general”. .

Also the WHO and the European Center for Disease Control and Prevention (ECDC). have published a joint document to launch prevention and information strategies during this type of festivals. In the final assessment of the current outbreak, the first body has announced that it will no longer differentiate between endemic and non-endemic countries when reporting the outbreak, in order to “offer a better joint response to the virus”.

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