LONDON (AP) – A leading adviser to the World Health Organization described the unprecedented outbreak of monkeypox in developed countries as an “accidental event” that could be explained by the sexual behavior of two recent raves in Europe.
Dr David Heyman, who previously headed the WHO’s emergency department, told the Associated Press that the leading theory explaining the spread of the disease was sexual transmission during raves in Spain and Belgium. The monkeypox has so far not caused widespread outbreaks outside Africa, where it is endemic to animals.
“We know that monkeypox can spread when there is close contact with the lesions of someone who is infected, and sexual contact now appears to have intensified this transmission,” Heyman said.
This is a significant departure from the typical pattern of disease spread in Central and West Africa, where humans are infected mainly by animals such as wild rodents and primates and outbreaks have not spread across borders.
Health officials say most of the known cases in Europe have been among men who have sex with men, but anyone can become infected through close contact with a sick person, his clothes or sheets. Scientists say it will be difficult to determine whether the spread is caused by sex or just close contact.
“In essence, sexual activity involves intimate contact, which can be expected to increase the likelihood of transmission, regardless of a person’s sexual orientation and regardless of the mode of transmission,” said Mike Skinner, a virologist at Imperial College London.
On Monday, Andrea Amon, director of the European Center for Disease Prevention and Control, said “the likelihood of the virus spreading further through close contact, for example during sexual activities between people with multiple sexual partners, is considered high”.
To date, the WHO has registered more than 90 cases of monkeypox in a dozen countries, including Canada, Spain, Israel, France, Switzerland, the United States and Australia. On Monday, Denmark announced its first case, Portugal revised its total to 37, Italy reported another infection and Britain added 37 more.
Germany has four confirmed cases involving “party events … where there was sexual activity” in the Canary Islands in Spain and Berlin, according to a government report to lawmakers received by the AP.
A senior health official in Madrid said on Monday that the Spanish capital has 30 confirmed cases. Enrique Ruiz Escudero said authorities were investigating possible links between a recent gay pride event in the Canary Islands, which attracted about 80,000 people, and cases at a sauna in Madrid.
The cases of monkeypox have so far been minor, with no reported deaths. The virus usually causes fever, chills, rash and lesions on the face or genitals. Most people recover within a few weeks without having to be hospitalized.
Vaccines against smallpox-related disease are effective in preventing monkeypox and some antiviral drugs are being developed. In recent years, the disease has been fatal in up to 6% of infections.
Heyman chaired an emergency meeting of the WHO advisory group on infectious disease threats on Friday to assess the outbreak, and said there was no evidence to suggest that monkeypox had mutated into a more infectious form.
The UN agency said the epidemic was a “very unusual event” and said the fact that the cases were occurring in so many different countries suggested that the virus may have been spreading quietly for some time. The director of the Agency for Europe warned that festivals and parties could speed up the spread.
However, at a public meeting on Monday, WHO officials described the outbreak as “restrained” and warned against stigmatizing the affected groups, saying the disease could infect anyone.
The agency said the cases appear to be linked to the monkeypox virus, which was first detected in cases exported from Nigeria to Britain, Israel and Singapore in 2018 and 2019.
Authorities in Britain, Spain and Portugal said most of the cases identified so far were in young men whose infections were diagnosed when they sought help for lesions in sexual health clinics.
Heyman, who is also a professor of infectious diseases at the London School of Hygiene and Tropical Medicine, said the monkeypox epidemic was probably an accidental event that could be traced back to an infection.
“It is very possible that someone became infected, developed lesions on the genitals, hands or elsewhere and then spread it to others when there was sexual or close physical contact,” Hayman suggested. “And then there were these international events that sparked the outbreak around the world, in the United States and other European countries.
He stressed that the disease is unlikely to spread.
“This is not COVID,” he said. “We need to slow it down, but it’s not spreading in the air, and we have vaccines to protect ourselves from it.
Hayman said research should be conducted quickly to determine whether monkeypox can be spread by asymptomatic people, and that populations at risk for the disease should take precautions to protect themselves.
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Barry Hatton in Lisbon, Portugal, and Frank Jordans and Kirsten Grishaber in Berlin contributed to this report.
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