LONDON –
Scientists who have observed multiple outbreaks of monkeypox in Africa say they are confused by the recent spread of the disease in Europe and North America.
Cases of smallpox have previously been reported only in people with links to Central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, the United States, Sweden and Canada have reported infections, mostly among young men who have not traveled to Africa before.
There are about 80 confirmed cases in the world and another 50 suspects, the World Health Organization said. France, Germany, Belgium and Australia announced their first cases on Friday.
“I am just amazed. I wake up every day and there are more countries infected, “said Oyuele Tomori, a virologist who previously headed the Nigerian Academy of Sciences and is a member of several WHO advisory boards.
“This is not the kind of proliferation we’ve seen in West Africa, so there may be something new happening in the West,” he said.
To date, no one has died at the hearth. Monkeypox usually causes fever, chills, rash, and lesions on the face or genitals. The WHO estimates that up to one in 10 people is fatal, but smallpox vaccines are protective and some antiviral drugs are being developed.
British health officials are investigating whether the disease is sexually transmitted. Health officials asked doctors and nurses to be alert to potential cases, but said the risk to the general population was low. The European Center for Disease Control and Prevention has recommended that all suspected cases be isolated and that a smallpox vaccine be offered at high-risk contacts.
Nigeria reports about 3,000 cases of monkeypox a year, the WHO said. Outbreaks appear to be exacerbated in rural areas where people come into close contact with infected rats and squirrels, Tomori said. He said many cases were probably missed.
Dr Ifedayo Adetifa, head of the country’s Centers for Disease Control, said none of the Nigerian contacts with British patients had developed symptoms and that investigations were ongoing.
The director of the WHO for Europe, Dr Hans Kluge, described the outbreak as “atypical”, saying that the outbreak in so many countries across the continent suggested that “transmission has been going on for some time”. He said most European cases were minor.
On Friday, the British Health Security Agency reported 11 new cases of monkeypox, saying that “a significant proportion” of infections in the UK and Europe were in young men with no history of travel to Africa and who were gay, bisexual or had sex with men.
Authorities in Spain and Portugal also said their cases involved young men who had mostly had sex with other men, and said the cases were initiated when the men had lesions in sexual health clinics.
The experts stressed that they do not know whether the disease is spread through sex or other close contact related to sex.
Nigeria has not had sexual transmission, Tomori said, but noted that viruses not originally known to be sexually transmitted, such as Ebola, were later shown to do so after major epidemics showed different distribution patterns.
The same can be said for monkeypox, Tomori said.
In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus was sequenced to see if there were any genetic changes that could make it more infectious.
Rolf Gustafson, a professor of infectious diseases, told Sweden’s SVT television that it was “very difficult” to imagine that the situation could get worse.
“We will certainly find a few more cases in Sweden, but I don’t think there will be an epidemic in any way,” Gustafson said. “There’s nothing to suggest at the moment.”
The researchers said that while it is possible that the first patient of the epidemic caught the disease while in Africa, what is happening now is extraordinary.
“We have never seen anything like this in Europe,” said Christian Happy, director of the African Center for Excellence in Infectious Genomics. “We haven’t seen anything to say that the patterns of monkeypox transmission are changing in Africa. So if something different is happening in Europe, then Europe needs to look into it.”
Happie also pointed out that the cessation of smallpox vaccination campaigns following the eradication of the disease in 1980 could inadvertently help the spread of monkeypox. Smallpox vaccines also protect against monkeypox, but mass immunization was stopped decades ago.
“Apart from people in West and Central Africa who may have some immunity to monkeypox from previous exposure, the lack of a smallpox vaccine means no one is immune to monkeypox,” said Happy.
Shabir Mahdi, a professor of vaccinology at the University of the Witwatersrand in Johannesburg, said a detailed investigation into the outbreak in Europe, including determining who the first patients were, was now critical.
“We really need to understand how this started and why the virus is gaining momentum,” he said. “There have been many controlled and rare outbreaks of monkeypox in Africa. If that is changing now, we really need to understand why.”
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Geir Mulson in Berlin, Jan M. Olsen in Copenhagen, Chinedu Assad in Lagos, Nigeria and AP reporters from across Europe contributed to this report.
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The Associated Press’s Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Scientific Education. AP is solely responsible for all content.
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