Monkeypox becomes endemic outside of Africa and becomes a new global disease

It took just six months for the monkeypox virus to spread around the world and become a new global disease.

After spending thousands of years circulating in a limited way among small mammals in central and western Africa, the humanization of jungle ecosystems has given the pathogen the opportunity to extend its domain.

The cases detected in people, exceptional only a few decades ago, then increased in number and frequency until they became commonplace in countries like Nigeria.

An unexpected increase in infections in London, Madrid and Lisbon last May marked the beginning of

on the entire planet.

More than 81,000 people in 110 countries have contracted the virus since then, of which 55 have died, according to laboratory-confirmed cases collected by the World Health Organization (WHO).

The actual number of infected, however, has been much higher due to underreporting due to the initial difficulties in many countries to extend the use of diagnostic tests and the existence of a small but significant part of asymptomatic cases.

The WHO has decided this week to rename the ailment to call it mpox in order to avoid the stigmatization that its name could cause.

“The future lies in what we would call the control of the disease.

There will not be many outbreaks nor will they be as big as those of the last few months.

The disease may even disappear from some areas for a while.

But as long as the virus continues to circulate and there are many people who are not immunized, either by vaccine or by natural infection, the disease will reappear due to imported cases that will generate new chains of transmission," says Santiago Moreno, head of infectious diseases at Hospital Ramón y Cajal (Madrid).

A spokesman for the Community of Madrid, one of the areas most affected in the world by the current outbreak, maintains that mpox "will remain in our area as an endemic disease, with a low incidence, and with small outbreaks associated with events in which people interact. with infection with people susceptible to the virus”.

Quique Bassat, an epidemiologist and ICREA researcher at the ISGlobal institute in Barcelona, ​​is concerned "by the evidence that it has not been possible to stop the outbreak before it has reached dimensions that make it almost impossible to eradicate, which shows the vulnerability of societies around the world to emerging infectious diseases.”

The most affected group in the current outbreak, with more than 90% of those affected, has been from the beginning that of young men who attend events or places where relationships with other men and having several sexual partners are frequent.

Without being a sexually transmitted disease —although this hypothesis is still under investigation— close contact that occurs during sexual intercourse has been revealed as an effective way of contagion due to the pustules that the infection causes on the skin, especially in areas close to the anus and genitals.

Although in the vast majority of cases the disease progresses mildly in two or three weeks with fever, pain and a skin rash, about 4% of those affected have to be hospitalized due to complications and intense pain.

Spain is the country in the world where the disease has had the greatest impact in relation to the population.

According to the latest report from the Center for the Coordination of Alerts and Emergencies of the Ministry of Health (CCAES), the 7,407 diagnosed cases represent an incidence of 156 cases per million inhabitants.

Peru (104 cases), Portugal (91), the United States (88) and Colombia (75) are the next countries on this list, while in absolute terms the United States, with almost 30,000, and Brazil, with 10,000, have the highest number. of positives.

The current trend of the disease is downward worldwide since August, when the peak of new infections was reached (one thousand a day) after three months of constant rise.

Despite this, the number of new cases is still significant, 1,696 in the second half of November, and the situation differs greatly depending on the area.

According to the WHO, the number of infections is currently growing again in a dozen countries, with Peru at the head of this group

In Europe, according to the European Center for Disease Control and Prevention (ECDC), between November 8 and 22, a total of 42 cases were diagnosed, with Spain in the lead (13 diagnoses), followed by from Sweden and Ireland (seven each).

The agency's update report reveals that Spain has registered a new death from monkey smallpox between these dates, a death that Health attributes to a "disseminated infection in the context of severe immunosuppression."

This is the third death caused by the disease in the country.

In the first two cases, the cause was meningoencephalitis, the most serious complication of those observed.

The limited availability of vaccines has been one of the reasons that have reduced the ability of governments to react to the outbreak, all the experts believe.

According to the Ministry of Health, Spain did not receive the first doses until the end of June (5,300 doses), to which another 12,000 were added in August.

This shortage, which has affected most of the countries, has made it necessary to change the form of administration of the drug from subcutaneous to intradermal.

With this route, according to international health recommendations, each dose can be used in five patients.

Despite this, the vast majority of people who have been immunized - the vaccine is indicated for people exposed to the virus - have only been able to receive one dose.

In Madrid, only 467 of the 7,836 administered injections have been second doses.

Health plans to receive another 47,000 before the end of the year.

Antonio Alcamí, a researcher specializing in the viruses that cause the different types of smallpox at the Higher Council for Scientific Research (CSIC), also considers that "a small incidence will remain, variable depending on the place and time" and that the disease " It will not be eradicated."

The current decline in the number of cases worldwide is attributed to "protection measures" adopted by those who maintain risky practices, although, like other experts, he warns that it is difficult for these to be maintained in the long term.

An investigation led by Alcamí and recently published in

highlights "that the virus produces a more systemic infection than previously thought", with a significant viral load in saliva.

“We have found the virus in droplets and aerosols that we produce when we speak,” he explains.

This does not necessarily mean that this is a very important route of transmission today, since the fact that a contagion occurs depends both on the amount of virus that a person exhales when speaking and on the amount needed by the person in front to develop the infection. (figure unknown).

"Until now, transmission by contact is dominant, but this finding opens the door for contagion to also occur by air, especially in the future if the virus adapts better to humans," concludes Alcamí.

This researcher regrets that, despite the WHO in July declaring monkeypox a "public health emergency of international concern", the work on the virus in his laboratory "has not received any specific funding from the Ministry of Health" and It has only been possible thanks to "the CSIC Global Health Platform financed with European recovery funds, to respond to COVID19 and prepare for future pandemics."

As an example of this lack of support,

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