The United Kingdom has identified the first documented case of a second infection in the same patient with monkeypox virus, a disease recently renamed mpox by the World Health Organization (WHO).
This is a man in his thirties who went to a health center last November with compatible symptoms —headache and throat, swollen glands, ulcers in the mouth and rectum...— and whom the tests carried out detected the pathogen.
The patient, who stated that he had had sexual relations with several men in the previous two weeks and did not suffer from immune problems, had overcome a first infection four months earlier and, in addition, had received the full schedule of the vaccine between the two clinical processes.
The finding is important for two reasons.
The first is due to the influence that this may have, if more cases occur, on the evolution of the first global outbreak of the disease, which until last May was restricted to endemic areas of Africa —where the reservoir is in small mammals, from which it jumps intermittently to humans—and which has since spread to practically the entire world with more than 85,000 cases and 89 deaths.
The second is that doctors will no longer be able to rule out that a patient has mpox even after the infection has passed, something that until now was thought to confer lifelong immunity.
"This case highlights the importance of continuing to include mpox in the differential diagnosis for individuals presenting with genital or mucosal ulceration, regardless of the assumed immunity derived from previous infection or vaccination", the authors of the article describing the case in the journal scientific
The British Medical Journal.
Santiago Moreno, head of the infectious diseases service at the Ramón y Cajal Hospital (Madrid), is surprised: “It is a first case, but one of great interest.
Now we will have to be very attentive to the possibility of new reinfections that confirm whether this is going to be something relatively frequent or we are facing something absolutely exceptional.
But we can no longer take it for granted that a patient who has had the disease will not suffer from it again ”, he affirms.
According to this expert, the finding reinforces the need to maintain prevention measures.
“It has been less than a year since mpox broke into Europe and we still have a lot to learn.
In any case, the need for people who may be most exposed to the virus to protect themselves and continue to do so even if they have had the disease or are vaccinated is evident, ”he says.
To explain such an exceptional case, the authors of the article have considered another hypothesis, although they see it as highly unlikely: that the two infections are actually the same.
“To our knowledge, there have not been any other published cases of reinfection during the 2022 mpox outbreak. An alternative explanation for reinfection would be that the mpox infection persisted after the first one during the intervening period.
[But] This is unlikely to explain the new clinical signs of disease that the patient experienced at second presentation, which could not be attributed to any other investigated sexually transmitted disease."
Another argument that would rule out this hypothesis is that in all the cases observed so far "the time from infection to viral elimination is usually less than 6 weeks", something that was verified again after this second diagnosis.
"A comparison of the nucleotide sequence of the mpox DNA detected both in clinical episodes and in additional testing between episodes would be required to shed more light on this," they add.
While new studies do not shed this light, the researchers propose that all patients with symptoms compatible with mpox be tested to detect this disease despite a previous infection or being vaccinated, that "the degree of immunity offered by the infection" continue to be investigated. and the influence that vaccination has on it.
The current global outbreak of mpox began last May.
After the first local infections of unknown origin detected in London —until then the few diagnoses made could always be epidemiologically linked to some endemic country—, the disease also began to be identified in dozens of patients in Madrid and Lisbon.
In just a couple of months, cases already exceeded 20,000 in more than 50 countries, prompting the WHO to declare an international health emergency on July 23.
Until then, only the coronavirus and polio had deserved this consideration by the body.
Virtually all of the initial cases were diagnosed in young men who had attended festivals or events where multiple same-sex intercourse is common.
Mpox is not considered a sexually transmitted disease, although there are some studies that point to this, but it is proven that infections are produced by contact with the blisters and wounds that the infection causes on the skin and mucous membranes.
This requires close contact which occurs in these situations.
According to the latest data published by the WHO, dated February 2, almost 85,500 cases and 89 deaths have been registered in the current outbreak in 110 countries.
The trend in recent months has been downward throughout the world, although this trend was broken in the last week with complete data —the one from January 22 to 29—, when 403 cases were diagnosed, 37% more than in the previous one.
Most of the cases and all the deaths that have occurred since the beginning of the year (15) have occurred in the American continent.
In Europe, according to the latest report from the European Center for Disease Control and Prevention (ECDC), new infections have stabilized at very low figures —a dozen a week—, although the presence of the virus has not been eliminated.
In the second half of January, there were 23 new diagnoses: six of them in Spain;
four in Denmark;
three in Belgium, Italy and Sweden;
two in France;
and one each in Ireland and Norway.
Spain, with 7,528 cases notified to the WHO, continues to be the European country most affected by the outbreak and the third in the world after Brazil and the United States.
Of the five deaths registered in the European Union, three have been in Spain (the other two have been in Belgium and the Czech Republic).
Antonio Alcamí, a researcher specializing in the viruses that cause the different types of smallpox from the Higher Council for Scientific Research (CSIC), values positively the current low incidences registered in most countries, although he does not believe that "the virus will disappear" and He considers this to be a “significant risk”.
“The problem is that, even at low levels, the virus continues to circulate and replicate.
This is giving it time to adapt better to humans and there is always the risk that it could mutate and become more transmissible ”, he concludes.
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