Monkeypox

British health authorities said Wednesday they had identified two new cases of monkeypox, one in London and another in southeast England.

The disease belongs to a family of viruses that includes smallpox. Health authorities in Spain’s central Madrid region said late on Wednesday that they were assessing 23 possible cases of monkeypox. Get a note directly from our foreign correspondents on what’s making headlines around the world. All the Portuguese cases involve men, most of them young, authorities said, on Wednesday, Portugal time. Earlier this week the UK agency reported four cases of monkeypox they said had been spread among gay and bisexual men in London. The agency said the risk to the general population “remains low”. British health authorities said on Wednesday they had identified two new cases of monkeypox, one in London and another in south-east England. They said neither case had previously travelled to Africa and that it was possible they were infected in Britain. The cases had no known links to other previously confirmed patients, suggesting there may be multiple chains of monkeypox transmission already happening in the country.

Infectious disease was first recorded in 1970 but a recent surge in cases has led to the largest outbreak in Europe to date.

But two other clusters of cases have emerged in the UK since, with no link established with that first case. But there have been warnings that countries outside Africa have become too complacent about the virus due to its rarity. When the virus appears outside Africa, it is because someone travelled to an endemic region, became infected, and returned home. And monkeypox is not like Covid, with a high transmission rate.” There are two strains of monkeypox; a Central African strain with a fatality rate of 10.6%, and a West African strain with a much lower mortality rate of between 1-to-3.6%. The latter is the strain identified in the UK. It seems it is mostly spread to humans through interaction with infected animals.

But health officials have little clue where people caught the monkeypox virus. And there's concern the virus may be spreading through the community — undetected ...

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Scientists are trying to answer questions about the outbreak of a disease not known to spread easily between humans.

The United States reported a case of the rare monkeypox disease in Massachusetts on Wednesday. Here's all you need to know about the virus.

The Massachusetts Department of Public Health said Wednesday’s case poses no risk to the public. The CDC says monkeypox cases in the United States are rare. The West African clade is less fatal, with deaths occurring in about one percent of infections. Rimoin said monkeypox is generally thought to have a low reproductive number, based on previous outbreaks — meaning rapid spread is believed to be unlikely. Since smallpox vaccines aren't widely given, the immune protection they provide is lacking for billions around the globe. Monkeypox is a rare disease that comes from the same family of viruses as smallpox. Human-to-human transmission is possible but less common, the World Health Organization said. The virus can also spread through contaminated materials. The sudden surge of cases has prompted concern from public health professionals around the world. The virus doesn’t spread easily between people, although human-to-human transmission typically happens through large respiratory droplets. Scientists have identified two forms of the virus: the West African clade and the Congo Basin clade. Early symptoms include fever, muscle aches, chills and fatigue.

On 15 May, four additional laboratory confirmed cases have been reported amongst Sexual Health Services attendees presenting with a vesicular rash illness and ...

Intensive public health measures should continue in the United Kingdom. In addition to the ongoing forward and backward contact tracing and source tracing, case searching, and local rash-illness surveillance should be strengthened in the GBMSM and wider community, as well as in primary and secondary health care settings. However, once monkeypox was suspected, authorities in the United Kingdom promptly initiated appropriate public health measures, including isolation of the cases and extensive forward and backward contact tracing to enable source identification. Health workers and other care givers caring for patients with suspected or confirmed monkeypox should implement standard, contact and droplet infection control precautions. Any illness during travel or upon return from an endemic area should be reported to a health professional, including information about all recent travel and immunization history. Although the West African clade of monkeypox virus infection sometimes leads to severe illness in some individuals, disease is usually self-limiting. In contrast to sporadic cases with travel links to endemic countries (see Disease outbreak news on Monkeypox in the United Kingdom published on 16 May 2022), no source of infection has been confirmed yet. The first case identified (index case) developed a rash on 5 May and was admitted to hospital in London, the United Kingdom on 6 May. On 9 May, the case was transferred to a specialist infectious disease centre for ongoing care. The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. No source of infection has yet been confirmed for either the family or GBMSM clusters. Health authorities in the United Kingdom have established an incident management team to coordinate the extensive contact tracing which is currently underway in health care settings and the community for those who have had contact with the confirmed cases. On 15 May, WHO was notified of four additional laboratory confirmed cases, all identified among GBMSM attending Sexual Health Services and presenting with a vesicular rash. Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur in forested parts of Central and West Africa. It is caused by the monkeypox virus which belongs to the orthopoxvirus family.

The monkeypox virus causes fever and a bumpy rash and is usually transmitted to people from wild animals.

WHO is working with national authorities to respond quickly & effectively to these outbreaks"- @DrTedros He had recently travelled to Canada. There are two main strains: the Congo strain, which is more severe – with up to 10 percent mortality – and the West African strain, which has a fatality rate of 1 percent of cases. The smallpox vaccine, which also protects against monkeypox, has been phased out. The UK infections have been reported as the West African strain. “Historically, there have been very few cases exported.

Monkeypox can cause fever, swollen lymph nodes and a rash that looks like chickenpox or syphilis, and while usually mild it has been known to have a ...

It is not clear whether the U.S. Biomedical Advanced Research and Development Authority (BARDA) exercised this option over the monkeypox outbreaks or for another reason (countries stockpile smallpox vaccines for defense purposes). It’s also unclear for how long the disease may have been circulating, though WHO’s Van Kerkhove told STAT News it’s “clearly… been going on for a few weeks.” There are also two broad strain of monkeypox, one circulating in West Africa and the other the Congo Basin. The West African strain, which officials believe is involved in the current outbreaks, has a fatality rate of around 1%. The Congo Basin strain has a much higher documented fatality rate, as high as 10%. Beyond that, scientists don’t know the host animal for the virus. While experts believe the pattern of infections indicate the disease spreading in the community, it’s not clear how or if different clusters are connected. Most of the monkeypox cases have been found among gay and bisexual men or men who have sex with men. Cases of monkeypox have been confirmed in the U.K., Spain, Portugal and Massachusetts, with more suspected and under investigation. The leader of the WHO’s emerging diseases unit Maria Van Kerkhove told STAT News people should be cautious about fixating on the pattern among men who have sex with men.

Evidence suggests transmission of the rare and deadly monkeypox virus may be spread by close contact. These are the signs to watch out for.

They are all men and they all live in the region of Lisbon and the Tagus Valley, the Portuguese health authorities said. British health authorities say they have identified four “rare and unusual” cases of the disease among men who appear to have been infected in London and had no history of travel to the African countries where the smallpox-like disease is endemic. Australian health authorities are keeping close watch after a rare and deadly strain of monkeypox was detected in the UK, the US and Europe.

It's a virus that is mainly spread by wild animals in parts of west and central Africa, according to the WHO — but human-to-human transmission can also occur, ...

Preston added: “Monkeypox is not recognized as a sexually transmitted disease — that is, something that’s hugely dependent on being spread through sexual contact. “That’s the worrying thing — the epidemiology would suggest there are other unrecognized cases at the moment. “As a whole, we shouldn’t be panicking — this is not a disease that spreads like COVID-19 within the general population,” Mabbott told Fortune. “Monkeypox isn’t very transmissible in humans. “That would suggest there are other contacts forming the connections between those cases,” he explained. “It’s still somewhat of a mystery as to how this is spreading. The West African variety – the strain currently circulating in Europe and the U.S. – has a recorded fatality rate of around 1%, while the Central African strain’s recorded fatality rate is around 10%. He added that it was concerning to see that some of the cases identified in the U.K. had no links to one another. The cases identified in the U.K. have all been the West African strain of the virus, which is thought to be milder than the Central African strain. Two cases of the virus were identified in London a week after the first case was reported — but authorities said the individuals had no connection to the previously confirmed case, and “where and how they acquired their infection remains under investigation.” It’s a virus that is mainly spread by wild animals in parts of west and central Africa, according to the WHO — but human-to-human transmission can also occur, and it is occasionally exported to other parts of the world when an infected person travels. Canada is investigating 13 suspected cases of the disease, with the U.S. patient reported to have recently traveled to the country. The first case associated with the current outbreak was reported in the U.K. on May 7 in a person who had recently traveled to Nigeria, where they are believed to have contracted the disease.

STAT had many questions about monkeypox. Fortunately, Andrea McCollum, an expert at the CDC, had many answers.

It depends on the person and it depends on the extent of the rash. If a patient’s been in bed, then the lesions have exudate and pus and that gets on the bed linens and the virus is in that material. A number of the cases are in men who have sex with men, which raises the question of sexual transmission. But at this point, everything we’re hearing and seeing is consistent with what we know about monkeypox, which is that it requires close contact. We do know that lesions themselves, including the ones that present on the surface of the skin, they’re loaded with virus. It’s only during that healing phase [with monkeypox] when there’s crusting and the skin is regenerating a bit, patients mention itching. But I will remind you that you can have an R-naught of less than one and the agent can still be transmitted person to person. I don’t think we have a really good handle on whether most of it is respiratory or skin-to-skin. We don’t have really good contemporary estimates of R-naught. [R-naught is the figure that estimates how many people an infected person, on average, will infect.] We don’t really have any estimates of R-naught for the West African clade. So far it seems that the cases are being caused by viruses from the West African clade, which triggers milder disease than the other family of viruses, called the Congo Basin clade. Monkeypox causes a flu-like array of symptoms, but also comes with a distinctive rash; one telltale sign is the fact that lesions often appear on the palms of hands. At this point, the cases are mainly being detected by clinics that treat sexually transmitted diseases and are being seen in men who have sex with men.

“We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if ...

The disease can also be transmitted by touching monkeypox skin blisters or scabs, or getting too close to coughs and sneezes from an infected person. Patients will usually need to stay in a specialist hospital so infection doesn’t spread and general symptoms can be treated. The rash is sometimes confused with chickenpox, because it starts as raised spots which turn into small scabs filled with fluid. But it is possible to spread the disease through touching clothing, bedding, or towels used by someone with the rash. It’s thought to be spread by rodents, such as rats, mice, and squirrels. Monkeypox can be caught from a bite by an infected animal, or by touching its blood, body fluids or fur.

The announcement raises the possibility that the first monkeypox infection found in the United States is connected to the Canadian cases.

The cases diagnosed in Europe have been caused by the West African clade of the virus, which is typically less dangerous than the Congo Basin clade. In Africa, monkeypox has been fatal in about 1 in 10 cases, with severe disease and death more likely among children, young adults, and people with compromised immune systems, though the ECDC said in its report that the case fatality rate for the West African clade has been 3.6%. One possible explanation for why so many cases in the current outbreak have been identified at STI clinics is that people have turned up with “a preponderance of lesions in the genital area,” the ECDC wrote. Health authorities have stressed cases are likely not limited to this population, both to try to avoid stigmatization, and to ensure that clinicians remain on the lookout for infections in other groups of people. The health officials in Montreal said the suspected cases there have included painful lesions in the mouth and on the penis. It’s also not clear, for example, if the U.S. case is related to the cases in Europe. Genomic sequencing can help answer that question.

The virus behind monkeypox is a close relative of the one that caused smallpox but is less deadly and less transmissible, causing symptoms that include fever ...

The oft-cited fatality rate of about 10 percent applies to a strain that infected people in the Congo Basin. The West African strain, which several of the current cases have been linked to, has a fatality rate closer to 1 percent—and that’s in poor, rural populations. And as another bioterrorism precaution, stockpiles of three smallpox vaccines are large enough “to vaccinate basically everyone in the U.S.” Inglesby said. It’s urgent to identify people early, get them treatment, and identify contacts.” It helps that one common symptom is an obvious rash, which looks like an extreme version of chickenpox. As for the U.S., “there are currently no additional suspected cases” beyond the individual in Massachusetts, McCollum told me. Are they the work of a new and more transmissible strain of monkeypox? A 2012 study suggested that the virus can persist in aerosols for several days—but that was under artificial laboratory conditions, and persistence is just one small part of the infection process. For decades, a few scientists have voiced concerns that the monkeypox virus could have become better at infecting people—ironically because we eradicated its relative, smallpox, in the late 1970s. “I’ve seen a lot of people writing as if everything we know about monkeypox is definitive and finalized, but the reality is that it is still a rare zoonotic infection,” she said. “I don’t think people should be freaking out at this stage,” Carl Bergstrom of the University of Washington told me, “but I don’t trust my own gut feelings anymore, because I’m so sick of all this shit that I tend to be optimistic.” Then again, Marr is less certain about monkeypox than she was about COVID. And Titanji notes that our knowledge of monkeypox is based on just 1,500 or so recorded cases, as of 2018. Rarely, monkeypox makes it to other continents, and when it does, outbreaks “are so small, they’re measured in single digits,” Thomas Inglesby, the director of the Johns Hopkins Center for Health Security, told me. This suggests that the monkeypox virus may be surreptitiously spreading from person to person, with some number of undetected cases.