Monkeypox : what do we need to know?
Lately since mid-May, an increased number of cases of an unknown disease, monkeypox, has been ongoing in many countries around the world. The first case in Europe, was reported on 7 May 2022 in the UK as imported from Nigeria. On 14 May two other cases were confirmed in the UK without being found to have any connection to the Nigerian case. In the following days, several other EU Member States as well as other countries reported cases of monkeypox not linked to travel to endemic countries
Thus by 31 May 2022, according to an ECDC announcement, a total of 321 confirmed cases have been reported from 12 EU/EEA countries and another 236 in 7 non-EU countries , bringing the total number of cases to 557, in countries where the disease has not been endemic until now. Most of these are diagnosed mainly in young men who identify themselves as men who have sex with men ( MSM). However, the WHO warns that anyone is at risk of the disease, regardless of their sexual orientation.
But what is monkeypox? It is a zoonotic disease caused by a virus of the genus Orthopoxvirus, the monkeypox (MPXV) virus, first isolated in 1958 as a disease transmitted in colonies of “laboratory monkeys”, hence the name “monkeypox”, and its symptoms resembled those of smallpox. In humans, the first cases of the disease appeared around 1970. There are two types of the virus: the West African strain and the Congo strain. All cases that have occurred outside Africa to date have been caused by the West African strain, which has a mortality rate of about 3.6%.
However, monkeypox virus (MPXV) occurs in endemic areas of Africa and is likely to be maintained in the wild through mammalian reservoirs and is occasionally transmitted to humans, possibly through bites or direct contact with blood, meat, body fluids or from the skin lesions of an infected animal.
In Europe there have been no deaths to date. The clinical picture is described as mild with most cases presenting with fever and rash lesions in the genital or perinatal area, indicating that transmission probably occurred during close physical contact, but it has not been established that simian smallpox is transmitted through mucosal secretions. However , it is recommended by the WHO that those infected should use condoms during sexual intercourse for eight weeks after infection as a precautionary measure.
The symptoms of the disease subside after about four weeks without the need for any treatment.
So far there is no evidence that the cases in Europe are epidemiologically linked to those in West or Central Africa, where the disease is endemic, and there are still many questions about how the disease is spreading, possibly accelerated by the decades-long cessation of smallpox vaccination, which deprives the younger population of protective cross-immunity. It should be noted that the vaccine used to eradicate smallpox shows cross-protection against monkeypox virus that is probably strong. Newer vaccines are now available, one of which is licensed for use against monkeypox virus.
Hopefully the indications so far will not be disproved and the sporadic outbreaks will remain and not turn into a pandemic because worldwide populations are tired and economies are decimated.
Nikolaos Malisiovas
Om. Professor at the Aristotle University of Thessaloniki, Scientific Director of Euromedica Group