Cases of smallpox have not been seen before in people with no ties to Central and West Africa. But in recent weeks, the United Kingdom, Spain, Portugal, Italy, the United States, Sweden and Canada have all reported infections, mainly in young men who had not previously traveled to Africa.
France, Germany, Belgium and Australia confirmed their first cases of chickenpox on Friday.
“I am just shocked. “Every day I wake up and more countries are infected,” said Oyewale Tomori, a virologist who previously headed the Nigerian Academy of Sciences and sits on several advisory committees of the World Health Organization.
“This is not the spread we’ve seen in West Africa, so it could be something new happening in the West,” he said.
One of the theories that British health officials are examining is whether the disease is transmitted sexually. Health authorities have asked doctors and nurses to be alert to possible cases, but say the danger to the public is small.
An epidemic in Nigeria, which reports about 3,000 cases of apes a year, is common in rural areas, where people have close contact with infected rats and squirrels, according to Tomori. He said that the disease did not spread very easily and that many cases were probably missing.
“Unless the person in question ends up in an advanced clinic, they will not attract the attention of the surveillance system,” he said.
Tomori hoped that the case of monkey poop in Europe and other Western countries would increase the scientific understanding of the disease.
The head of the World Health Organization on Emergency Response, Dr. Ibrahima Soce Fall, admitted this week that “so much is still unknown in terms of the mechanism of infection, the clinical features (and) the epidemiology”.
British officials have so far reported nine cases of monkey pox, pointing out that the most recent cases have all been in young men who had no travel history to Africa and were gay, bisexual or had sex with men.
Authorities in Spain and Portugal also said their cases were involving young men who were having sex with other men, and said those cases had been taken up when the men showed up with wounds at sexual health centers.
Experts have stressed that they do not know whether the disease is spread through sex or other intimate contact related to sex.
“This is not something we have seen in Nigeria,” said virologist Tomori. He said that viruses that were not initially known to be transmitted through sexual activity, such as Ebola, were later proven to do so after major epidemics showed different distribution patterns.
The same could be true of monkey pox, Tomori said. “We would have to go back through our records to see if this could have happened, as between a husband and a wife,” he said.
In Germany, Health Minister Karl Lauterbach said the government was confident the epidemic could be curbed. He said the virus was being sequenced to see if there were any genetic mutations that could have made it contagious.
Researchers say that although it is possible that the first patient to break out was infected with the disease while he was in Africa, what is happening now is unique.
“We have never seen anything like what is happening in Europe,” said Christian Happi, director of the African Center for the Genetics of Infectious Diseases. “We have not seen anything that says that the transmission pattern of monkey pox has been changing in Africa, so if something else is happening in Europe, then Europe needs to investigate it.
Happi also pointed out that stopping vaccination campaigns against smallpox after the disease was eradicated in 1980 could inadvertently help the spread of monkey vaccine. The smallpox vaccine also protects against monkey vaccine, but mass vaccination was stopped decades ago.
“Apart from people in West and Central Africa who may be immune to monkey pox from previous exposure, it means that not having any smallpox vaccine means that no one has any immunity to monkey pox,” said Happi.
Shabir Mahdi, a professor of vaccine chemistry at the University of the Witwatersrand in Johannesburg, said a detailed study of the epidemic in Europe, including determining who the first patients were, was now important.
“We really need to understand how this started in the first place and why the virus is now taking hold,” he said. “In Africa, there has been a very controlled and rare occurrence of monkey pox. If that’s changing now, we really need to understand why. ”
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