A case of monkeypox has been reported in the United States, with Spain and Portugal reporting infections in a growing outbreak

A case of monkeypox has been reported in the United States, with Spain and Portugal reporting infections in a growing outbreak

TThe United States confirmed a case of monkeypox infection on Wednesday in a man who had recently traveled to Canada. It is not yet clear whether the man, who lives in Massachusetts, was linked to the outbreak of monkeypox in Europe.

The case was announced in a statement posted on the website of the Massachusetts Department of Public Health. Earlier today, a Centers for Disease Control and Prevention official said cases in this country are likely to begin detection.

“As we’ve now seen confirmed cases outside of Portugal, and suspected cases outside of Spain, we’re seeing this expansion of confirmed and suspected cases globally, we have a feeling no one has arms around this to know how big and how wide that’s likely to be,” Jennifer McQuiston said. D., deputy director of the CDC’s Division of High-Score Pathogens and Pathology, and given the amount of travel there is between the United States and Europe, I’m pretty confident we’ll see cases in the United States.


This development adds the United States and possibly Canada to a growing list of countries reporting cases of monkeypox in an outbreak first detected in the United Kingdom.

Spain has now confirmed some cases and other countries will join that list, said Maria Van Kerkhove, who leads the emerging and zoonotic diseases unit in the WHO’s health emergencies programme.


“We have positive cases identified in the UK, Portugal and Spain. We expect there will be others,” Van Kerkhove told Stat Agency on Wednesday.

Earlier in the day, Spain announced it was investigating eight suspected cases, and Portugal said it was investigating more than 20 suspected cases, five of which have already been confirmed. It is currently not clear whether the outbreaks are linked to each other or to the one in the UK, where nine confirmed cases and one probable case have been reported.

If they are connected, it is not yet known whether the virus has spread from the UK to Europe, or vice versa. It is not known how long the virus has spread in these countries. “Obviously it’s been going on for a few weeks,” Van Kerkhove said.

She emphasized that most of the cases were detected in gay, bisexual or men who have sex with men, but cautioned against overemphasizing this fact.

“We find what we’re looking for,” Van Kerkhove said, noting that countries have been calling sexual health clinics asking about patients with unusual rashes. It is important that other health care providers elsewhere – general practitioners, dermatologists, and others – be aware of the possibility of seeing cases of monkeypox so that if the virus spreads more widely, they take appropriate precautions and these cases are not missed.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the details disclosed so far raise the possibility of a more geographically spread outbreak.

“There could be a dynamic transmission here that we didn’t appreciate because of the potential number of contacts,” he said, adding that it would be important to gather information about how much intimate contact patients had and where they might have come from.

A number of countries outside Central and West Africa, where monkeypox is more common, have experience dealing with introductions to the virus, so there is a possibility that the outbreaks are “relatively small,” said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

“I think that’s still a possibility, given the past,” Inglesby told STAT. “But on the other hand, this started with a lot more foothold, in a more distributed way, and we don’t understand how it got … into those networks.”

“This could have potential to act and would require a very strong public education effort in the affected communities and possibly more broadly, so that people realize the possibility of ‘monkeypox infection,'” he said.

The UK’s Health Security Agency announced on Wednesday that it had detected two additional cases, bringing the number of cases reported there this month to nine. Prior to this outbreak, the United Kingdom had detected only seven cases of monkeypox. The agency said in a statement that the last two cases had not traveled to countries where monkeypox virus is common, and they had no known links to any of the previous cases “so it is likely that they contracted the infection through community transmission.” The latter cases were mostly among men who identify as gay, bisexual, or have sex with men.

The rapid accumulation of cases raises alarm bells.

On Tuesday, the CDC indicated it was concerned about the state of the outbreak in the UK and the possibility of finding cases in other countries.

“We have a level of concern that this is very different from what we normally think of monkeypox,” McQuiston said. “We don’t understand how many other cases there could be in the UK, for example, with undefined chains of transmission. We have a feeling there may be some unusual modes of transmission, through intimate contact or some form of close personal contact that has not been We associate it before with monkeypox.”

The World Health Organization, which has designated monkeypox as a priority pathogen, organized an expert meeting on monkeypox and orthopoxviruses – the broader family of smallpox viruses – early next week. Among the issues that experts are likely to address is the apparent change in the epidemiology of the disease in countries where the virus is endemic, which has occurred in recent years.

“We are seeing a shift in the age distribution of cases. We have to really understand that deep environment,” said Michael Ryan, Executive Director of the WHO Health Emergencies Programme. We have to really understand human behavior in those areas and we have to try to prevent the disease from getting to humans in the first place.”

Monkeypox virus is related to the smallpox virus, which causes smallpox, a frightening disease that was declared eradicated in 1980. The symptoms of monkeypox are similar to smallpox but much milder.

Infected people develop flu-like symptoms — fever, body aches, and chills — but also swollen lymph nodes. With one to three days after the onset of fever, a characteristic rash appears, often starting on the face. Many conditions can cause the rash but the monkeypox rash has some unusual features, particularly the fact that vesicles can form on the palms of the hands.

In countries where the virus is endemic, the virus is believed to be transmitted primarily to people from infected animals when they kill people or prepare bushmeat for consumption.

Once transmitted to humans, human-to-human transmission of the virus can occur via respiratory droplets — virus-laden saliva that can infect the mucous membranes of the eyes, nose, and throat — or by contact with monkeypox lesions or body fluids, with the virus entering through Small cuts in the skin. It can also be transmitted by contact with clothing or linens contaminated with material from monkeypox pests.

Cases outside Africa were rare, although there was a major outbreak in the United States in 2003 that included 47 confirmed and probable cases in six states. That outbreak, first reported from outside Africa, was traced back to the import of small mammals from Ghana.

However, there have been slight increases in the past few years in the incidence of exported monkeypox. The United States discovered two in 2021, both in travelers who had returned from Nigeria. The UK has seen multiple imports in the past few years and Israel and Singapore have also detected cases.

McQuiston said the number of cases that have been exported from Nigeria in particular appears to be inconsistent with the number of cases reported in the country itself.

I think we’re concerned about the number of exported cases of travelers that we’ve seen. And having a lot of them in the last few years is just letting us know that there’s a lot more monkeypox transmission going on in Nigeria than there are. [official] The numbers might suggest,” she said.

“And I also think this is a science to us that the more traditional modes of transportation that we think about, like hunting wild animals, contacting bushmeat, living at that interface between the forest and small communities doesn’t seem to be a transmission engine in terms of what we see happening. And that makes us take a broader look. on the nature of the risk factors.

There is no licensed vaccine to prevent monkeypox, and there are no specific medications for this disease. But vaccines and drugs that are developed and stockpiled to hedge against a recurrence of smallpox are thought to be beneficial. In the 2003 outbreak in the United States, a smallpox vaccine was used.

Van Kerkhove of the World Health Organization noted that some of these products have been licensed using what is known as an animal base, where animal efficacy data is used as a proxy because the absence of smallpox means that vaccines or drugs cannot be tested for effectiveness in people. As a result, she said, any such product can only be used in the context of a clinical trial.

“There are options. We just have to make sure to use it appropriately. One of the things about vaccines is that we want to make sure that if the vaccines are needed and used, they are used in the population that needs them most. “There is not enough supply of anything at the moment,” she said.

However, she expressed confidence that the outbreak could be brought under control.

“What we need to do now is focus on stopping the spread. And we can do that. We can do that with the right messaging, the right testing…with supportive isolation and clinical care as necessary, while protecting health workers,” Van Kerkhove said.

2022-05-18 20:48:45

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