LISBON, Portugal (AFP) – Portuguese health authorities on Wednesday confirmed five cases of monkeypox in young men, and Britain announced two more, marking an unusual outbreak in Europe of a disease usually confined to Africa.
Portugal’s Directorate General of Health said it was also investigating 15 suspected cases, all of which were identified this month in the area around the capital, Lisbon.
The authorities said all of the Portuguese cases concerned men, mostly young men. They have skin lesions and have been reported to be in a stable condition. The authorities did not say whether the men had a history of traveling to Africa or any connection to recent cases in Britain or elsewhere.
British health authorities said on Wednesday they had identified two new cases of monkeypox, one in London and one in southeast England. They said that neither of the cases had ever traveled to Africa and that it was likely that they had been infected in the UK.
Dr Susan Hopkins, Senior Medical Adviser to Britain’s Health Security Agency, said the recent cases, along with other infections reported in Europe, “confirm our initial concerns that monkeypox could spread within our communities.”
The agency said the latest cases were seen “mostly in gay and bisexual people or men who have sex with men,” although it noted that it was unclear exactly how people were infected.
The spread of monkeypox through sex has not previously been documented, but it can be transmitted through close contact with infected people, their clothing, or bed linen.
Earlier this week, the British agency reported four cases of monkeypox that they said had spread among gay and bisexual men in London. The risk to the general population “remains low,” the agency said.
Health authorities in Spain’s central Madrid region said late on Wednesday that they were assessing 23 possible cases of monkeypox. They pointed out that all the suspected cases are young men and that the majority of them had sex with other men.
This disease belongs to a family of viruses that includes smallpox. Most people recover from monkeypox within weeks, but the World Health Organization has said the disease is fatal in up to one in ten people. Sporadic cases of monkeypox have previously been seen in countries including Britain and the United States, but nearly all of them have been in people who were likely infected while traveling in Africa.
Dr Ibrahim Seuss Fall, WHO’s assistant director-general for emergency response, said the spread of monkeypox in the UK needed to be investigated to understand how the disease was transmitted between MSM.
Fall said health officials still need to better understand how monkeypox is generally spread, even in countries where the disease is endemic.
He noted that although there were more than 6,000 cases reported in Congo and nearly 3,000 in Nigeria last year, there were still “a lot of unknowns regarding the transmission dynamics.”
Britain previously reported three previous cases of monkeypox, two of them in people who lived in the same household and the third in a person who had traveled to Nigeria, where the disease is most common in animals.
The virus usually spreads to people from infected animals such as rodents, although human-to-human transmission has been known to occur.
Some British experts said he soon concluded that monkeypox had been spread sexually, although outbreaks there suggested that possibility.
“The recent cases point to a potential new means of spread,” said Neil Mabout, a disease expert at the University of Edinburgh, adding that related viruses are known to spread through sex.
Keith Neal, an infectious disease expert at the University of Nottingham, said transmission may not have occurred through sexual activity, but only “close contact associated with intercourse”.
Monkeypox usually causes fever, chills, a rash, and lesions on the face or genitals similar to those caused by smallpox. A vaccine developed against smallpox has been approved against monkeypox, and several antivirals also appear to be effective.
Cheng reported from London. Joe Wilson in Barcelona, Spain, and Aretz Parra in Madrid contributed to this report.
Barry Hutton and Maria Cheng, The Associated Press