African scientists baffled by monkeypox cases in Europe, U.S
Scientists who have monitored
numerous outbreaks of monkeypox in Africa say they are baffled by the disease's
recent spread in Europe and North America.
Cases of the smallpox-related
disease have previously been seen only among people with links to central and
West Africa. But in the past week, Britain, Spain, Portugal, Italy, U.S.,
Sweden and Canada all reported infections, mostly in young men who hadn't
previously traveled to Africa.
France, Germany, Belgium and
Australia confirmed their first cases Friday.
"I'm stunned by this. Every
day I wake up and there are more countries infected," said Oyewale Tomori,
a virologist who formerly headed the Nigerian Academy of Science and who sits
on several World Health Organization advisory boards.
"This is not the kind of
spread we've seen in West Africa, so there may be something new happening in
the West," he said.
To date, no one has died in the
outbreak. Monkeypox typically causes fever, chills, a rash and lesions on the
face, hands or genitals. WHO estimates the disease is fatal for up to 1 in 10
people, but smallpox vaccines are protective, and some antiviral drugs are
being developed.
British health officials are
exploring whether the disease is being sexually transmitted. Health officials
have asked doctors and nurses to be on alert for potential cases but said the
risk to the general population is low. The European Center for Disease Control
and Prevention recommended all suspected cases be isolated and that high-risk
contacts be offered smallpox vaccine.
Nigeria reports about 3,000
monkeypox cases a year, WHO said. Outbreaks are usually in rural areas, when
people have close contact with infected rats and squirrels, Tomori said. He
said many cases are likely missed.
Dr. Ifedayo Adetifa, head of the
country's Center for Disease Control, said none of the Nigerian contacts of the
British patients have developed symptoms and that investigations were ongoing.
WHO's Europe director, Dr. Hans
Kluge, described the outbreak as "atypical," saying the appearance of
the disease in so many countries across the continent suggested that
"transmission has been ongoing for some time." He said most of the
European cases are mild.
On Friday, Britain's Health
Security Agency reported 11 new monkeypox cases, saying that "a notable
proportion" of the most recent infections in the U.K. and Europe have been
in young men with no history of travel to Africa who had sex with men.
Authorities in Spain and Portugal said their cases were the same.
Experts have stressed they do not
know if the disease is being spread through sex or other close contact related
to sex.
Nigeria hasn't seen sexual
transmission, Tomori said, but he noted that viruses that hadn't initially been
known to transmit via sex, like Ebola, were later proven to do so after bigger
epidemics showed different patterns of spread.
The same could be true of
monkeypox, Tomori said.
In Germany, Health Minister Karl
Lauterbach said the government was confident the outbreak could be contained.
He said the virus was being sequenced to see if there were any genetic changes
that might have made it more infectious.
Rolf Gustafson, an infectious
diseases professor, told Swedish broadcaster SVT that it was "very
difficult" to imagine the situation might worsen.
"We will certainly find some
further cases in Sweden, but I do not think there will be an epidemic in any way,"
Gustafson said. "There is nothing to suggest that at present."
Scientists said that while it's
possible the outbreak's first patient caught the disease while in Africa,
what's happening now is exceptional.
"We've never seen anything
like what's happening in Europe," said Christian Happi, director of the
African Centre of Excellence for Genomics of Infectious Diseases. "We
haven't seen anything to say that the transmission patterns of monkeypox have
been changing in Africa. So, if something different is happening in Europe,
then Europe needs to investigate that."
Happi also pointed out that the
suspension of smallpox vaccination campaigns after the disease was eradicated
in 1980 might inadvertently be helping monkeypox spread. Smallpox vaccines also
protect against monkeypox, but mass immunization was stopped decades ago.
"Aside from people in west
and Central Africa who may have some immunity to monkeypox from past exposure,
not having any smallpox vaccination means nobody has any kind of immunity to
monkeypox," Happi said.
Shabir Mahdi, a professor of
vaccinology at the University of Witwatersrand in Johannesburg, said a detailed
investigation of the outbreak in Europe, including determining who the first
patients were, was now critical.
"We need to really
understand how this first started and why the virus is now gaining
traction," he said. "In Africa, there have been very controlled and
infrequent outbreaks of monkeypox. If that's now changing, we really need to
understand why."
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