Monkeypox has started to claim lives outside of Africa. In just a few days, Spain has reported two deaths; Brazil, India and Peru have each reported one. Although these deaths do not imply a greater severity of the disease, the Carlos III Health Institute in Spain is studying samples of the bodies in an attempt to draw better conclusions. This is the most relevant information known so far about it.
Generally, it is a mild disease. Only a small percentage has required hospital care, usually to handle the pain and the infections caused by the pustules. The vast majority of cases do not go beyond that, although it can be worse in people who suffer from comorbidities, in children (particularly in areas with few health resources), or in those with a weakened immune system.
Experts are still studying the matter. In both of Spain's cases, the deceased suffered from encephalitis caused by the infection; the Carlos III Health Institute is studying samples from the bodies to try to find out if it is a coincidence or if the virus is actually causing a specific condition. In the case of Brazil, the deceased was a 41-year-old man who suffered from an oncologic disease.
According to the Coordination Center for Health Alerts and Emergencies, the most frequent symptoms are pustules in the anogenital area (60.3%), fever (56.6%), pustules in locations other than the anogenital and oral areas (52.8%), swollen glands (52.2%), difficulty breathing (33.8%), headache (24%), muscle pain (21.3%), oral pustules (20.7%), and sore throat (13%).
Although the specific mechanism of transmission needs to be further studied, it is known that it is produced by very close interaction. Similarly to smallpox, it has been transmitted through large respiratory droplets during direct and prolonged face-to-face contact. Monkeypox can also be spread by direct contact with bodily fluids from an infected person or with contaminated objects, like bed sheets or clothing. Other forms of transmission, such as mother to child, have been documented as well.
It does not exactly fit the definition of a sexually transmitted infection; however, experts are still studying whether it can be spread through sexual fluids. Regardless, the most frequent form of infection in this outbreak is, by far, the transmission between sexual partners.
The virus can be passed on to anyone who is in direct contact with it. Other outbreaks that have occurred over the past decades did not reach groups of men who have sex with men; this one has, and that is where it is growing the most. However, that does not mean it cannot happen to others.
Several studies have shown an infection rate (known as R0) of between 1.6 and 1.8. This means that without mitigating interventions, every infected person transmits the disease, on average, to between one and a half and almost two people. When the number is less than one, the outbreak tends to subside on its own, which is what has happened in recent decades with other outbreaks. As WHO spokeswoman Maria Van Kerkhove warns, this is an average, but depending on the group and the place it can actually be higher or lower. Recently, at a press conference, she said that it has been estimated that the communities of men who have sex with men are where it exceeds 1. Nonetheless, there are opportunities to bring that number below 1 by providing those communities with the correct information and empowering them, she explained.
The vaccines that are currently being used against monkeypox are not specific for this disease; they are designed for traditional smallpox. They do seem to show a high level of efficacy, but further studies are still needed.
At first, the vaccines were only recommended for those who had direct contact with a patient. Later, people with risky practices were included: men with several male sexual partners. However, it should be noted that there are not enough doses for everyone.
Beyond the vaccine - which is not available to everyone - the WHO recommends being on the lookout for the aforementioned symptoms in order to detect it as soon as possible, and asks people who show signs of the disease to isolate themselves so as not to spread the virus. The organization also suggested that men who have sex with men reduce their number of partners.
As of August 2, there were 24,679 confirmed cases, according to Our World in Data. More than 25% of those (5,793) have been detected in the United States.F
The message from the WHO is that the virus can be controlled by being vigilant, tracing the infections and breaking the chains of transmission. However, this is not what is happening. Even though we are not seeing an exponential growth like we did with Covid-19, the outbreak does continue to grow. Locating contacts is difficult, precisely because of the stigma that it can entail and because of the anonymity that surrounds many risky relationships. Despite the fact that most WHO advisers were not in favor of declaring an emergency, its director general, Tedros Adhanom Ghebreyesus, decided to do so due to the inaction he saw in some countries. One of the measures recommended by the organization is to limit international travel to people with symptoms of the disease, which has already spread to more than 75 countries.