Monkeypox continues its unstoppable advance in Spain: in a matter of a few days we have reached practically 5,000 registered cases and the first deaths associated with the disease have occurred. We continue to be the European country that accumulates the most official cases, But the figures for the United States have gained momentum and for a week it has been the country with the most cases in the world. In fact, this Thursday the American country has declared a state of national public health emergency. Many experts explain that this is not the way the outbreak should have progressed, but the measures have been insufficient.
“You have to say things clearly: this disease has not been taken seriously, the information has not been given well and people have gone wild“, assures Raúl Rivas, Professor of Microbiology at the University of Salamanca. The scientist explains that monkeypox is a disease that requires very close contact to be transmitted, has very clear symptoms and is self-limited —it subsides by itself in a certain time.” Therefore, the outbreak should have been brought under control soon after it appeared.
The vast majority of cases in this outbreak have been among men who have sex with men (MSM) and with multiple partners. In any case, it is due to a circumstantial situation; that is, the disease is not produced or transmitted by sexual behavior specific to this community and, therefore, it could have occurred in other population groups. Moreover, it is already occurring, monkeypox has already infected other sectors of the population: there are a thousand cases in Spain that are not associated with MSM.
According to the latest data from the Ministry of Health published this Friday, in Spain there are 4,942 cases of monkeypox, of which 3,943 are MSM. If the difference is obtained, it is observed that there are 999 cases of people who are not associated with MSM. “It is a high number, but it will be more. As the outbreak progresses, if we don’t take action, the chances of it reaching other groups increase. Infected people also relate to friends and relatives outside the most affected population group, it is evident that the number of cases in this group is going to grow,” the biologist reasons.
The lack of control of monkeypox is worrying, among other reasons, because it is a disease that can cause death, although in this outbreak the deaths have been few. The population of particular concern are immunosuppressed people, pregnant women and children. Outside of Africa, where the disease is endemic in certain areas, there have been a total of four deaths: Europe registers two deaths – both in Spain – and America, another two – one in Brazil and one in Peru.
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According to data provided by the Ministry of Health, the two recent deaths in Spain are two young men, one from Valencia and the other from Córdoba. Most cases of monkeypox are not fatal, but scientists warn that the disease becomes more complicated if there are more infections. In this sense, a study conducted in Spain and recently published in British Journal of Dermatology points out that of the 185 monkeypox patients they studied, 76% of them had at least one sexually transmitted infection (STI) at the same time.
The two deaths from monkeypox are still under investigation, although they have been associated with encephalitis resulting from infection by the virus. For this reason, the Ministry of Health has asked this Friday the public health services of the autonomous communities to be notified urgently of cases of monkeypox that reverse “particularly serious” as pneumonia, encephalitis, meningoencephalitis, or pharyngeal lesions that prevent swallowing.
The World Health Organization (WHO) made a move two weeks ago and declared monkeypox a Public Health Emergency of International Concern (PHEIC). This measure, explains Rivas, serves to mobilize more resources against the advancement of the disease. However, while in the rest of the world the risk is moderate, in Europe it is very high. “The situation we have here is not a small feat, there is the problem that the virus establishes itself in the fauna and, if it happens, we will have recurring outbreaks and not in MSM, but in whoever it touches,” says Rivas.
Is there a chance that monkeypox could become a pandemic? “At the moment we are not at that point and we hope that it does not occur, it would be very bad,” explains the microbiologist. “But we are at the limit of being able to remain optimistic, we are going very badly if we do not stop the transmission. Monkeypox is a very stable virus, but the more it gets out of control, the more likely it is to adapt to humans and, even, that it may produce variants that escape current treatments”.
At the moment, the main route of transmission of monkeypox remains the same: close contact in the sexual context and with multiple partners between MSM. However, the virus has not been shown to be transmitted through semen or vaginal fluids—that is, it is not an STI and therefore condoms and other barrier prophylactics do not prevent transmission—and have already been observed quite a few cases outside this population group. In these cases, close contact with the fluid of the typical lesions of the disease through sexual intercourse or skin-to-skin rubbing or rubbing against clothing or bedding where they have been is the main risk contact.
where it spreads
In recent weeks, some stories have become popular on the internet about infections through objects such as the handlebars of a scooter or a package received by a sales app. Although Raúl Rivas admits that contagion through this route is possible, He maintains that it is very unlikely that infections will occur due to these causes. “Monkeypox is an orthopoxvirus, it can stay in clothes and bedding, which are porous environments, especially if they are in cold and dark environments. But glass, plastic or metal are environments in which this virus does not survive too long.”
The expert comments that the common disinfectants that we have are highly effective in eliminating the virus. If we have an affected person at home, Rivas recommends that they handle their clothes themselves, that, if possible, the dishes, cutlery and glasses be washed in a dishwasher at high temperatures, that we take care to disinfect the objects that they touch and that they do not shake their clothes or bedding. Affected people must quarantine for three weeks, until the lesions of the disease have completely healed.
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The symptoms for which we should consult a doctor are very easy to identify, as the microbiologist explains: “pustules and papules —generally, in the area through which the virus has entered—, also systemic symptoms such as fever, muscle aches and swollen glands. Symptoms are also produced in the genital mucous membranes, which was not known before.” The virus can also be transmitted through drops of saliva if we are very close to the infected person, although it is not easy this way, it does not resemble covid .
The professor of Microbiology asks those who have these symptoms to contact a doctor to diagnose the disease and start isolation as soon as possible, in order to break the chain of transmission.
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