Seven cases of monkeypox have been confirmed in London and the north east of England, only one of which was linked to travel abroad, health officials said. Current evidence suggests the rare disease may now be spreading in the local community, according to the UK Health Security Agency (UKHSA).
This viral spread, if it occurs, could potentially extend beyond the UK and affect people in other countries, US health officials warned on Tuesday (May 17). according to STAT† These concerns were confirmed on Wednesday, when two more European countries announced suspected and confirmed cases of the disease, STAT reported on May 18. These countries include Spain, where eight possible cases are under investigation, and Portugal, where five have been confirmed and more than a dozen possible cases have been identified.
Monkeypox is a rare infection caused by a smallpox virus that belongs to the same family and genus as the variola virusthat causes smallpox, according to the Center for Disease Control and Prevention (CDC). The infection initially causes symptoms of fever, headache, muscle aches, exhaustion, and swollen lymph nodes; a rash then appears on the face and spreads over the body, eventually giving rise to discolored patches, blisters, scabs and raised bumps on the skin. In Africa, where the disease is endemic, the infection is estimated to be fatal in an estimated 10% of cases, but in most cases the disease remains mild and resolves within about two to four weeks.
Historically, cases of monkeypox outside of Africa have been linked to international travel or animal imports, according to the CDC. (African rodents and non-human primates can carry the virus.) However, the source of the six non-travel-related infections in the UK remains a mystery and it is unknown whether the new cases in Spain and Portugal are linked to UK infections. according to STAT.
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“This is rare and unusual,” said Dr. Susan Hopkins, UKHSA’s chief medical adviser, in the statement released Monday (May 16). “UKHSA is rapidly investigating the source of these infections as the evidence suggests there may be community transmission of monkeypox virus spread through close contact.”
In general, monkeypox virus does not spread easily between people, but can enter the body through contact with broken skin, the airways or the mucous membranes of the eyes, nose or mouth, according to the CDC. Inter-human transmission is believed to occur primarily through large respiratory droplets, meaning that saliva droplets and mucus are infused with viral particles.
“Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required” for transmission to occur, the CDC said. However, people can also contract the virus through contaminated objects, especially clothing and linen, or by coming into contact with contaminated body fluids with damaged skin.
Earlier this month, on May 7, UKHSA reported a case of monkey pox linked to travel; in that case, the infected person contracted the infection while in Nigeria, the agency stated:† UKHSA worked with the National Health Service (NHS) to notify people who may have been in close contact with the infected person; they identified no additional cases through this study.
After discovering this travel-related infection, the UKHSA identified two people in a London household who had also contracted monkey pox; however, these infections were not linked to the original travel-related case, UKHSA announced on May 14. Then, on May 16, the agency announced four more cases of monkeypox – three in London and one in Newcastle – that were unrelated to any of the earlier cases.
“Investigations are underway to establish links between the latest 4 cases, all of which appear to have been infected in London,” the UKHSA statement said. “All 4 of these cases identify themselves as gay, bisexual, or other men who have sex with men.” So far, common contacts have been found for two of these four cases.
The overall risk of contracting the virus remains low among the general public, as the pathogen again requires prolonged close contact to spread, according to the UKHSA statement. “We particularly urge men who are gay and bisexual to be aware of any unusual skin rashes or lesions and to contact a sexual health service immediately,” Hopkins said.
(Spanish news channel El País reported that the eight suspected cases in Spain were initially spotted at a clinic treating sexually transmitted diseases.)
When the UK launched its investigation into the monkeypox cases in the country, CDC officials expressed concern that multiple transmission chains are rippling across the country, only a few of which have been discovered, STAT reported.
“You have two clusters that have no link with travel or with other people that are known to be associated with a recognized outbreak. It suggests unknown chains of transmission are taking place,” Dr. Jennifer McQuiston, a senior CDC official, told STAT earlier this week. “If there appear to be unknown chains of transmission, it just puts us on edge to think: Could this spread beyond the UK?” Now, there is reason to believe that it is.
In anticipation of possible spread to the US, the CDC may issue a warning to healthcare facilities, especially clinics that treat sexually transmitted diseases, to watch out for possible cases of monkeypox, McQuiston told STAT.
Originally published on Live Science.