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.
Smallpox cases have been reported in people who are from central or 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 and Australia all confirmed the first case of monkeypox 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.
Monkeypox is characterized by a fever, chills, and genital lesions. WHO says the disease could be fatal, however smallpox vaccines can protect you and there are antiviral drugs that are currently being developed.
British officials have been investigating the possibility that the disease could be sexually transmitted. Officials have asked nurses and doctors to keep an eye out for possible cases but they said that the overall risk is very low.
WHO reported that Nigeria sees about 3,000 cases of monkeypox each year. Tomori stated that outbreaks tend to occur in rural areas where there is close contact between infected squirrels and rats. Many cases will likely be missed, he said.
Tomori believed that the emergence of monkeypox patients in Europe and elsewhere would increase scientific knowledge of the disease.
The WHO‘s lead on emergency response, Dr. Ibrahima Soce Fall, acknowledged this week that there were still “so many unknowns in terms of the dynamics of transmission, the clinical features (and) the epidemiology.”
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 were gay, bisexual or had sex with men.
Spain and Portugal officials also claimed that these were young men who had sex mostly with other men. The cases were then reported to the authorities when they were presented with sexual health clinics.
Experts say they are unsure if the disease spreads through close contact or 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.
Tomori suggested that monkeypox could also be a possibility.
Karl Lauterbach, Germany’s Health Minister said that the government is confident the outbreak can be controlled. The virus was being sequenced, Lauterbach said. This will determine whether any genetic modifications might have made the virus more infective.
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 said that the failure to immunize smallpox patients after the 1980 eradication was achieved might have inadvertently contributed to monkeypox’s spread. Although smallpox vaccinations protect monkeypox from the disease, mass immunizations were stopped many 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 from the University of Witwatersrand) said that it was critical to conduct a comprehensive investigation of European influenza outbreaks, and determine who were the first victims.
“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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This report was contributed by Geir Moulson, Jan M. Olsen and AP journalists across Europe.
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