LONDON (AP) – Scientists who have monitored numerous outbreaks of monkeypox in Africa say they are baffled by the recent spread of the disease in Europe and North America.
Cases of the smallpox-related disease have previously only been seen in people with ties to Central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, the US, Sweden and Canada all reported infections, especially in young men who had not previously traveled to Africa.
There are about 80 confirmed cases and 50 more suspected cases worldwide, according to the World Health Organization. France, Germany, Belgium and Australia reported their first cases on Friday.
“I am amazed by this. Every day I wake up and more countries are infected,” said Oyewale Tomori, a virologist who previously headed the Nigerian Academy of Science and sits on several WHO advisory boards.
“This isn’t the kind of spread we’ve seen in West Africa, so something new could be happening in the West,” he said.
To date, no one has died from the outbreak. Monkeypox usually causes fever, chills, rashes, and lesions on the face or genitals. The WHO estimates the disease kills up to one in ten people, but smallpox vaccines are protective and some antiviral drugs are being developed.
UK health officials investigate whether the disease is sexually transmitted. Health officials have asked doctors and nurses to be alert to possible cases, but said the risk to the general population is low. The European Center for Disease Control and Prevention recommended isolating all suspected cases and offering high-risk contacts a smallpox vaccine.
Nigeria reports about 3,000 cases of monkey pox each year, the 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 to be 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 investigations are underway.
The director of WHO Europe, Dr. Hans Kluge, described the outbreak as “atypical”, and said the appearance of the disease in so many countries across the continent suggested that “the transmission has been going on for a while”. He said most European cases are mild.
On Friday, the UK’s Health Security Agency reported 11 new cases of monkeypox, saying that “a remarkable proportion” of infections in the UK and Europe occurred in young men with no histories of traveling to Africa and who were gay, bisexual or had sex with men .
Authorities in Spain and Portugal also said their cases involved young men who usually had sex with other men and said those cases were picked up when the men with lesions showed up at sexual health clinics.
Experts have emphasized that they do not know whether the disease is spread through sex or other close contact related to sex.
Nigeria has seen no sexual transmission, Tomori said, but he noted that viruses initially not known to be transmitted through sex, such as Ebola, later did after larger epidemics showed different patterns of distribution.
The same could be true for monkey pox, 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 would have made it more contagious.
Rolf Gustafson, professor of infectious diseases, told Swedish broadcaster SVT it was “very difficult” to imagine the situation getting worse.
“We will certainly find more cases in Sweden, but I don’t think there will be an epidemic in any way,” Gustafson said. “There’s nothing to indicate that at the moment.”
Scientists said that while it is possible that the outbreak’s first patient contracted the disease in Africa, what is happening now is exceptional.
“We’ve never seen anything like what’s happening in Europe,” said Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases. “We have not seen anything to indicate that monkeypox transmission patterns in Africa have changed. So if there’s something else going on in Europe, Europe needs to investigate.”
Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 could inadvertently contribute to the spread of monkeypox. Smallpox vaccinations also protect against monkeypox, but mass immunization was discontinued decades ago.
“Apart from people in West and Central Africa who may have some immunity to monkeypox from past exposure, the fact that no vaccination against smallpox has means that no one 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 into the outbreak in Europe, including determining who the first patients were, was now critical.
“We really need to understand how this started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and rare outbreaks of monkeypox. If that changes now, we really need to understand why.”
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Geir Moulson in Berlin, Jan M. Olsen in Copenhagen, Chinedu Asadu in Lagos, Nigeria, and AP reporters across Europe contributed to this report.
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
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