Portuguese authorities said on Wednesday they had identified five cases of rare monkeypox infection and Spain’s health services are testing eight potential cases after Britain put Europe on alert for the virus.
The five Portuguese patients, out of 20 suspected cases, are all stable. They are all men and they all live in the region of Lisbon and the Tagus Valley, the Portuguese health authorities said.
European Health authorities are monitoring any outbreak of the disease since Britain has reported its first case of monkeypox on May 7 and found six more in the country since then.
None of the eight suspected cases in Spain has been confirmed yet, the Spanish Health Ministry said in a statement on Wednesday.
Monkeypox is a rare viral infection similar to human smallpox, though milder, first recorded in the Democratic Republic of Congo in the 1970s. The number of cases in West Africa has increased in the last decade.
Symptoms include fever, headaches and skin rashes starting on the face and spreading to the rest of the body.
It is not particularly infectious between people, Spanish health authorities said, and most people infected recover within a few weeks, though severe cases have been reported.
Disease may spread via sexual contact: officials
Four of the cases detected in Britain self-identified as gay, bi-sexual or other men who have sex with men, the U.K. Health Security Agency said, adding evidence suggested there may be a transmission in the community.
The agency in Britain urged men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.
The Spanish Health Ministry and Portugal’s DGS health authority Spanish did not release any information on the sexual orientation of the monkeypox patients or suspected patients.
The two countries sent out alerts to health professionals in order to identify more possible cases.
Dr. Ibrahim Soce Fall, the World Health Organization’s assistant director-general for emergency response, said the spread of monkeypox in the U.K. needed to be investigated to understand how the disease was being transmitted among men who have sex with other men.
Fall said that health officials still need a better understanding of how monkeypox spreads in general, even in the countries where it is endemic.
He noted that while there were more than 6,000 reported cases in Congo and about 3,000 cases in Nigeria last year, there are still “so many unknowns in terms of the dynamics of transmission.”
Britain previously reported three earlier cases of monkeypox, two involving people who lived in the same household and the third someone who had traveled to Nigeria, where the disease occurs frequently in animals.
The virus has typically spread to people from infected animals like rodents, although human-to-human transmission has been known to occur.
Among people, the disease is spread when there is very close contact with lesions, body fluids, respiratory droplets or contaminated materials, like bedsheets.
Some British experts said it was too soon to conclude that monkeypox had spread through sexual contact, although the outbreak there suggested that possibility.
Vaccine approved, anti-virals appear effective
“The recent cases suggest a potentially novel means of spread,” Neil Mabbott, a disease expert at the University of Edinburgh, said, adding that related viruses were known to spread via sex.
Keith Neal, an infectious diseases expert at the University of Nottingham, said the transmission might not have occurred through sexual activity but just “the close contact associated with sexual intercourse.”
Monkeypox typically causes fever, chills, a rash and lesions on the face or genitals resembling those caused by smallpox.
A vaccine developed against smallpox has been approved for monkeypox, and several anti-virals also appear to be effective.
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