What is monkeypox and how is it spread?

 Several dozen cases of this rare disease originating in Africa have been reported in Europe since early May. Spain has issued a health alert, and the United Kingdom fears a community infection.

After the United Kingdom, Portugal and Spain, it is Canada and the United States that have indicated on Wednesday that they have detected people with monkeypox, a rare disease normally confined to the African continent. Characterized by its impressive pustules, this infection is transmitted by close contact or exchange of body fluids.

The United Kingdom has warned that all of the carriers of the disease on its soil are men who have homosexual relations. The World Health Organization (WHO) said on Tuesday that it wanted to shed light on these cases.

- Where does monkeypox come from?

Monkeypox, or simian orthopoxviruses, is a rare viral zoonosis, as indicated by the WHO on its website, that is a virus transmitted to humans by animals. The disease was first detected in humans in 1970, in the Democratic Republic of Congo. Since then, the majority of cases have been reported in rural and rainforest areas in the Congo Basin and West Africa, where the virus is endemic, according to WHO.

Infection from animals to humans results from direct contact with blood, body fluids, or skin or mucous membrane lesions of animals that are carriers of the disease. The WHO lists monkeys, giant Gambian rats and squirrels as species at risk. Consumption of meat infected with the virus may also be at risk.

- How is this disease transmitted?

Human-to-human transmission is the result of close contact with a person who has the disease. Either by coming into contact with their respiratory secretions or by touching infected lesions and biological fluids.

"Transmission occurs primarily through respiratory droplet particles and usually requires prolonged face-to-face contact," adds the WHO.

- What are the symptoms?

Human infection by monkeypox is divided into two periods. The first is called "invasive", with fever, headache, swollen glands and muscle pain.

It is then followed by a period of rash, which starts on the face and spreads to other parts of the body. The face is most affected, followed by the palms of the hands and soles of the feet.

"The skin rash evolves in about ten days from maculo-papules (lesions with a flattened base) to vesicles (small blisters filled with liquid), then pustules and finally crusts. The complete disappearance of the latter can take up to three weeks," says the World Health Organization.

It should be noted that two different versions of the virus exist, the one from the Congo Basin and the one from West Africa. The first version is the most virulent.

• Can monkeypox be cured?

Monkeypox is not a particularly dangerous disease for humans, although it is inconvenient because of the pustules it generates. The WHO, thus ensures that in the vast majority of cases, it heals itself. Symptoms can last from 14 to 21 days.

The disease can still be fatal, but the case fatality rate remains below 10%. It is especially the youngest children who are likely to develop a severe form.

There is currently no vaccine or treatment for the disease, although the smallpox vaccine has shown some effectiveness in preventing its development. However, the latter is no longer produced since the eradication of the disease.

- Where were the last cases reported?

If this relatively rare infection is attracting attention today, it is because, since the beginning of May, many European and North American countries have reported cases of this disease on their soil.

The alert was first issued in the United Kingdom on May 6. A total of nine cases have been detected in the UK. With the exception of the first individual who had recently travelled to Nigeria, all other individuals were infected on British soil, as reported by the UK Health Security Agency (UKHSA).

At the beginning of the week, Spain and Portugal announced that they had detected around 40 suspected cases on their territory, prompting the two countries to issue a health alert.

On the other side of the Atlantic, Canada indicated on Wednesday that it was looking into more than a dozen suspected cases, which are currently being examined in Montreal. As for the United States, a man who had recently visited Canada tested positive for monkeypox in the state of Massachusetts.

Since the detection of this disease in humans in 1970, cases of contamination outside the African continent have been very rare. It was only in 2003 that the disease was detected outside the continent, in the United States. Patients had been in contact with domestic prairie dogs, which had been infected by imported African rodents.

- Is there a risk of community contamination among homosexual men?

The surge in infections in Europe is accompanied by concerns that they may be the result of sex between men. Indeed, London reported that patients identified as carriers of monkeypox had all had sex with other men.

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In Geneva, Ibrahima Socé Fall, WHO assistant director-general for emergency response, said:

"We are seeing transmissions among men who have sex with men," which is "new information that we need to study properly to better understand the dynamics" of transmission."

How can I avoid getting infected?

Monkeypox can be spread when a person is in close contact with an infected person. The virus can enter the body through skin lesions, the respiratory tract, or through the eyes, nose or mouth.

It has not previously been described as a sexually transmitted infection, but it can be transmitted through direct contact during sex.

It can be spread by any of the following:

• contact with clothing worn by an infected person (including bedding or towels)
• direct contact with lesions or scabs on the patient's skin
• coughing or sneezing from an infected person

For this reason, health officials recommend not wearing clothing and not having close contact with people who may be sick.

If you have symptoms, isolate yourself and, once you have recovered, wash your clothes, including towels and sheets.

Also, they suggest using disposable tissues when coughing and sneezing and, if you can, avoiding doing so in the presence of others.

Hygiene and other care

The U.S. Centers for Disease Control and Prevention (CDC) reminds us that handwashing remains a decisive action against this virus.

'Practice good hand hygiene after contact with infected animals or humans. Wash your hands with soap and water or use an alcohol-based hand sanitizer," the CDC recommends.

The Cleveland Clinic recalls that in Africa, the disease has become more common in children, so parents should also apply these precautions to minors.

Although it has not yet been detected in animals, other outbreaks of monkeypox have appeared in some species transported from Africa.

That's why the Cleveland Clinic generally recommends cooking all foods that contain meat or animal parts thoroughly.

Some public health experts have also recommended that people travelling abroad pay attention to the recommendations of local authorities and follow their instructions and protocols, if they exist, to avoid potential contagion.

If you work with infected people in hospitals, clinics, or health centers, the CDC recommends using personal protective equipment.

Monkeypox can also be spread through contact with infected animals, such as monkeys, rats and squirrels, or through objects contaminated with the virus, such as bedding and clothing.

How common is monkeypox?

Monkeypox is caused by the virus of the same name, a member of the same family of viruses as smallpox, although it is much less severe and experts say the risk of infection is low.

The virus was first identified in a captive monkey and, since 1970, sporadic outbreaks have been reported in ten African countries.

It occurs mainly in remote areas of central and western African countries near tropical rainforests.

In 2003, an outbreak occurred in the United States, the first time the disease has been observed outside of Africa. Patients acquired the disease through close contact with prairie dogs that had been infected by various small mammals imported into the country. A total of 81 cases were reported, but none resulted in death.

In 2017, Nigeria experienced the largest documented outbreak, approximately 40 years after the country experienced its last confirmed cases of monkeypox. There were 172 suspected cases of monkeypox, and 75% of the victims were men between the ages of 21 and 40

There are two main strains of the virus - West African and Central African.

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Two of the infected patients in the UK were from Nigeria, so it is likely that they are suffering from the West African strain of the virus, which is usually mild, but this has not yet been confirmed.

Another case is that of a health care worker who contracted the virus from one of the patients.

The more recent cases have no known connection to each other, nor any history of travel. They appear to have caught it in the UK by spreading it in the community.

How dangerous is it?

Most cases of the virus are mild, sometimes resembling chickenpox, and go away on their own within a few weeks.

However, monkeypox can sometimes be more severe and has been reported to have caused deaths in West Africa.

What is the treatment?

There is no treatment for monkeypox, but outbreaks can be controlled by preventing infection.

Vaccination against smallpox has been shown to be 85% effective in preventing monkeypox, and it is still sometimes used.

According to reports, Spain is preparing to order thousands of doses of smallpox vaccine to be used against monkeypox.

Experts believe that vaccination after exposure to monkeypox may help prevent the disease or make it less severe.