Monkeypox hits Europe: Portugal says five men have virus while Spain probes eight suspected cases
Monkeypox has been detected in Portugal and Spain in what could be the first global outbreak of the rare disease.
Six people in Portugal have tested positive and more than a dozen more are under investigation, health officials there said today.
Spain is monitoring eight people who it believes could be infected, with tests being carried out to confirm the virus.
The latest cases are all among men, most of whom are ‘young’, but it is not yet clear how they caught the virus.
Until now, monkeypox cases were confined to travellers and their relatives returning from western and central Africa, where the virus is endemic.
But experts now fear it is spreading in the community for the first time, after seven Britons were diagnosed in the past fortnight.
Six of them appear to have been infected in the UK and the majority are not linked, which suggests more cases are going undetected.
Four of the British cases are gay or bisexual men, and officials say the pattern of transmission is ‘highly suggestive of spread in sexual networks’.
Dr Simon Clarke, a microbiologist at the University of Reading, told MailOnline he suspects UK case numbers are already ‘in the tens’.
But he insisted the disease will not spread like Covid, adding: ‘I would be surprised if we ever got to more than 100 cases [in Britain]’.
Monkeypox is a rare viral infection which kills up to one in ten of those infected but does not spread easily between people. The tropical disease is endemic in parts of Africa and is known for its unusual rashes, bumps and lesions (file photo)
Seven Britons have been diagnosed with monkeypox and six of them appear to have contracted it in the UK — in a sign the virus is spreading in the community. The seventh UK patient had brought the virus back from Nigeria, where the disease is widespread. At least three patients are receiving care at specialist NHS units in London and Newcastle
Regions across Spain have been put on alert following the announcement of eight suspected cases in Madrid.
Confirmation is still awaited from the National Centre for Microbiology but health chiefs say ‘great care must be taken.’
The country’s top public health doctor, Fernando Simón, said ‘it is not likely that monkeypox will generate a significant transmission but it cannot be ruled out.’
STI clinics bring social distancing BACK ‘as patients with monkeypox rash mistake it for syphilis’
Sexual health clinics have reintroduced social distancing amid fears about a spate of monkeypox cases in the UK.
At least one practice in West London had already brought in stricter infection control measures yesterday, before the total number of British cases rose to seven.
Patients were told to keep a one-metre distance in the waiting room and were asked if they had any unusual bumps or rashes prior to each appointment.
Monkeypox can be mistaken for syphilis or other common rash illnesses, making it difficult to diagnose early.
A health source told MailOnline the stricter measures were not part of new national guidance but they could not rule out some NHS boards ‘putting in measures locally’.
UK Health Security Agency (UKHSA) bosses have now written to regional NHS teams telling them to stock up on PPE and be on alert for patients with a new rash.
The Spanish health alert system has called on communities to notify public health services ‘urgently’ of patients with symptoms.
He said it was now necessary to take extreme surveillance measures and investigate all the hypotheses about the routes of contagion.
Mr Simon was talking to the media in Valencia during the I International Summit on Pandemic Management.
Spanish newspaper El Pais says it has had access to health papers and that the health leaders have confirmed the investigation.
Meanwhile, the suspected cases in Portugal were all detected in the Lisbon and Tagus Valley region.
The men are said to be ‘stable’ and all suffering from ‘ulcerative lesions’, one of the tell-tale signs of the virus.
Portugal’s health ministry has issued a warning urging people with lesions and rashes to see a doctor.
When these symptoms appear, ‘direct physical contact’ should be avoided, officials added.
Health officials investigating the monkeypox outbreak in Britain believe it may have morphed into a sexually transmitted infection, which would explain the unexpected spate of cases.
It was thought the virus could only be passed on through close contact with the likes of body fluids, respiratory droplets and lesions.
But an expert from the UK Health Security Agency said the latest UK cases ‘appear to have acquired the infection via sexual contact’.
Dr Mateo Prochazka, who leads the UKHSA team investigating monkeypox, described this route of transmission as ‘novel’.
Seven people have been diagnosed with the virus in England over the past two weeks, six of which are in London and one in the North East.
Four are in gay or bisexual men and only the first has recent travel links to a country where the virus is endemic, which is ‘highly suggestive’ of spread in ‘sexual networks’, Dr Prochazka added.
Writing on Twitter, he said: ‘Transmission is not easy but can happen person to person from direct contact with lesions, or respiratory secretions.
‘The closer and longer the contact, the more likely it is to transmit.
‘Close contact between two people (such as during sex) could also facilitate transmission – but this has never been described before.
‘However, the high proportion of cases in the current outbreak in England that are gay or bisexual (4/7, 57%) is highly suggestive of spread in sexual networks.
‘This is further suggested by the fact that common contacts have been identified for only 2 of the 4 latest cases.’ Dr Prochazka continued: ‘Finding monkeypox cases that do not have travel links is rare, and suggestive of importation followed by some extent of community transmission.
‘This situation is being rapidly assessed.
‘What is even more bizarre is finding cases that appear to have acquired the infection via sexual contact – this is a novel route of transmission that will have implications for outbreak response and control.’ Sexual health services are now working to identify more cases, control its spread and tackle potential stigma.
Other experts said further research is necessary before it will be possible to conclude if the virus is sexually transmissible.
Paul Hunter, Professor in Medicine at the University of East Anglia, said: ‘Transmission of Monkeypox from one person to another can occur by skin contact with the pocks of an infected individual and this is an important pathway, often though unnoticed breaks in the skin.
‘So, it would not be surprising that sex which does tend to require close person to person skin contact over a quite wide area of the body would also enable transmission of Monkeypox.
‘Whether or not that is genital to genital contact or through other contact is not clear to me, though if pocks occur in the genital area than such sexual transmission is likely.’ Dr Michael Head, Senior Research Fellow in Global Health at the University of Southampton, said: ‘This may indeed be the first time transmission of monkeypox via sexual contact has been documented, although it has not been confirmed to be the case.
‘The implications are not so significant, in that we know close contact is required for transmission, and therefore some form of close contact will have happened here.’ Keith Neal, Emeritus Professor in the Epidemiology of Infectious Diseases at the University of Nottingham, said: ‘It may not be actual transmitted by sexual intercourse rather than the close contact associated with sexual intercourse.
‘Further work looking at whether the virus is found in semen is required to say truly sexually transmitted.’ Monkeypox can kill up to one in ten people who get it but the new cases have the West African variant, which is deadly for around one in 100.
Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.
A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.
The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.