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Monkeypox outbreak: What we know so far

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Just when the world thought it was done with the worst of COVID, an outbreak of another virus has scientists worried. 

Cases of monkeypox have been confirmed in the U.K., Portugal, Sweden, Italy, Spain, France, Belgium, Germany, the U.S., Canada and Australia. 

What's concerning experts is the unusual spread of the disease. Monkeypox usually circulates in Africa, with occasional individual cases linked to travel detected overseas. But according to the EU's disease control agency, recent cases in Europe appear to have spread from person to person, for the first time, without any direct link to Africa. What's more, health authorities in a number of countries have noted that the spread appears to be concentrated among gay or bisexual men. 

Public health officials in the U.K. have put out an urgent call for virologists to volunteer, to scale up the response to the monkeypox outbreak, according to the U.K. media, while the World Health Organization is holding daily meetings on the fast-changing situation.

POLITICO digs into what we know so far. 

What is monkeypox? 

Monkeypox is a disease caused by a virus that is in the same family as smallpox. 

The symptoms of monkeypox typically start with a fever, sore muscles, swollen lymph nodes and headaches. Typically, within one to three days after the fever begins, a distinct bumpy rash begins to develop — often starting on the face — and spreads, including over the hands and feet. 

However, monkeypox is less deadly than smallpox. The West African type that scientists have detected in Europe has a mortality rate of a little under 4 percent. So far, no deaths have been reported in the recent European outbreak but monkeypox can leave patients bedbound for days at a time. The disease usually lasts between two to four weeks.  

Where are the cases?

In this most recent outbreak, the U.K. became the first country to detect a case of monkeypox on May 6. Since then, a total of 20 people have been found with the disease in the country. The U.K. Health Security Agency said that these cases have mostly been among gay or bisexual men. The virus was also found elsewhere in Europe. Portugal reported 14 cases of monkeypox, and Spain confirmed 30 cases. Italy has three confirmed cases, Belgium two, and France and Sweden have one confirmed each case so far. Germany's first case has been identified in Munich, Health Minister Karl Lauterbach confirmed at a G7 press conference on Friday.

Canada's Public Health Agency confirmed two cases in the country. A case has also been reported in the U.S., with the man having recently traveled to Canada, while other possible cases are being monitored. Australia reports two confirmed cases. 

Why are experts concerned? 

The concern, expressed by virologist Marion Koopmans, is the fact that the cases of monkeypox have been detected in several different countries, given that monkeypox is ordinarily not very contagious. Koopmans, head of the Erasmus MC department of viroscience, tweeted Thursday that the outbreak is "starting to be worrisome." She said that in the past that the occasional imported cases usually didn't keep spreading. "In this situation, new cases have been detected in different countries," she said. "That is very unusual."

Koopmans said it could be that monkeypox has become more transmissible and there's "an urgent need" for more information. 

This concern was echoed by Germany's Lauterbach: "Only genetic studies will show … whether the infectious pathway has changed," he told the press.

This information looks likely to come next week. Francesco Vaia, director of Italy's National Institute for Infectious Diseases, the Lazzaro Spallanzani Institute, told a press briefing on Friday that their virology lab expects to isolate the virus next week. This will also allow tests on whether antibodies from smallpox vaccination can neutralize the virus, he said.

Concerns have also been raised about whether this virus has evolved to be transmitted sexually as well as through close contact. "We are studying it, doing research on sperm," Andrea Antinori, director of the viral immunodeficiencies unit at the Lazzaro Spallanzani Institute, told the press briefing in Italy.

More broadly, Michael Head, senior research fellow in global health at the University of Southampton, said the imported cases "indicate a wider burden of disease elsewhere in the world."

"It may be that in a post-pandemic environment, we should be giving more consideration to understanding the local and global implications of Lassa, monkeypox, Ebola and other rare but serious pathogens," he said. 

What are experts recommending?

The ECDC is asking public health groups to raise awareness of monkeypox in communities of people identifying as men who have sex with men, who have multiple sexual partners or who are having casual sex. 

Monkeypox isn't known to be transmitted sexually, said the University of Southampton's Head earlier this week, commenting on the U.K. cases. "It's more that here the close contact during sexual or intimate activity, including prolonged skin-to-skin contact, may be the key factor during transmission," he explained. 

Jimmy Whitworth, professor of international public health at the London School of Hygiene & Tropical Medicine, said that the outbreak in the U.K. was "unprecedented." However, he said if the cases were identified, isolated and treated as well as close contacts identified and monitored, it could be "quickly brought under control." 

In countries where vaccines against smallpox are available, the ECDC recommends consideration of vaccination of high-risk close contacts, after a risk-benefit assessment. And if antivirals are available, they should be considered for the treatment of severe cases, the agency said. In the U.K. some health care staff, as well as other at risk contacts, are being offered smallpox vaccines. In Spain, the newspaper El País reported that the country's health ministry is preparing to buy thousands of doses to help contain the outbreak.

 In Italy, Vaia said the country has antivirals ready to be used experimentally "if necessary."

This article has been updated.

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