Monkeypox infections continue to rise in Spain, the country with the most cases per inhabitant in the world and the country with the most deaths in non-endemic locations: two. The group of men who have sex with men, who accumulate the vast majority of cases (98% worldwide and more than 80% in Spain), are calling for more vaccines to protect themselves. Currently, only 5,300 doses have been distributed among the autonomies and the additional 7,000 promised two weeks ago by the Ministry of Health have not yet arrived. Even with those it is not enough for all those who are most exposed to the risk of infection. This is what is known about the disease so far:
How serious is monkeypox?
In general, it is a mild disease. A study published in The Lancet on Tuesday showed that four out of 10 patients need medical treatment, particularly for pain relief. It is also the main reason for hospitalizations, affecting about 3% of those infected in Spain. In the vast majority of cases, it doesn’t go beyond that, but it can be complicated in people with comorbidities, in children (especially in areas with low health resources), or in people with weakened immune systems.
What are the deaths due to?
There is little information about the deaths in Spain. In both cases, the deceased suffered from encephalitis caused by the infection. The first deceased in the Valencian Community did not exceed old age, although according to Health it is a “young man”; the second, in Córdoba, was 31 years old. The Carlos III Health Institute is examining samples from the corpses to determine if it is pure coincidence or if the virus is causing a specific condition. In the other known cases outside of the endemic countries (in India, Ecuador, Peru and Brazil), the deceased suffered from serious previous illnesses.
What are the most common symptoms?
According to the Coordination Center for Health Alerts and Emergencies (CCAES), the most common symptoms are anogenital pustules (60.3%), fever (56.6%), pustules on sites other than the anus, genital and oral (52.8% ). , swollen glands (52.2%), difficulty breathing (33.8%), headache (24%), myalgia (21.3%), oral pustules (20.7%) and sore throat (13%). The study in Spanish patients published on Tuesday also registered inflammation of the glans, tonsils and anus.
How is it transmitted?
Unlike previous monkeypox outbreaks, where transmission through saliva droplets was suspected, direct skin contact is now the main route of infection, the study published in The Lancet confirms. To reach this conclusion, they observed that the viral load in the pustules was much higher than in the larynx, reducing the weight of the respiratory infection. The area most affected is usually the one that comes in contact with the virus.
Can it be spread through casual contact with another person?
It’s unlikely. As far as is known, the route of infection is direct and intimate contact. It is also thought to be transmitted through contact with contaminated items such as sheets or clothing. Other routes of infection are documented, such as from mother to child.
Is it a sexually transmitted disease?
no It’s not exactly what’s defined as a sexually transmitted infection, although there’s also research into whether it can be transmitted through sexual fluids. In any case, the most common route of infection in this outbreak is transmission between sexual partners through intimate contact. Health thus quantifies 82.1% of cases for which there is sufficient information to determine the path.
Why are there more cases of men having sex with men?
The virus can be transmitted to anyone who has direct contact with it. Other outbreaks that have occurred in recent decades hadn’t reached groups of men who have sex with men, but it so happens that it has, and that’s where it’s growing most. That doesn’t mean it can’t happen to others. Although the World Health Organization quantifies 98% of detected cases in men who have sex with men, data from Spain reduces that figure to 83%.
Is it very contagious?
Various studies have shown an infection rate (known as R0) between 1.6 and 1.8. This means that without mitigation measures, each infected person transmits the disease to between one and a half and almost two people on average. When the number is less than one, the outbreak tends to subside on its own, which has occurred in others over the past several decades. As Maria Van Kerkhove, spokeswoman for the WHO, warns, it is an average value that can be higher or lower depending on the group and location. “It has been estimated that the communities of men who have sex with men are where it exceeds 1. That means the outbreak is expanding and there are ways to get that reproductive number below 1 by giving these communities the right information and empowering them,” he said at a news conference.
Are vaccines effective?
The vaccines used against monkeypox are not specific to this disease but were developed for traditional smallpox. Although it seems that they show high effectiveness (about 80% in full two-dose therapy), it is necessary to study them better.
How many doses are necessary?
The latest generation of the Bavarian-Nordic pharmaceutical company is being vaccinated in Spain, which requires two doses and unfolds its full effect two weeks after the second puncture. However, due to the scarcity of doses, only the first dose is currently administered, and its effectiveness is estimated at around 30%.
Does vaccination prevent infection?
no Similar to Covid, the vaccine improves the prognosis of those affected and prevents many of the symptoms, but does not sterilize.
Who can be vaccinated?
In principle, the vaccinations were only indicated in the case of direct contact with the infected. Later also for all people with risk practices: men who had several male sexual partners. However, there aren’t enough doses for everyone. 5,300 have arrived in Spain, which would not even be enough for direct contact between those infected. Another 7,000 were expected last week, which is still not enough. The Ministry of Health has not yet distributed them to the communities. Both Madrid and Catalonia have enabled vaccination services by appointment for this group, but this shortage is proving very difficult to access one.
How long is the incubation period of the virus?
In this outbreak, incubation lasts about a week, compared to 15 to 22 days reported in the Democratic Republic of the Congo. For some experts, this means that post-exposure vaccination of close contacts of infected people does not make sense because there is not enough time for an immune response. According to this thesis, all efforts should be aimed at preventively vaccinating people with risky practices.
How can a person be protected?
In addition to the vaccine, which is not available to everyone, the WHO recommends paying very close attention to the symptoms described above in order to detect the disease as soon as possible and asks people who show signs of the disease to isolate themselves, to not spread the virus. He has also advised men who have sex with men to reduce the number of their sexual partners. This has outraged the LGTBI community in Spain, who feel marginalized. The state coordinator for HIV and AIDS (Cesida) also thinks this is the wrong message. It is appropriate, they explain to EL PAÍS, to issue a general warning to the entire population that a high number of sexual partners can increase the risk of infection without focusing on a specific group, which “can lead to a stigma similar like three decades ago with HIV.”
How many cases have been discovered?
Globally, 30,638 cases have been reported so far, including 5,162 in Spain, the country with the most diagnoses per capita in the world and second in absolute terms after the United States (8,934), according to figures presented Tuesday by the CCAES. The cases reported in Spain come from the 17 autonomous communities, but two-thirds of the total (3,453) were recorded in Madrid and Catalonia.
Why has the WHO declared the outbreak an international public health emergency?
The WHO message is that the virus can be controlled with vigilance, tracing infections and breaking the chains of transmission. But that’s not what happens. Although the virus does not show an exponential explosion like the Covid did, it does not stop growing. It’s difficult to find contacts precisely because of the stigma that can come with it and the anonymity that comes with many risky relationships. Despite the fact that WHO advisers were largely opposed to declaring a state of emergency, its director-general, Tedros Adhanom Ghebreyesus, opted to do so because of the inaction he saw in some countries. One of the measures recommended by the agency is to limit international travel to people with symptoms of the disease, which has already spread to more than 75 countries.