Monkeypox: “Given the increase in cases, the truth is that we must be prepared for a trickle of deaths from now on”

Three deceased by monkey pox outside of Africa, the endemic area, two in Spain and one in Brazil. These are added to the five that the World Health Organization has accounted for on the African continent. The deaths have been confirmed a week after the WHO declared a public health emergency in the infection.

The fatal outcome of at least three cases outside the borders should call for reflection on the course that “the situation is taking. We must appeal to responsibility and make a call to caution without stigmatizing. Because until now things have been done wrong: the detection of cases, the containment of outbreaks, the treatment of patients…”. This is how Alfredo Corell, professor of Immunology at the University of Valladolid and member of the Spanish Society of Immunology, the current situation.

The number of cases that are added, “and those that may be yet to come”, Correll points out in reference to the fact that “almost three weeks have passed since the Pride celebrations, the necessary ones in which the disease is incubated, and there may be an increase in cases worldwide.” In Spain have already been notified According to data from the National Epidemiological Surveillance Network (Renave), As of July 30, a total of 4,298 confirmed cases of monkeypox or monkeypox.

“The more viruses that are being transmitted, the more chances that vulnerable people or patients at risk will get infected and these are the ones that have the most problems with the infection,” recalls Corell. The two deceased in Spain are due to complications of the infection.

Avoid infection and its complications

From the first case reported on Friday afternoon, it has transpired that it was caused by infection-associated encephalitis and that is analyzed to determine definitive confirmation of the cause. Of the confirmed on Saturday, it has been reported that he is a 31-year-old man who was admitted to the Intensive Care Unit of the Reina Sofía University Hospital in Córdoba. Samples taken during necropsy will determine if the cause of death is meningoencephalitis or another pathology.

“Given the increase in cases (and new ones continue to be added), the truth is that we must be prepared for a trickle of deaths from now on“, laments Corell, and insists that “we are facing the least lethal variant, the one that comes from Nigeria with a 1% risk of death. Since, if it were that of Congo, it would amount to 10% “.

In addition, it makes a point that the vaccines that are already available are used wisely. Specific, Madrid, 557 doses administeredof which 393 are pre-exposure and 164 post-exposure (contacts) and in Catalonia, some 655. “If we do the tracking of cases well, we can avoid the complications of the disease and that they have a tragic end [actualmente hay 120 pacientes ingresados (3,2%) y un 7% de los leves 7% presentaron complicaciones a lo largo de su proceso clínico] and if it is used in people at pre-exposure risk, we will avoid more cases”.

It should be remembered that the Carlos III Health Institute sequenced 23 samples in just over a week since the first cases were registered and confirmed that the circulating strain in our country is the West African variety, the least serious. Another study published in ‘Nature’, by Portuguese researchers revealed the genetic changes of the current outbreak of monkeypox and pointed to a single origin.

“The truth is that the traceability of the cases has complicated everything a lot. It is known that there was a first case in the United Kingdom from a trip to Nigeria and from there the transmission has reached Spain, Portugal… It is very important that the work of close contacts is done well“, emphasizes the immunologist.

corell emphasizes doing epidemiological surveys well. “We have to know who has been with whom after the infection. If you don’t want to say, whatever the circumstances, at least you have to quarantine, limit interactions with others for a few weeks.”

And also point out something with which WHO has sparked controversy: reduce sexual intercourse. “Yes, I know this can be controversial, but wouldn’t it be a good public health measure to close or avoid certain entertainment venues for a month to see how cases go down?” Corell says.

Contagions in other groups

because remember that we must prevent the infection from making the leap to other groups, “such as brothels or families with children. Or, at least, we still don’t know if it has happened,” says the professor. In Spain, of the patients reported in SiViES, a total of 4,081 are men and 64 are women; in three this information is not stated; Y, age ranges from 10 months to 88 years.

If we compare the transmission of our country with the rest of the world, differences can be glimpsed. In Spain, in 82.1% of cases have been caused by close contact in the context of a sexual relationship y in 10.5% due to close contact sexual. At a global level, the WHO estimates sexual transmission at more than 98% because it has been declared in men who have sex with men.

“All this leads us to reflect that we must take action on the matter,” says Corell. “The LGBTI community is concerned about stigma. But the recipe is simple, responsibility and common sense. If you have suspicion, go to the doctor; if it gets infected, keep quarantine “.

Searching for new evidence for the current outbreak

Corell explains that at this moment there are many ongoing studies to find out what is particular about the transmission of the virus, “because until now it was always from animal reservoirs”; why is it important or not that virus DNA has been found in semen and saliva“to know if it is spread by droplets, so wearing the mask and washing hands is essential again.”

In the rest of Europahave been notified a total of 10,059 confirmed cases. Germany (2,540), the United Kingdom (2,367), France (1,837), the Netherlands (878) and Portugal (633) are the most affected countries after Spain. Most are young men with a history of relationships in a risky sexual context.

To these figures must be added globally another 7,342 cases recorded in non-endemic countries, with the United States (4,907), Canada (761), Brazil (978), Peru (269) and Israel (133), among the most affected countries.