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United Kingdom, Portugal and

Spain

record an

unusual outbreak

of

monkeypox

.

The alert and public health systems of the different countries are studying how and

why this rebound in cases occurs outside the usual areas

, Africa.

Given the alarm that may arise and the doubts about

dermatological lesions that make this

infection

suspect

from the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc), its spokesman, Francisco Javier Membrillo de Novales, points out (in a Twitter thread) that "

Those who have doubts that they may be infected are advised to contact their reference hospital

to make the appropriate therapeutic diagnostic decisions."

How is the disease that causes monkeypox?

It is

a rare viral zoonotic disease, it is not a sexually transmitted infection.

The first human cases were identified in the Democratic Republic of the Congo in 1970. The number of cases in West and Central African countries has increased over the last decade.

Outside of Africa, cases of human infections with

monkeypox

have been documented in different countries, including the US, UK, Israel and Singapore.

In all cases, it has been associated with an imported case or with contact with imported animals.

From the Seimc it is explained that according to the

case definition of

the United Kingdom Health Security Agency (UKHSA) and provisionally adopted since last Tuesday by the Center for the Coordination of Health Alerts and Emergencies (CCAES) of Health and the Autonomous Communities, there would have been This infection should be suspected in: "A person with an

unexplained vesicular rash anywhere on the body

, plus at least one of the main symptoms (described in the next question). In addition to having an

epidemiological link to a confirmed case

or probable case of monkeypox in the 21 days before symptom onset; be

a man who has sex with men (MSM)

; or have

history of travel to West or Central Africa within 21 days prior

to symptom onset.

What are the main symptoms of this virus?

According to Fernando Fariñas, international coordinator of the group of experts on emerging infectious diseases and zoonoses of the Spanish Society of Virology and director of the Institute of Clinical Immunology and Infectious Diseases, "it is the sum of a series of

symptoms

. It is not just one of them. ".

The initial clinical picture usually includes:

  • Fever

    , with temperatures above 38º-38.5ºC.

  • Severe

    headaches, headache.

  • Myalgia

    or muscle pain and

    arthralgia

    or joint pain "similar to body pain or discomfort from the flu," says Fariñas.

  • Lymphadenopathies

    , that is, an increase in lymph nodes, "which are palpable in the cervical area and under the jaw," highlights the director of the Institute of Clinical Immunology and Infectious Diseases

  • Tiredness

    .

  • A few days after the onset of fever, a

    rash

    (

    skin lesion)

    develops, often starting on the face and then spreading to other parts of the body.

Monkey pox on the skin

One of the most striking characteristics of

zoonotic infection

is the

skin lesion

it produces.

"There is a certain

resemblance to the spots produced by chickenpox

, but here we must emphasize that

their progression is simultaneous

," explains Raúl Ortiz de Lejarazu, professor of microbiology at the University of Valladolid and former director of the National Center for Influenza from Valladolid.

This skin rash that

often starts on the face and spreads to other parts of the body

, including the genitals.

The

traces on the skin

have the following evolution: "

First it looks like a spot

, which after two or three days becomes a

papule

(less than a centimeter lesion with well-defined edges). Later it becomes a kind of

blister

and later it is scarified", explains Ortiz de Lejarazu.

"The rash evolves and goes through various stages.

It can have an appearance similar to chickenpox or syphilis

, before finally forming a scab that later falls off," the British authorities describe.

It usually produces

a self-limited disease and most people recover in several weeks

, from two to four according to Seimc.

However, in some cases serious illness can occur.

How is monkeypox spread?

The

monkeypox virus

is not considered particularly contagious between people.

In general, person-to-person transmission is limited.

From the Seimc it is stated that

the transmission is through saliva or respiratory excretions, or by contact with the exudate of the lesion or the material of the scab

.

Viral excretion through

feces and sexual intercourse

may represent another source of exposure.

In the latter case, most of the infections produced in Spain to date are framed.

What is the incubation and contagion period of this virus?

The

incubation

period (interval between infection and onset of symptoms) for monkeypox

is usually 6 to 16 days, although it can range from 5 to 21 days.

Furthermore, it is usually a self-limited illness with

symptoms lasting 14 to 21 days.

Severe cases occur more frequently among children and their evolution depends on the degree of exposure to the

virus

, the patient's health status and the severity of complications.

If most cases have been among men who have sex with men, is it a sexually transmitted infection?

No. Experts insist that it

is a zoonotic infection

.

The main route of infection common to current cases is through

fluids in sexual intercourse

, but it can also be spread in the ways described above.

Despite this, the UKHSA

recommends "particularly those gay, bisexual and men who have sex with other men

to be alert to any rash or unusual injury."

What is the treatment for monkeypox?

There is no vaccine or specific treatment available.

Treatment is symptomatic and supportive, including prevention and treatment of secondary bacterial infections.

The people under study in Spain evolve positively and are

isolated in their homes,

although they must maintain close surveillance since they may require hospital admission.

Does the smallpox vaccine serve or protect against the simian virus?

Since 1980 there has been no vaccination against

smallpox

, understood as the infectious disease of humans.

"

There are observational works

that indicate that

this vaccine could protect against other smallpox, like this one

", explains Ortiz de Lejarazu.

How did monkeypox arise?

It first appeared in humans

in 1970 in the Democratic Republic of the Congo

(then called Zaire) in a nine-year-old boy, in a region where smallpox had been eradicated in 1968.

Since then,

most reported cases have come from rural rainforest regions of the Congo Basin and West Africa

, particularly the Democratic Republic of the Congo, where it is considered endemic.

In 2017, Nigeria suffered the largest documented outbreak, approximately 40 years after the last confirmed cases.

Cases of monkeypox were confirmed in the United States in

the spring of 2003, marking

the first time the disease had been detected outside of the African continent.

Most of the patients had had close contact with domestic prairie dogs that had been infected by African rodents imported into the country.

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