"Control measures present difficulties: it is impossible to completely trace each chain of transmission"

• Health A Spanish study points to the new dermatological characteristics of monkeypox: fewer skin lesions, but in areas of sexual contact

• Monkeypox The latest news from the infectious outbreak

Spain could be considered one of the current epicenters

of the monkeypox outbreak outside of Africa.

Together with the USA, although in our country the loss of two lives as a result of the complications of the infection must be regretted.

Araceli Arce

, Deputy Director General of Public Health Surveillance of the General Directorate of Public Health of the Ministry of Health of the Community of Madrid, is one of the authors of one of the recent studies that have been published on the virus in

.

From the

, after Covid, Arce breaks down with EL MUNDO the impact of the virus in the Madrid region and in Spain and the

of the entire General Subdirectorate of Public Health Surveillance.

How do you discover the first cases and try to see the traceability of them? The UK Health Security Agency established the first alert on May 14 (Saturday).

On Tuesday the 17th, a center for Sexually Transmitted Infections in Madrid reports that it treated seven patients with symptoms compatible with the aforementioned alert.

All of them were men who reported having sex with other men (MSM).

After notification, the epidemiological investigation is initiated, samples are requested and the National Center for Microbiology is contacted to carry out the microbiological diagnosis.

Likewise, from Public Health of the Community of Madrid the Ministry of Health is informed.

With the epidemiological investigation of the first cases, the common characteristics of these patients are determined,

in terms of symptoms, possible factors and risk situations and the first recommendations are issued for the control of transmission. Given the growth of infections, what has gone wrong? From the point of view of Public Health, it is not considered that there has been a failure occurred.

It is a new disease in Spain and in most European countries with a previously unknown transmission mechanism.

The description of this and the population it is affecting has been made in a short period of time, in our case, four days.

Although the implementation of control measures presents some difficulties, such as the impossibility of completely tracing each chain of transmission because most of the close contacts are with strangers,

In addition to the limited pharmacological measures to heal the lesions and the limited availability of vaccines. They do not mention it in the study, although they discuss it, what is the impact of vaccines in controlling the outbreak and their current double use: pre and post-exposure? In the article, referring to the first 500 cases of the outbreak in the Community of Madrid, reference is made only to the existence of a history of vaccination against classical smallpox as a possible protective factor against smallpox. mono, produced by a virus of the same family.

Specific vaccines were not available at the time of writing the article.

Post-exposure vaccination is having limited impact due to difficulties in identifying close contacts.

It is foreseeable that the pre-exposure vaccination strategy can contribute effectively to the control of the disease, but for this it is necessary to have a much higher number of vaccines than the current one [Health has distributed 5,000 among the Autonomous Communities and expects 7,000 more doses in the next weeks].

In Madrid, they are being administered at the Vaccination Center dependent on the General Directorate of Public Health [yesterday 1,083, 885 pre-exposure and 198 post-exposure were confirmed]. In addition to the stigma in the community, to what extent does it weigh that one of the outbreaks most cases worldwide is Spain, with the epicenter in Madrid? In Madrid, a great effort is made for early detection, diagnosis and identification of close contacts and communication of cases at the national level.

This may be a reason that has contributed to the communication of a significant number of infections in the region.

It is expected that large cities concentrate a greater number of cases, not only because of the density of the population, but as in our case, as a result of a high leisure offer aimed at the MSM population, with specific venues, ease of organizing private parties and contact with people from other countries.

We cannot forget that Madrid is an important communication hub.

On the other hand, the latest data offered by Health show that other Autonomous Communities, such as Catalonia, also diagnose a high number of cases and therefore contribute to the weight that Spain has in the EU. The PCR test in hospitals,

Has it streamlined the procedures? In the first moments it was especially important to cut the chains of transmission, to indicate the isolation of the cases and the identification of their contacts.

Madrid detected and diagnosed a high number of cases, it was necessary to urgently provide diagnostic capacity to four large hospital laboratories and the Regional Public Health Laboratory.

This facilitates that the results are in 24 hours.

In Public Health, through epidemiological research, work is done to identify and minimize risks in population groups affected by a given communicable disease.

The majority profile found in the cases in this outbreak is that of men who have sex with men (MSM) who have risky relationships, especially with multiple and unknown partners.

In this outbreak, risk identification is associated with the existence of risky sexual relations, not with sexual orientation or gender identification.

It cannot be ruled out that people with symptoms hide the diagnosis from their contacts,

Once the first cases of monkeypox were identified, some doctors recalled treating patients with similar symptoms in previous days and weeks.

Some of these patients could be investigated because they had very significant skin involvement and lesion samples were available in the laboratories of the hospitals where they were treated, thus retrospectively confirming the diagnosis.

The first European alert corresponds to the United Kingdom and within three days both Spain and Portugal reported the existence of cases with the new transmission mechanism.

This occurred in mid-May, but it is likely that there had already been some transmission since April that had gone unnoticed and was diagnosed as other diseases that present with a skin rash.

In Spain, and specifically in the Community of Madrid, the absence of connections with travelers from endemic areas of Africa or with animals from this continent confirmed that the transmission mechanism was different.

The challenges are similar to those existing before said declaration, since the objective continues to be transmission control, since at this time most of the cases are not serious.

What the declaration of a public health emergency of international importance has revealed is the rapid extension of the outbreak in many countries, grouping itself mostly in men with risky sexual practices and, therefore, the necessary international coordination.

The measures that are being carried out must be maintained over time: improve knowledge of the clinical management of patients by health professionals;

strengthen the indication and compliance with isolation, make people with risk factors co-responsible in measures related to safe sex, continuing to work with representatives of LGTBIQ+ groups;

continue to strengthen education for the health of the population and promote pre-exposure vaccination of groups at higher risk.

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