Is monkeypox spreading across the world two years after the first wave of infections? It’s too early to answer this question, experts say, but the disease is currently causing a serious crisis in part of the African continent.
What is monkeypox?
The disease was known as monkeypox because it is caused by a virus closely related to smallpox that was discovered in 1958 in monkeys used in research. It was later named “Mpox” by health authorities.
The virus causes fever, muscle aches and a rash.
The first human case was detected in the Democratic Republic of the Congo in 1970, and the disease remained confined for a long time to about 10 African countries.
But the year 2022 witnessed the beginning of its spread to the rest of the world, especially developed countries that had not recorded any infections before.
What are the risks?
It is difficult to determine the stage at which a disease becomes fatal. Before the 2022 monkeypox outbreak, the mortality rate was reported to be between 1 and 10%.
This wide variation is due to the presence of two main strains of the Impox virus: strain 1 and the much less virulent strain 2.
This second strain caused the outbreak of the epidemic in 2022, and the death rate resulting from it was less than 1%, which also explains the effectiveness of health care systems in developed countries.
What’s new?
This time, it is strain 1 that has been causing an outbreak of monkeypox for about a year in the Democratic Republic of the Congo, and to a lesser extent in other African countries such as Burundi and Kenya. Congo announced on Thursday that it had recorded 548 deaths since the beginning of the year out of about 16,000 “probable” cases that had been counted.
This outbreak is partly linked to strain 1, but also to the emergence of a new variant, “1B,” which is suspected to be more dangerous, but has not been proven.
This new variant was detected this week in Sweden, the first case outside Africa. In Asia, the first case of monkeypox was detected in Pakistan, but the strain is not known.
“It is not surprising, given the severity and prevalence of the epidemic in Africa, that intercontinental travel has brought this infection to Europe,” said Brian Ferguson, a professor of immunology at Cambridge, predicting that more cases will likely occur worldwide if no specific measures are taken.
Who is at risk of the disease?
The current outbreak in Africa has been most deadly among children, which is not surprising since strain 1 “is known to cause more severe disease in younger children, pregnant women and immunocompromised people,” said virologist Jonas Albaraz.
But he noted that the P1 variant is spreading particularly among young adults and appears to be transmitted through sexual contact.
This difference raises the question of how each variant transmits the virus. In 2022, the virus spread through sexual contact, and the vast majority of those infected were gay or bisexual.
However, the virus is more widely transmitted through bodily fluids such as saliva, and direct contact with the rash, which explains why children are more likely to be infected.
What now?
It is not known how far the virus will spread outside Africa. The infected person in Sweden had come from Africa. “There is currently no evidence of transmission in Europe,” said Professor Francois Balloux of University College London.
The European Centre for Disease Prevention and Control considers this risk to be low. But the agency said on Friday that it was “very likely” that European countries would face an increase in imported cases of strain 1, and recommended that health authorities be prepared “to enable rapid detection and response to any new cases.”
Although health authorities are currently monitoring the spread of the virus with concern, led by the World Health Organization, which has declared a high-level alert, this is because of its serious consequences in Africa.
Vaccination is key. There are several highly effective vaccines against monkeypox, but none are available in Africa, whereas when the virus broke out in 2022, developed countries easily launched vaccination campaigns. It is “possible” to combat the outbreak, said immunology professor Brian Ferguson, but “this requires rapid international cooperation.”