Smallpox is a zoonotic disease, meaning it can be transmitted between animals and humans by direct or indirect contact. Following the eradication of smallpox and the end of universal smallpox vaccination, smallpox is currently the most common orthopoxvirus infection in humans.
Since May 2022, several countries around the world have reported an evolving outbreak of monkeypox cases, which mainly affects young men who identify as men who have sex with men. Four quick communications published today in Eurosurveillance describe cases diagnosed in Italy, Portugal, the United Kingdom (United Kingdom) and Australia.
United Kingdom: one outbreak, three separate incidents
Vivancos et al. describe the epidemiology and public health response to a monkeypox outbreak in the UK with 86 confirmed cases of monkeypox virus infections between 7 and 25 May 2022.
The authors grouped the currently known cases into three different incidents: an isolated case confirmed in the laboratory after a trip to Nigeria, two confirmed cases of monkeypox from a separate household group, including a case whose infections have already been reported. ‘had been resolved clinically (without laboratory confirmation) and as a third party. incident, 82 cases of monkeypox confirmed to the laboratory that they are not related to the other two incidents nor did patients report trips to areas where monkeypox is endemic.
Although investigations are still ongoing to determine whether cases of Incident 3 may have been infected outside the UK, sexual health records have identified links to sex at the facility, private sex parties and the use of geospatial dating applications in both the UK and the UK. abroad. In the group linked to the third incident, gender information was available for 79 cases, all of them men. Of these, a large majority, 66 identify as gay or bisexual or other men who have sex with men.
To date, no single factor or exposure has been identified to link the cases.
According to Vivanco et al., “The current outbreak indicates a shift in basic assumptions about the epidemiology of MPXV in Europe with profound implications for surveillance and control” and is the first sustained transmission of MPXV in the UK with evidence from people to people. – Human transmission by close contact, even in sexual networks.
Possible undetected spread of suspected smallpox in Portugal
Portugal confirmed the first case of human smallpox in the country on May 17, 2022 and Duque et al. describe the detection of the outbreak of so far 96 confirmed cases of smallpox in the Lisbon region and the Tagus Valley. The onset of symptoms in the first cases in Portugal was reported on April 29, 2022.
Most patients were not part of identified transmission chains, nor could a link be established for travel or contact with symptomatic people or animals. According to the authors, this suggests a possible spread of monkeypox previously undetected.
Among the 23 confirmed cases, Duque et al. describe, 14 were HIV positive and the most common symptoms were rash (n = 14), inguinal lymphadenopathy (n = 14), fever (n = 13), genital ulcers (n = 6). The authors hypothesize “that MPX has been circulating below the detection of surveillance systems. Although some cases have a clear epidemiological link, the lack of exposure identified in others raises unanswered questions.”
Positive seminal fluid samples in Italy for smallpox
Vita et al. Provide a clinical description of the four cases of monkeypox reported in Italy in adult men with different clinical pictures in the literature, as the skin lesions were asynchronous, ranging from simple or clustered spots to ulcerated papules with ulceration. progressive central and finally to crusts. . The lesions were located mainly in the genital and perianal sites.
Biological samples of seminal fluid were positive for monkeypox viral DNA in all four patients, with a quantification cycle interval of 27 to 30. Based on this, the authors hypothesize that “all and that these findings cannot be considered definitive evidence of infectivity, they demonstrate viral spread, the efficiency of which in terms of transmission cannot be ruled out. “
Risk of bacterial superinfection
In their description of the case, Hammerschlag et al. sharing data on a virally suppressed HIV-positive patient who had a genital rash in Australia after a visit to Europe in May 2022, who was then hospitalized.
The clinical presentation in this case was considered atypical given the presence of the rash exclusively at the site of sexual intercourse 3 days before developing fever and the preponderance of lesions in a central distribution with fewer lesions present on the face and limbs after the eruption. diffused.
The authors emphasize that “the hospitalization of our patient was not due to severe manifestations of viral infection of the monkeypox, but to allow the diagnostic evaluation, pain management and treatment of bacterial superinfection” and that the Normal patient CD4 + T cell count and suppressed HIV viral load in antiretroviral therapy “were potentially important factors in preventing more serious outcomes of their monkeypox infection.”
Source:
European Center for Disease Prevention and Control (ECDC)
Magazine reference:
Duke, MP, et al. (2022) Outbreak of monkeypox virus in progress, Portugal, 29 April to 23 May 2022. Eurosurveillance. doi.org/10.2807/1560-7917.ES.2022.27.22.2200424.