2022 monkeypox outbreak in Spain

The 2022 monkeypox outbreak in Spain is a part of the outbreak of human monkeypox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Spain on 18 May 2022.[1]

2022 monkeypox outbreak in Spain
DiseaseMonkeypox
Virus strainMonkeypox virus (West African clade)
LocationSpain
Index caseMadrid[1]
Arrival date18 May 2022 (5 months, 2 weeks and 2 days ago)[1]
DateAs of 19 July 2022
Confirmed cases
Suspected cases‡0 (Regional governments)
Hospitalized cases155 (Ministry of Health)[2]
Deaths
2 (Ministry of Health)[2]
Government website
Monkeypox alert in Spain and other European countries
(in Spanish)
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

Background
These paragraphs are an excerpt from Monkeypox and 2022 monkeypox outbreak.

Monkeypox is an infectious viral disease that can occur in humans and some other animals.[3] Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over.[3] The time from exposure to onset of symptoms ranges from five to twenty-one days.[4][5] The duration of symptoms is typically two to four weeks.[5] There may be mild symptoms, and it may occur without any symptoms being known.[4][6] The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks.[3][7] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[8]

The disease is caused by the monkeypox virus, a zoonotic virus in the genus Orthopoxvirus.[9] The variola virus, the causative agent of smallpox, is also in this genus.[10] Of the two types in humans, clade II (formerly West African clade)[11] causes a less severe disease than the Central African (Congo basin) type.[12] It may spread from infected animals by handling infected meat or via bites or scratches.[13] Human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route.[3][13] People can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted.[12] Diagnosis can be confirmed by testing a lesion for the virus's DNA.[14]

There is no known cure.[15] A study in 1988 found that the smallpox vaccine was around 85% protective in preventing infection in close contacts and in lessening the severity of the disease.[16] A newer smallpox and monkeypox vaccine based on modified vaccinia Ankara has been approved, but with limited availability.[4] Other measures include regular hand washing and avoiding sick people and animals.[17] Antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin and the smallpox vaccine may be used during outbreaks.[18][19] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[19] Estimates of the risk of death vary from 1% to 10%, although few deaths as a consequence of monkeypox have been recorded since 2017.[20]

An ongoing outbreak of monkeypox was confirmed on 6 May 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with monkeypox on 29 April 2022. The resident returned to the United Kingdom on 4 May, creating the country's index case of the outbreak.[21] The origin of several of the cases of monkeypox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May,[22] but it has been suggested that cases were already spreading in Europe in the previous months.[23]

Transmission
Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where monkeypox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[24]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[25]

History

On 18 May 2022, the Community of Madrid regional government reported the first eight suspected cases of monkeypox, and seven of them were confirmed by the Ministry of Health on 20 May.[1]

On 20 May, the health authorities of Madrid closed the gay sauna Paraíso, which was under investigation as a possible high transmission point in Madrid.[26][27] The sauna reopened again on 9 June after receiving an authorization from the regional health department.[28][29]

Outbreak characteristics

According to the Community of Madrid regional government on 6 June 2022, all cases in the region were men, except one woman who is cohabitant with one of the infected men. The most likely contagion event for most was sexual relations with strangers, usually at parties in private residences, a sauna, or the gay pride event at Maspalomas, Canary Islands. 48% of cases were also HIV-positive.[30]

On 10 June, the Ministry of Health disclosed that out of a sample of 78 cases, 21 had a previous smallpox vaccine dose.[31]

On 26 August, the Ministry of Health published additional data about 6,459 cases. 6,334 of them were men, and 125 were women. Age ranged between 7 months and 88 years, with a median age of 37 years. Out of 5,198 cases with recorded data, 5,022 were men who have sex with men. Out of 3,700 cases with recorded data, 92,6% had prolonged intimate contact during sexual relation as the most likely transmission mechanism.[32]

LGBT stigmatization

Several experts have raised concerns about stigmatization of LGBT people in connection to the monkeypox outbreak.[33]

In June 2022, the public prosecutor of Valencia opened an investigation of a publication about the monkeypox outbreak by the far-right political party España 2000, which could constitute hate speech against the LGBT community.[34]

Cases per region
Monkeypox cases in Spain per autonomous community
Community Confirmed Suspected As of Ref.
Andalusia 685 96 12 August 2022 [35]
Aragon 53 — 12 August 2022 [2]
Asturias 53 — 12 August 2022 [2]
Balearic Islands 134 — 12 August 2022 [2]
Canary Islands 136 — 12 August 2022 [2]
Cantabria 27 — 12 August 2022 [2]
Castilla–La Mancha 42 — 12 August 2022 [2]
Castile and León 54 — 12 August 2022 [2]
Catalonia 1,782 — 12 August 2022 [2]
Ceuta — — 12 August 2022 [2]
Valencian Community 353 — 12 August 2022 [2]
Extremadura 22 — 12 August 2022 [2]
Galicia 83 — 12 August 2022 [2]
Community of Madrid 2,169 — 12 August 2022 [36]
Melilla — — 12 August 2022 [2]
Murcia 33 — 12 August 2022 [2]
Navarre 13 — 12 August 2022 [2]
Basque Country 162 — 12 August 2022 [2]
La Rioja 4 — 12 August 2022 [2]
Total 5,805 96

See also

References
  1. "Casos de viruela del mono en España y en el mundo, estadísticas y gráficos". epdata (in Spanish). Archived from the original on 2 June 2022.
  2. "Alerta sobre infección de viruela de los monos en España y otros países no endémicos" (PDF). Ministry of Health (in Spanish). 12 August 2022.
  3. "Multi-country monkeypox outbreak: situation update". www.who.int. World Health Organization. 4 June 2022. Archived from the original on 6 June 2022. Retrieved 7 June 2022.
  4. "WHO Factsheet – Monkeypox". World Health Organization. 19 May 2022. Retrieved 28 May 2022.
  5. "Signs and Symptoms Monkeypox". CDC. 11 May 2015. Archived from the original on 15 October 2017. Retrieved 15 October 2017.
  6. Sutcliffe, Catherine G.; Rimone, Anne W.; Moss, William J. (2020). "32.2. Poxviruses". In Ryan, Edward T.; Hill, David R.; Solomon, Tom; Aronson, Naomi; Endy, Timothy P. (eds.). Hunter's Tropical Medicine and Emerging Infectious Diseases E-Book (Tenth ed.). Edinburgh: Elsevier. pp. 272–277. ISBN 978-0-323-55512-8.
  7. Harris, Emily (27 May 2022). "What to Know About Monkeypox". JAMA. 327 (23): 2278–2279. doi:10.1001/jama.2022.9499. PMID 35622356. S2CID 249096570.
  8. "Multi-country monkeypox outbreak in non-endemic countries". World Health Organization. 21 May 2022. Retrieved 25 May 2022.
  9. Taha, M. J., Abuawwad, M. T., Alrubasy, W. A., Sameer, S. K., Alsafi, T., Al-Bustanji, Y., ... & Nashwan, A. J. Ocular manifestations of recent viral pandemics: A literature. health, 13, 14.
  10. Petersen, Brett W.; Damon, Inger K. (2020). "348. Smallpox, monkeypox and other poxvirus infections". In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. pp. 2180–2183. ISBN 978-0-323-53266-2.
  11. "Monkeypox: experts give virus variants new names". World Health Organization. 12 August 2022.
  12. Adler, Hugh; Gould, Susan; Hine, Paul; Snell, Luke B.; Wong, Waison; Houlihan, Catherine F.; et al. (24 May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". The Lancet. Infectious Diseases. 22 (8): S1473–3099(22)00228–6. doi:10.1016/S1473-3099(22)00228-6. PMC 9300470. PMID 35623380. S2CID 249057804.
  13. "Transmission Monkeypox". CDC. 11 May 2015. Archived from the original on 15 October 2017. Retrieved 15 October 2017.
  14. "2003 U.S. Outbreak Monkeypox". CDC. 11 May 2015. Archived from the original on 15 October 2017. Retrieved 15 October 2017.
  15. "Treatment Monkeypox Poxvirus CDC". www.cdc.gov. 28 December 2018. Archived from the original on 15 June 2019. Retrieved 11 October 2019.
  16. Fine, P. E.; Jezek, Z.; Grab, B.; Dixon, H. (September 1988). "The transmission potential of monkeypox virus in human populations". International Journal of Epidemiology. 17 (3): 643–650. doi:10.1093/ije/17.3.643. ISSN 0300-5771. PMID 2850277.
  17. "Prevention". www.cdc.gov. 29 November 2019. Archived from the original on 14 March 2022. Retrieved 14 May 2022.
  18. "Interim Clinical Guidance for the Treatment of Monkeypox | Monkeypox | Poxvirus | CDC". www.cdc.gov. 26 May 2022. Archived from the original on 7 June 2022. Retrieved 8 June 2022.
  19. "Monkeypox". GOV.UK. 24 May 2022. Archived from the original on 18 May 2022. Retrieved 28 May 2022.
  20. "Multi-country monkeypox outbreak in non-endemic countries: Update". www.who.int. Retrieved 2 July 2022.
  21. "Monkeypox – United Kingdom of Great Britain and Northern Ireland". World Health Organization. 16 May 2022. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
  22. Pinkstone, Joe (17 May 2022). "Monkeypox 'spreading in sexual networks'". The Telegraph. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
  23. Nsofor, Ifeanyi (2 June 2022). "OPINION: Media coverage of monkeypox paints it as an African virus. That makes me mad". NPR. Retrieved 2 June 2022.{{cite web}}: CS1 maint: url-status (link)
  24. Vargas, Ramon Antonio (7 June 2022). "US raises monkeypox alert level but says risk to public remains low". the Guardian. Retrieved 9 June 2022.
  25. "Monkeypox update: Where the outbreak stands now".
  26. "Madrid estudia si hay vínculo entre los casos de viruela del mono de la capital y Canarias". RTVE (in Spanish). 22 May 2022.
  27. Pascual, Alfredo (21 May 2022). "Así es la sauna Paraíso, foco del brote de viruela del mono en Madrid". El Confidencial (in Spanish).
  28. "La sauna 'Paraíso' niega "cualquier responsabilidad sobre el foco de infección de la viruela del mono" en Madrid". La Vanguardia (in Spanish). Servimedia. 8 June 2022.
  29. Soto, Álvaro (8 June 2022). "Reabre la sauna Paraíso, foco de la viruela del mono en Madrid". La Voz de Galicia (in Spanish).
  30. "La mayoría de los contagiados con la viruela del mono mantuvo relaciones con desconocidos" [A majority of monkeypox infected had relations with strangers]. La Vanguardia (in Spanish). 7 June 2022.
  31. "Alerta sobre infección de viruela de los monos en España y otros países no endémicos" (PDF). Ministry of Health (in Spanish). 10 June 2022.
  32. http://www.mscbs.es/profesionales/saludPublica/ccayes/alertasActual/alertaMonkeypox/docs/Informe_de_situacion_MPX_20220826.pdf
  33. Vargas, Natalia G. (25 May 2022). "La viruela del mono y el uso de la salud como gasolina para la discriminación". Canariasahora (in Spanish).
  34. "La Fiscalía investiga por delito de odio unas publicaciones sobre el colectivo LGTBI y la viruela del mono". ABC (in Spanish). 10 June 2022.
  35. "Andalucía registra 332 casos activos de viruela del mono, con 96 en investigación, y suma ya 319 personas vacunadas". europapress (in Spanish). 12 August 2022.
  36. "La Comunidad de Madrid detecta 2.169 casos de viruela del mono y supera las 1.900 dosis de vacuna administradas". europapress (in Spanish). 12 August 2022.
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