More than 90 countries affected and 53,000 cases of monkeypox have occurred since the outbreak began in May. Spain was not the first country – it was the UK – but it became the most affected, with more than 6,645 cases as of September 2, according to the latest data from the Ministry of Health.
However, in Spain the number of new cases has been stabilizing for weeks and the trend is downward. A dynamic that coincides with that of other countries among the most affected, such as the United Kingdom and the United States.
Daily confirmed cases of monkeypox
“This decrease in cases was expected, although personally I believed that it would happen sooner,” he explains to The Independent the professor of parasitology at the University of Valencia Rafael Toledo. “It is an infection whose transmission requires close and prolonged contact, which occurred basically in a group, men who have sex with men, and through sexual contact. We are talking here about a probable international event where the epidemic started and then spread all over the world. That is why at the beginning there is an explosive epidemic but later with the natural immunity, the vaccine and above all a change in behavior, it declines”, he explains.
This international event, he explains, probably happened in Spain and that is why Spain has been the country with the most cases in relation to its population. Although the professor prefers not to specify what this super-diffusing event could have been, the Maspalomas Pride festivities, which took place in Gran Canaria from May 5 to 15, have been repeatedly pointed to this. .
End of the epidemic or diagnostic difficulties?
Despite this drop, epidemiologist Joan Caylá believes that a certain caution must be maintained: “The question is whether this is a real drop or an effect of the month of August, which left diagnostic difficulties due to holidays. Or a combination of the two.”
Caylá believes that in managing this outbreak, rapid case notification and contact tracing have failed. “In September, we will check what the real situation is,” he insists.
Average daily cases of monkeypox
In the event that the decline is confirmed, Toledo believes that now is not the time to lower our guard but to direct surveillance in the direction of the strategy. One Healthwhich aims to meet health challenges from the point of view of animal and human health.
Focus on animal surveillance
Although the transmission is controlled, Toledo insists on the need to look at the animal world, where this disease (which is a zoonosis) originates. “Traditionally, this disease was endemic in Africa and had produced a specific epidemic in a traveller. This is why now that the virus has been circulating for so long, the danger is that there is circulation of the virus in animals and that they maintain a reservoir which can cause periodic epidemics”; explains the teacher.
Although Toledo points out that the situation for the zoonosis to return to humans in Spain is less likely than where it is endemic, in African countries. “Here the treatment with animals is different, there is more hunting or more butchering, but above all you have to think about both the pets of people who have suffered from the disease, monitor them, and do regular checks. on wild animals, to search for the virus, on a routine basis”, he underlines.
Monkeypox was transmitted in Africa mainly by rodents such as rats, mice and the so-called prairie dog, another rodent considered an agricultural pest in Africa.
“Low” risk in schools
Before the start of the school year, Toledo believes that “cases can arise” but on the one hand it is difficult to transmit the disease and on the other hand it is very easy to diagnose in this area: “In current cases, where most produced by sexual contact, the pustules often appear in the genital or perianal area. But if contagious by contact, as usually happens in children, the marks would be on the hands and would be easier to identify. In addition, the number of cases in children has been very low, so the probability of transmission is also very low.
Until September 2, Spain has recorded 49 cases (0.7%) among those under 20, so an even lower percentage is among minors. In a study recently published in The Lancet with cases of Spanish children until August 3, only 16 patients were minors (0.3%).
In these 16 cases, four were under the age of four and 12 others were teenagers between the ages of 13 and 17. Childhood infections had occurred from an infected cohabitant and among adolescents, through a tattoo parlor where there had been one outbreak and three through sexual contact. Only one case occurred without knowing the origin of the infection.
Uncommon complications
In recent days, information has come to light about a possible new complication of monkeypox, of a cardiac nature. The case was published in Journal of the American College of Cardiology (JACC) and it was a 31-year-old man whose disease was complicated by myocarditis or inflammation of the heart. “It is a special case and with any infection a complication can arise, it is possible that there are previous comorbidities which make one person more vulnerable than another. But these are still abnormal situations, ”explains the professor of parasitology.
For his part, Caylá explains that although the mortality associated with monkeypox in Africa has varied according to the data from 3 to 10%, in this epidemic there are two different circumstances: “On the one hand, we have very different and d on the other hand it seems that the variant that is transmitted is a bit milder.Complications can occur but are rare.
According to the latest report from the Ministry of Health, 8.5% of patients in Spain suffered complications, which are as follows. Only 3.4% of all patients have been hospitalized and two deaths have been reported so far.
| complications | Number of cases |
| mouth ulcer | 112 |
| Secondary bacterial infection | 85 |
| genital ulcers | seven |
| anal ulcers | seven |
| Proctitis (inflammation of the rectal mucosa) | 6 |
| Faringoamigdalitis | 4 |
| Pharyngeal/peritonsillar abscess | 4 |
| corneal infection | 3 |
| Cellulite | 2 |
| Treatment of painful genital area | 2 |
| Meningoencephalitis | 2 |
| Myocarditis / myocardiopericarditis | 2 |
| shingles | 1 |
| monoarthralgia | 1 |
| pyelonephritis with sepsis | 1 |
Joan Caylá insists on caution: “We must continue to insist on the rapid diagnosis of cases and the prevention of further transmission of the disease and the risk of becoming endemic”.
In recent weeks, the vaccination of cases has also started and the Ministry of Health has changed the administration strategy to intradermal, so that the the dose is reduced to the fifth and promote potential vaccination coverage.