So far in May, both the United Kingdom and Spain, Portugal, Italy and the United States have reported several cases of monkeypox, which has raised the alarm.
1. What is monkeypox?
It is a zoonosis (disease transmitted between vertebrate animals and humans) caused by a DNA virus. Although it produces symptoms and has a presentation similar to smallpox, a disease that has been eradicated since the 1980s, its severity, infection and mortality rate are low.
It is mainly endemic in Central and West Africa, and has seen a marked increase in both frequency and distribution in recent years. Sporadic imported cases have mainly been reported in the United Kingdom. There are two types: the West African version and the Central African version.
2. How does it spread?
It is thought that transmission occurs through saliva or respiratory excretion, or exposure to exudate from wounds or crusting material. The possibility of contagion during sexual intercourse is also being considered and viral excretion through faeces may represent another source of risk, although more data are needed on this.
Continuous person-to-person transmission is limited and much less efficient than animal-to-person transmission.
3. What symptoms does it cause?
The incubation period (time from infection to onset of symptoms) of the disease is usually 7 to 14 days, although it can vary between 5 and 21 days.
The picture begins with flu-like symptoms (fever, headache, muscle aches, back pain, chills and tiredness), associated with significant swollen glands. Then a rash appears, often starting on the face and then spreading to other parts of the body, especially the hands and feet. These wounds go through various stages before becoming scabs and eventually falling off. The course of the disease usually lasts 2-4 weeks.
Monkeypox does not appear to be contagious during its incubation period, but only after symptoms appear and infection is likely to persist until the scabs fall off.
4. How is it diagnosed?
To reach a diagnosis, samples may be taken from skin lesions, crusts, and oropharynx. Molecular techniques are commonly used for its diagnosis by PCR.
5. How serious is this?
The most frequent complications are bacterial superinfection of wounds, keratitis, bronchopneumonia, corneal superinfection or encephalitis.
The mortality rate in outbreaks in Africa varies from 1 to 10%. Cases identified in the United Kingdom are of the West African variant, which accounts for about 1%, compared with the Central African variant, which has a higher mortality (10%).
The highest mortality rates occur in children, youth and the immunosuppressed. A more severe course of infection has been observed in people who have not been vaccinated against smallpox.
6. Do you have treatment?
There is no specific antiviral treatment. Some antivirals have been used experimentally. Administered treatment is supportive, to control symptoms and prevent bacterial superinfection.
7. What measures of isolation should be applied in a suspected case?
As this is a new virus in Spain, protocols are currently being worked out for its specific management.
According to the definition of the United Kingdom Health Security Agency (UKHSA) and recently adopted provisionally by the CCAES and the Spanish Autonomous Communities, subjects with vesicular exanthema without apparent cause in any part of the body associated with at least one of monkeypox There must be doubt. One of the classic symptoms of monkeypox infection (acute illness with fever, severe headache, muscle and joint pain, back pain, lymphadenopathy) since March 15, 2022.
It must also meet other requirements: there must be an epidemiological link with a confirmed or probable case of monkeypox in the first 21 days from the onset of symptoms; o be a man who has sex with men (MSM); or are traveling to West or Central Africa in the 21 days prior to the onset of symptoms.
At the present time, and with the available information, the epidemiological evolution of monkeypox is unknown. For this reason, people who suspect they may be infected are advised to wear a mask and cover injuries.
In addition, it is advisable to contact the reference health center or local public health authorities to make the most appropriate diagnostic and therapeutic decision in each case.
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