Two young men have died of monkeypox in Spain in just 24 hours, the Ministry of Health confirmed yesterday. They are the only two deaths recorded in Europe in this epidemic, along with five in Africa and one in Brazil. Has monkeypox been neglected these three months?
A the death of Friday in the Valencian Communitydue to encephalitis derived from the virus, according to Efe joined yesterday another in Cordoba. The Junta de Andalucía indicated that he was a 31-year-old man, who died of meningoencephalitis, according to Europa Press. Health pointed out that the epidemiological information on the cases is still being expanded and was awaiting analysis from the National Center for Microbiology of the Carlos III Health Institute. However, the Ministry reported the deaths to the World Health Organization (WHO) and the European Commission (EC).
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Deaths are few in this epidemic. Until now, in Spain, with 4,298 declared cases, 135 patients have presented complications, the most frequent, secondary bacterial infections and mouth ulcers, according to Health. Some 120 had to be hospitalized, mainly due to rectal pain caused by pustules from the infection, but the two deaths show that there is a risk of very serious complications.
Roger Paredes, head of infectious diseases at the Germans Trias (Can Ruti) hospital in Badalona and an IrsiCaixa researcher, points out that this is the case and the more the number of cases of this smallpox grows, it is logical, purely statistically, that there are more serious infections and deadly.
The more cases there are, the more serious and deadly they will appear
Without knowing the details of the deceased patients or encephalitis being confirmed as the cause by Health, Paredes explains that it is not exceptional, that some cases have already been described due to monkeypox. Same as myocarditis and keratitis can also occur (all three are inflammations that can be very serious of the brain, heart muscle and cornea).
The infectologist indicates that these inflammations, bronchopneumonia or sepsis are sometimes related to viral infections such as chicken pox, herpes or measles. The WHO and the British authorities have pointed out the risk of these serious effects and some non-fatal cases.
Roger Paredes: “The balance between not downplaying it and not generating panic is difficult”
Samples of the lesions caused by this smallpox
Paredes points out that these serious complications are rare, they still occur in 1% or less of cases and therefore “it is difficult to find the balance between not generating panic and not detracting from the importance that the infection may have; In general, it has an annoying but mild presentation, but it can lead to these serious complications, which require taking it seriously and working on prevention with the most affected groups”. However, the doctor appeals not to think that “it only concerns gay people.”
The age of infected people in Spain is very wide, ranging from 10 months to 88 years and 64 are women. The vast majority of infections are men who have sex with men. The contagion would be through close contact, especially during sexual intercourse: 82% of cases studied. However, in 10.5%, it was due to non-sexual contact.
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The pustules caused by the infection are highly contagious. Yesterday a Twitter user reported that she has been infected by contact with a scooter that she had bought second-hand.
Health has warned that Spain is the second country with the most cases after the US and the epidemic continues to rise. And if the current transmission “is not optimally controlled, there is a significant risk that it will spread to other population groups” and that serious cases will occur in vulnerable populations. The WHO also warned that infections among children are growing.
Vaccines and limited treatments
Paredes believes that the European health authorities must speed up and strengthen their actions to contain the virus, from public health aspects (facilitating diagnosis, isolating those infected until the scabs dry…) to the availability of vaccines and treatments, which is limited in Spain, because the EC has made a unitary purchase and has assigned 5,300 doses of vaccine to Spain. They are administered to people at higher risk of contagion or of having health complications.
There is a vaccine against smallpox already eradicated, which would be effective, but which caused many side effects and the vaccine created a few years ago by Bavarian Nordic against conventional smallpox and already approved by the European Medicines Agency (EMA) and by the US FDA against monkeypox. But the EC has only purchased about 165,000 doses. Paredes points out that it is a safe vaccine, but that it will surely require two doses (at the moment one is given to reach the maximum possible risk population)
The Bavarian Nordic vaccine, approved against monkeypox as Jynneos in the US and now as Imvanex in Europe, although those injected in Spain are now the American version
Of the two main antivirals against this type of smallpox, Paredes points out that one must be used with great care because it is highly toxic and the other is not yet available in Spain.
You have to think that monkeypox has been for decades (since 1970) a rare disease that occurred only in a dozen African countries or in cases imported from there. The production of drugs is very low, nothing comparable to that of flu or covid vaccines.
Can Ruti studies the infection
At the Can Ruti hospital, for example, Paredes and other specialists such as Oriol Mitjà and Bea Mothe, are analyzing the virus and the infection to see, for example, how long immunity lasts after passing the infection and whether or not it is easy to get reinfected.
monkey pox endemic in Africa used to cause, explains Paredes, infections with a lot of rash, first in children and then in young people, which was related to the fact that they had not received the human smallpox vaccine, eradicated in 1980. Until the start of this epidemic outside of Africa in May, there were fewer than 70 deaths this year in Africa from monkeypox. The current epidemic would have changed in some aspects, although it is still being studied. It already has some 21,000 cases in some seventy countries, most of them in Europe.
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