Monkeypox cases continue. Health has raised the confirmed cases of the disease in Spain to 142 due to an outbreak already affecting more than 30 countries. we talked to Xavier CantonDoctor of Virology and Professor at the International Campus for Security and Defense on a virus that once again reminds us that human health is closely related to animals and the planet.

Do you think there will be an epidemic of monkeypox? Making the virus endemic in Europe?

What has happened outside Africa is being expanded far beyond that. Fortunately, we have designed vaccines that can be used to limit cases. In addition, the fact that the symptoms are transmitted also contributes in favor of the fact that transmission is preventable. However, since the disease is already prevalent in many countries, it is not unreasonable to think that the virus will manage to find an animal reservoir outside endemic areas, which are the countries of Central and West Africa. There is some risk of this happening. It is also necessary to control pets to avoid this, which can be a way for pathogens to reach wildlife.

Why is this outbreak different from what we’ve seen with monkeypox before?

The genetic surveillance that is being carried out suggests that the virus is closely linked to cases that were already detected in the United Kingdom, Singapore, Israel in 2018 and 2019 … but the first sequencing done in Portugal. showed that despite this similarity, the virus that is circulating has 50 new mutations, a number much higher than expected. All viruses mutate, but depending on the virus group, the rate of change is higher or lower. The number of mutations at that time is higher than expected for this type of virus. Not much is known yet, but it has been observed that some of these mutations were already detected in the circulation of the virus among people in Africa. They are mutations that appear as a result of adaptation to humans.

What are the risks with this?

If the virus is allowed to circulate indefinitely, it is known to have “biological efficacy in humans”. This is what has happened, for example, with the coronavirus when variants such as Delta or Micron have appeared. However, we are still far from it. The genetic improvement this virus has achieved is far from the level that the coronavirus achieved as it left Wuhan in the micron sublineage. We are talking about very few mutations in a DNA which consists of 190,000 nucleotides.

Why in this case can the smallpox vaccine be used to prevent transmission even in cases where infection has already occurred?

The incubation period of this virus is relatively long. The virus normally enters through the respiratory tract and takes four or five days to progress until it reaches the lymph nodes. Once that happens it starts multiplying and symptoms start to appear. First non-specific, such as fever, and then more specific, such as skin rash. These signs show their face already around the eighth or tenth day. When we inject the smallpox vaccine, it goes directly to the lymph nodes and overtakes the virus. But, apart from this, the vaccine is made from the virus. chicken pox, a poxvirus that has a short vaccination period. In short, the vaccine manages to overtake the virus and generate immunity before it can act. However, this is only available if the vaccination is done in the first few days, it is not valid at any time.

At what point can an infected person become contagious?

By the time non-specific symptoms begin, such as fever, the patient is infectious, but the level of transmission is still very low. The peak of infection is when the nodes are already inflamed and skin lesions appear. Therefore it is relatively easy to stop the transmission.

Will it be necessary to resume vaccination against smallpox?

The data we have now does not suggest that global vaccination is necessary. Now, I believe it will be necessary to vaccinate against smallpox in West and Central African countries. Yes, vaccination will be implemented in those countries, because with the vaccine we will protect the population of these countries and we will also count the transmission in other areas.

Are we ready for other pandemics?

We are not prepared for everything that comes from nature. The key is the coordination between animal, human and planetary health, which is known as ‘one health’. This is the key to controlling newly emerging diseases.

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