Nacho de Blas is a specialist in veterinary epidemiology and a researcher at the University of Zaragoza
An expert in veterinary epidemiology, Nacho de Blas is a full professor in the Department of Animal Pathology at the University of Zaragoza and has been closely following the development of the international outbreak of monkeypox. The chain of infection, he predicts, can be contained with the tools available, but we must better prepare ourselves to respond to such emerging pathogens. “We don’t know which one is going to happen next, but I know there are going to be others.”
- Do you think there will be an epidemic of monkeypox in Europe?
- I honestly don’t think so. I know there is going to be an outbreak of relative importance depending on the timing and the measures. Cases will keep coming up for a few weeks, but I think transmission will be cut. In my opinion, this situation will not last more than a month.
- Was this emerging virus already a target of researchers?
- The first human cases occurred in 1970. We know that the virus has two lineages, one from Central Africa and one from West Africa. In recent years, there was an increase in cases in Africa, but outside there were sporadic cases, always of the Western variant. The most relevant occurred in 2003, in the United States, due to the import of animals from Ghana. They imported a variety of Gambian rats, squirrels, porcupines and dormouse, and these animals were bred with prairie dogs that became infected and were later sold as pets. Those animals infected 47 people in several states, but did not lead to second-generation transmission between people.
- What has changed in this outbreak? Why are there so many cases, so many infections, and so many countries?
- There are a number of issues that could have been affected. On the one hand, countries such as Portugal, which have given a lesson in their way of acting, have performed rapid sequencing, showing that the virus has taken a phylogenetic ‘jump’ with respect to the way in which it comes. Is. It is being investigated whether these mutations may give it a certain ability to become more transmitted, although this would not be sufficient to explain the outbreak. The importance of superspreading events is also investigated, such as the Maspalomas festival mentioned, which may have contributed significantly to the international spread of the pathogen.
- Why are there more cases in men?
- The incubation period of the disease is up to 21 days. The initial mass transition probably occurred between 7 and 12 May, coinciding with the huge party at Maspalomas, which was attended by about 80,000 people, mainly young men. Had there been a bigger party with more women, perhaps cases would have come to the fore among women too. It is not a sexually transmitted disease nor is it related to homosexuality. The virus is also spread by close contact with wounds, with oral, vaginal or anal mucosa, and by the respiratory tract. I believe second-generation infections will start to occur, not only in male adults. Actually, there is already a case of a positive child in the UK.
- Is there any risk that the situation will spiral out of control?
- The disease is identified, there is a health alert, the population knows the symptoms and health workers know how to act. We have the diagnostic tools and we know that the smallpox vaccine protects against disease, so it can be used. I believe the situation can be controlled as soon as all the cases came to light when we had no idea what was happening. The main risk would be if the virus manages to find a reservoir in Europe. It is essential to control that domesticated animals and above all, wild animals do not become infected.
- Which animals are susceptible?
- There is still no absolute certainty which species are receptive to the virus. In principle, all mammals are susceptible to infection, so the indication is isolation of potential infections until it is determined whether infection is present. There is no need to panic, but precautions must be taken to contain the pathogen, which is able to survive very well in the environment. The main risk is that it manages to reach a wild species and find a reservoir there.
- SARS, Bird Flu, Monkey Pox… Why are we dealing with so many emerging viruses now?
- We are giving them all facilities to reach the humans in the world and we are going to face these emerging pathogens fast. There are two factors in favor of their arrival: globalization and the increasingly common invasion of the area by wild species. In the world we live in, it is possible to be on the other side of the world in six hours. The movements have a very high tempo and move a large number of people. If we add to this that the need to hunt for food is infiltrating more and more wild areas and we come into contact with wild animals, there is a favorable environment for the emerging virus. We don’t know who will be next, but I know there will be others.
- Have we learned a lesson from the pandemic and are we better prepared to face this type of emergency?
- Some countries have done so. As I mentioned earlier, Portugal sequenced the DNA of the identified monkeypox virus in less than 24 hours. When they already had all the details, in Spain we were still waiting for the confirmation of the suspected cases. Our reaction system is slow. Lack of coordination and clear leadership. Kovid is an example. More than two years later, each autonomous community continues to deliver data in a different way. There is a lack of planning and coordination in Spain, but also at the European level.
- What contribution can the veterinary world contribute if left aside?
- The proposed model for 15 years is a ‘one health’ concept that combines human, animal and planetary health. Many infectious diseases in humans have disappeared thanks to the efforts of veterinarians. 60% of diseases in humans are caused by animals, these are zoonoses. Decades ago people mostly died of infectious diseases. Control of diseases such as rabies, brucellosis or cholera means that, at least in the developed world, infectious diseases have begun to cause fewer deaths than problems such as cancer or cardiovascular disorders. This is proof that the different sectors involved in global health have to go hand in hand.
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