2022–2023 mpox outbreak in Spain
DiseaseMpox
Virus strainMonkeypox virus (West African clade)
LocationSpain
Index caseMadrid[1]
Arrival date18 May 2022 (1 year, 7 months, 3 weeks and 5 days ago)[1]
DateAs of 19 July 2022
Confirmed cases
Suspected cases‡0 (Regional governments)
Hospitalized cases155 (Ministry of Health)[2]
Deaths
2 (Ministry of Health)[2]
Government website
Monkeypox alert in Spain and other European countries
(in Spanish)
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

The 2022–2023 mpox outbreak in Spain is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. Spain was the second country outside the African countries with endemic mpox, to experience an outbreak in 2022. The outbreak was first reported in Spain on 18 May 2022.[1]

Background

Mpox (formerly known as monkeypox)[3] is an infectious viral disease that can occur in humans and some other animals.[4] Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes.[4] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[5] The time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks.[6] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[7]

The disease is caused by the monkeypox virus,[lower-alpha 1] a zoonotic virus in the genus Orthopoxvirus. The variola virus, the causative agent of the disease smallpox, is also in this genus.[4] Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact.[4] People remain infectious from the onset of symptoms until all the lesions have scabbed and healed.[7] It may spread from infected animals by handling infected meat or via bites or scratches.[7] Diagnosis can be confirmed by PCR testing a lesion for the virus' DNA.[4]

An ongoing outbreak of mpox was confirmed on 6 May 2022, beginning with a British resident who, after travelling to Nigeria (where the disease is endemic), presented symptoms consistent with mpox on 29 April 2022. The resident returned to the United Kingdom on 4 May, creating the country's index case of the outbreak.[8] The origin of several of the cases of mpox in the United Kingdom is unknown. Some monitors saw community transmission taking place in the London area as of mid-May,[9] but it has been suggested that cases were already spreading in Europe in the previous months.[10]

Transmission

Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[11]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[12]

History

On 18 May 2022, the Community of Madrid regional government reported the first eight suspected cases of mpox, and seven of them were confirmed by the Ministry of Health on 20 May.[1]

On 20 May, the health authorities of Madrid closed the gay sauna Paraíso, which was under investigation as a possible high transmission point in Madrid.[13][14] The sauna reopened again on 9 June after receiving an authorization from the regional health department.[15][16]

Outbreak characteristics

According to the Community of Madrid regional government on 6 June 2022, all cases in the region were men, except one woman who is cohabitant with one of the infected men. The most likely contagion event for most was sexual relations with strangers, usually at parties in private residences, a sauna, or the gay pride event at Maspalomas, Canary Islands. 48% of cases were also HIV-positive.[17]

On 10 June, the Ministry of Health disclosed that out of a sample of 78 cases, 21 had a previous smallpox vaccine dose.[18]

On 26 August, the Ministry of Health published additional data about 6,459 cases. 6,334 of them were men, and 125 were women. Age ranged between 7 months and 88 years, with a median age of 37 years. Out of 5,198 cases with recorded data, 5,022 were men who have sex with men. Out of 3,700 cases with recorded data, 92,6% had prolonged intimate contact during sexual relation as the most likely transmission mechanism.[19]

LGBT stigmatization

Several experts have raised concerns about stigmatization of LGBT people in connection to the mpox outbreak.[20]

In June 2022, the public prosecutor of Valencia opened an investigation of a publication about the mpox outbreak by the far-right political party España 2000, which could constitute hate speech against the LGBT community.[21]

Cases per region

Mpox cases in Spain per autonomous community
Community Confirmed Suspected As of Ref.
Andalusia Andalusia 685 96 12 August 2022 [22]
Aragon Aragon 53 — 12 August 2022 [2]
Asturias Asturias 53 — 12 August 2022 [2]
Balearic Islands Balearic Islands 134 — 12 August 2022 [2]
Canary Islands Canary Islands 136 — 12 August 2022 [2]
Cantabria Cantabria 27 — 12 August 2022 [2]
Castilla–La Mancha Castilla–La Mancha 42 — 12 August 2022 [2]
Castile and León Castile and León 54 — 12 August 2022 [2]
Catalonia Catalonia 1,782 — 12 August 2022 [2]
Ceuta Ceuta — — 12 August 2022 [2]
Valencian Community Valencian Community 353 — 12 August 2022 [2]
Extremadura Extremadura 22 — 12 August 2022 [2]
Galicia (Spain) Galicia 83 — 12 August 2022 [2]
Community of Madrid Community of Madrid 2,169 — 12 August 2022 [23]
Melilla Melilla — — 12 August 2022 [2]
Region of Murcia Murcia 33 — 12 August 2022 [2]
Navarre Navarre 13 — 12 August 2022 [2]
Basque Country (autonomous community) Basque Country 162 — 12 August 2022 [2]
La Rioja La Rioja 4 — 12 August 2022 [2]
Total 5,805 96

See also

Notes

  1. ↑ The World Health Organization (the authority on disease names) announced the new name "mpox" in November 2022. But virus naming is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which is currently reviewing all orthopoxvirus species. As of March 2023, the official name of the virus remains "monkeypox virus".[3]

References

  1. 1 2 3 4 "Casos de viruela del mono en España y en el mundo, estadísticas y gráficos". epdata (in Spanish). Archived from the original on 2 June 2022.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 "Alerta sobre infección de viruela de los monos en España y otros países no endémicos" (PDF). Ministry of Health (in Spanish). 12 August 2022.
  3. 1 2 "WHO recommends new name for monkeypox disease" (Press release). World Health Organization (WHO). 28 November 2022. Retrieved 29 November 2022.
  4. 1 2 3 4 5 "WHO Factsheet – Mpox (Monkeypox)". World Health Organization (WHO). 18 April 2023. Archived from the original on 21 April 2022. Retrieved 21 May 2023.
  5. ↑ "Monkeypox". GOV.UK. 24 May 2022. Archived from the original on 18 May 2022. Retrieved 28 May 2022.
  6. ↑ "Mpox Symptoms". U.S. Centers for Disease Control and Prevention (CDC). 2 February 2023. Archived from the original on 21 May 2023. Retrieved 21 May 2023.
  7. 1 2 3 "Mpox (monkeypox)". World Health Organization. 12 May 2023. Archived from the original on 23 May 2023. Retrieved 24 May 2023.
  8. ↑ "Monkeypox – United Kingdom of Great Britain and Northern Ireland". World Health Organization. 16 May 2022. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
  9. ↑ Pinkstone, Joe (17 May 2022). "Monkeypox 'spreading in sexual networks'". The Telegraph. Archived from the original on 17 May 2022. Retrieved 17 May 2022.
  10. ↑ Nsofor, Ifeanyi (2 June 2022). "OPINION: Media coverage of monkeypox paints it as an African virus. That makes me mad". NPR. Retrieved 2 June 2022.
  11. ↑ Vargas, Ramon Antonio (7 June 2022). "US raises monkeypox alert level but says risk to public remains low". the Guardian. Retrieved 9 June 2022.
  12. ↑ "Monkeypox update: Where the outbreak stands now".
  13. ↑ "Madrid estudia si hay vínculo entre los casos de viruela del mono de la capital y Canarias". RTVE (in Spanish). 22 May 2022.
  14. ↑ Pascual, Alfredo (21 May 2022). "Así es la sauna Paraíso, foco del brote de viruela del mono en Madrid". El Confidencial (in Spanish).
  15. ↑ "La sauna 'Paraíso' niega "cualquier responsabilidad sobre el foco de infección de la viruela del mono" en Madrid". La Vanguardia (in Spanish). Servimedia. 8 June 2022.
  16. ↑ Soto, Álvaro (8 June 2022). "Reabre la sauna Paraíso, foco de la viruela del mono en Madrid". La Voz de Galicia (in Spanish).
  17. ↑ "La mayoría de los contagiados con la viruela del mono mantuvo relaciones con desconocidos" [A majority of monkeypox infected had relations with strangers]. La Vanguardia (in Spanish). 7 June 2022.
  18. ↑ "Alerta sobre infección de viruela de los monos en España y otros países no endémicos" (PDF). Ministry of Health (in Spanish). 10 June 2022.
  19. ↑ "Alerta Monkeypox" (PDF). Archived from the original (PDF) on 29 August 2022. Retrieved 29 August 2022.
  20. ↑ Vargas, Natalia G. (25 May 2022). "La viruela del mono y el uso de la salud como gasolina para la discriminación". Canariasahora (in Spanish).
  21. ↑ "La Fiscalía investiga por delito de odio unas publicaciones sobre el colectivo LGTBI y la viruela del mono". ABC (in Spanish). 10 June 2022.
  22. ↑ "Andalucía registra 332 casos activos de viruela del mono, con 96 en investigación, y suma ya 319 personas vacunadas". europapress (in Spanish). 12 August 2022.
  23. ↑ "La Comunidad de Madrid detecta 2.169 casos de viruela del mono y supera las 1.900 dosis de vacuna administradas". europapress (in Spanish). 12 August 2022.
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