Monkeypox likely to be spread through sex at 2 raves in Europe, expert says

A leading advisor to the World Health Organization described the unprecedented outbreak of monkeypox in developed countries as “a random event” that could be explained by sexual behavior at two recent raves in Europe.

dr. David Heymann, who previously headed the WHO’s emergency department, told The Associated Press that the main theory to explain the spread of the disease was sexual transmission between men during raves in Spain and Belgium. Monkeypox has not previously led to widespread outbreaks outside of Africa, where it is endemic to animals.

“We know that monkeypox can spread when there is close contact with the lesions of someone who is infected, and it seems that sexual contact has now enhanced that transmission,” Heymann said.

Monkeypox is traditionally only found in Africa, or in people who have recently returned from the continent.
Monkeypox is traditionally only found in Africa, or in people who have recently returned from the continent. (AP)

That marks a significant departure from the typical distribution pattern of the disease in Central and West Africa, where humans are primarily infected by animals such as wild rodents and primates and outbreaks have not spread across borders.

Health officials say most of the known cases in Europe have occurred among men who have sex with men, but scientists say it will be difficult to unravel whether the spread is caused by sex itself or just close contact. Anyone can become infected through close contact with a sick person — or their clothing or bedding.

“By nature, sexual activity involves intimate contact, which would be expected to increase the likelihood of transmission regardless of one’s sexual orientation and regardless of mode of transmission,” said Mike Skinner, a virologist at Imperial College London.

Andrea Ammon, director of the European Center for Disease Prevention and Control, said on Monday that “the risk of further spreading the virus through close contact, for example during sexual activity between people with multiple sexual partners, is considered high.”

To date, the WHO has registered more than 90 cases of monkeypox in a dozen countries, including Britain, Spain, Israel, France, Switzerland, the US and Australia. On Monday, Denmark announced its first case, Portugal adjusted the total to 37 and Italy reported another infection.

This image shows the right arm and upper body of a patient whose skin showed a number of lesions due to an active case of monkeypox.
This image shows the right arm and upper body of a patient whose skin showed a number of lesions due to an active case of monkeypox. (AP)

Germany has four confirmed cases linked to exposure to “celebratory events … where sexual activity took place” in the Spanish Canary Islands and in Berlin, according to a government report obtained by the AP to lawmakers.

Madrid’s senior health official said Monday the Spanish capital had 30 confirmed cases. Enrique Ruiz Escudero said authorities are investigating possible links between a recent Gay Pride event in the Canary Islands, which drew some 80,000 people, and falls in a sauna in Madrid.

Monkey pox cases to date have been mild, with no deaths reported. Most commonly, the virus causes fever, chills, rashes, and lesions on the face or genitals. Most people recover within a few weeks without hospitalization.

Vaccines against smallpox, a related disease, are effective in preventing monkeypox and some antiviral drugs are being developed. In recent years, the disease has been fatal in up to 6 percent of infections.

Heymann chaired an urgent meeting Friday of the WHO advisory group on infectious disease threats to assess the outbreak and said there was no evidence to suggest monkeypox had mutated into a more contagious form.

This electron microscopy (EM) image showed a monkeypox virion obtained from a clinical sample related to the prairie dog outbreak in 2003. It was a thin section of a human skin sample.  On the left were mature oval-shaped virus particles and on the right were the crescents and globular particles of immature virions.  High resolution: Click here for high resolution image (5.21 MB) Content providers: CDC/ Cynthia S. Goldsmith Date created: 2003 Photo credits: Cynthia S. Goldsmi
This electron microscopy (EM) image showed a monkeypox virion obtained from a clinical sample related to the prairie dog outbreak in 2003. It was a thin section of a human skin sample. On the left were mature oval-shaped virus particles and on the right were the crescents and globular particles of immature virions. High resolution: Click here for high resolution image (5.21 MB) Content providers: CDC/ Cynthia S. Goldsmith Date created: 2003 Photo credits: Cynthia S. Goldsmi (AP)

The UN agency said the outbreak is “a highly unusual event” and said the fact that cases are seen in so many different countries indicates that the virus may have been spreading quietly for some time. The agency’s Europe director warned that festivals and celebrations could accelerate the spread.

Still, in a public hearing on Monday, WHO officials described the outbreak as “manageable” and warned against stigmatizing affected groups, saying the disease can infect anyone.

Authorities in Britain, Spain and Portugal have said most of the cases identified so far have involved young men whose infection was picked up when they sought help for lesions at sexual health clinics.

Heymann, who is also a professor of infectious diseases at the London School of Hygiene and Tropical Medicine, said the monkeypox outbreak was likely a random event traceable to a single infection.

“It’s entirely possible that there was someone who got infected, developed lesions on the genitals, hands or elsewhere, and then spread it to others when there was sexual or close physical contact,” Heymann hypothesized. “And then there were these international events that triggered the outbreak all over the world, in the US and other European countries.”

He stressed that the disease was unlikely to lead to widespread transmission.

“This is not COVID,” he said. “We need to slow it down, but it’s not spreading in the air and we have vaccines to protect against it.”

Heymann said studies should be conducted quickly to determine whether monkeypox can be spread from people without symptoms and that populations at risk for the disease should take precautions to protect themselves.

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