Several questions without clear and immediate answers surround the monkeypox outbreaks we are seeing in more than a dozen countries.
With few exceptions, this virus had usually been limited to the West and Central African regions, but we are now in a new situation that is surprising and worrying.
Previously, the small number of cases that had arisen in other parts of the world could be linked to people who had traveled to affected countries and brought them home.
Now it is not clear cOw people are getting infected.
Although patients are evolving favorably, the scientific community has set to work to quickly define what is happening.
Characteristic pustules of monkeypox in patient in the Democratic Republic of the Congo.
At BBC Mundo we address some of the main unknowns surrounding this monkeypox.
1. Can monkeypox become a pandemic?
“It’s quite unlikelyProfessor Brian Ferguson, from the Department of Pathology at the University of Cambridge in the UK, tells BBC World.
There seems to be quite a bit of consensus in the scientific community about how far we are from monkeypox becoming another pandemic.
However, it is a valid question after seeing how a mysterious pneumonia in China ended up becoming a global pandemic that forced total lockdowns and unprecedented measures to contain it.
And why is it considered unlikely that it will become a pandemic?
The first reason is that it is very difficult to transmit from person to person, unlike a respiratory virus such as SARS-Cov-2.
Transmission of monkeypox occurs when the person comes into contact with the virus through an animal, human, or contaminated materials.
Although experts rule out right now that monkeypox can become a pandemic, they warn that we are facing a surprising situation that worries and therefore must be addressed seriously.
The reservoir host (main carrier of the disease) of monkeypox is still unknown, although it is suspected that African rodents they participate in transmission, according to guidelines from the U.S. Centers for Disease Control and Prevention.
To be infected with another human requires above all close contacts, exchange of temporary fluids and direct or indirect friction with infected harmful material.
The second reason is that the obvious symptoms of monkeypox, especially the appearance of skin pustules, help identify cases faster and control outbreaks with relative ease.
And finally, it is a disease that although many have not heard of it until now, known since 1958 and it is more studied.
But that scientists are ruling out right now that the evolution in pandemic does not imply relaxing. We are facing the largest outbreak of monkeypox outside of Africa and that requires taking the matter seriously and seeking scientific answers, which brings us to the next unknown.
2. Why are we seeing simultaneous outbreaks in several countries?
Answering this question is the main urgency of scientists, the key to preventing cases from continuing to appear and rule out that outbreaks can get out of control.
At the moment, monkeypox seems to be spreading mostly during sexual activities, which does not imply that it is a sexually transmitted disease.
“But the unusual occurrence of several outbreaks in several countries means that we must be open-minded about what happened and not rule anything out immediately,” Ferguson said.
That is why other possibilities of transmission are being investigated right now, such as through aerosols, “in case there has been any change in the way the virus is transmitted,” adds the expert from the University of Cambridge.
The authorities ask the population to be alert to the classic symptoms of monkeypox to control outbreaks as soon as possible.
It’s too early to draw conclusions, but right now there is no evidence that we are dealing with an unknown variant of the pathogen.
Early genetic analyses suggest that the current cases are very closely related to forms of the virus observed in 2018 and 2019.
One possibility is that the virus was simply found in the right place and time to thrive, such as hWe have seen in the last decade with the Ebola and Zika viruses, which without changes in their genetics they caused unexpected outbreaks.
Medical researcher Sir Jeremy James Farrar, director of the Wellcome Trust, a London-based biomedical research charity, spoke to the BBC about the possibility of a “super-spreading event” where people became infected and took the virus to different countries.
3. Why are we seeing more cases in gay men?
Do sexual behaviors facilitate the spread? Is it just a coincidence? Is a community more aware of sexual health and medical checkups to facilitate diagnosis?
There are several of the questions that should be asked when seeing that many of those affected are young homosexuals and bisexuals, but scientists warn that “there is nothing biological in the virus that says that this community is more susceptible than others,” says Ferguson, who urges not to stigmatize without foundations to this group.
There is no evidence that monkeypox affects individuals of a certain sexual orientation anymore. If anything, children seem to be more susceptible because they have a less developed immune system.
“We are all equally susceptible to monkeypox according to what we know. It does not depend on sexual preference and it is not a sexually transmitted disease either,” he reinforces.
Therefore, the reason these outbreaks appear to be affecting this demographic more could be more a matter of luck than a specific feature in the biology of the virus.
The experts consulted by BBC Mundo do point out that children would be more susceptible for having a less developed immune system.
And that because the human smallpox vaccine eradicated in 1980 appears to work against monkeypox, those over the age of 55-60 who received the immunizer may be more protected than younger adults who have not been vaccinated.
4. ¿See many more cases in the coming weeks?
It is difficult to predict because the magnitude of the infections and the reasons why we are seeing the largest outbreak of this disease outside of Africa are not yet fully understood.
However, experts insist that once cases are identified and health alerts are issued, it should be “relatively easy to control outbreaks“.
It is difficult to predict whether we will see many more cases in the coming weeks, although scientists hope that once the health alert is issued it will be “relatively easy to control outbreaks.”
“Now that it is known that it is circulating and that this information has been given to society, the logical thing is to wait for more specific cases to appear, but that in the course of four or five weeks the cases will disappear,” Raúl Rivas González, professor of microbiology at the University of Salamanca in Spain, explains to BBC Mundo.
In the same way, scientists do consider it necessary to remember that what we are experiencing is one more sample of the danger that humanity faces with emerging viruses, especially those of animal origin.
“There is increasing contact with wild animals due to deforestation, uncontrolled urbanization, tourism and climate change… there are a lot of factors that, together with low herd immunity, make outbreaks appear more frequently, which is what is happening,” concludes Rivas.