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UPDATED: Monkeypox in Sweden: what causes it, and is it serious?

Sweden reported its first case of the monkeypox virus on May 20th. What causes the virus, and should we be worried?

UPDATED: Monkeypox in Sweden: what causes it, and is it serious?
An electron microscope image of a monkeypox virion. Photo: Cynthia S. Goldsmith, Russell Regner/CDC via AP

What is monkeypox?

Monkeypox, apkoppor in Swedish, is a zoonotic virus (a virus spread from animals to humans) which most often occurs in areas of tropical rainforest in Central and West Africa. It is occasionally found in other regions, and cases have recently been discovered in Europe, North America and Australia.

“We’ve known about this virus in apes since the 1950s,” Fredrik Elgh, consultant and professor of virology at Umeå told TT newswire. “Every type of animal has its own type of pox, us humans had closely-related smallpox which was wiped out in the 1980s. Smallpox were an enormous issue throughout the history of humanity, we can see that on old mummies.”

“In more recent times, like the 1700s, we know that in every family, multiple children died of smallpox.”

There is no vaccine for monkeypox approved in Europe, but vaccines for smallpox are effective against the virus, as the two viruses are members of the same family.

“The vaccine used against smallpox also has an effect on monkeypox,” Elgh told TT. “That means that those born in the mid-70s or earlier will have a degree of immunologic memory. Young people have no immunity. There’s also a new, sophisticated vaccine which gives good coverage after two doses.”

“What’s good about poxes is that even if you take the vaccine after you’ve been infected, it has an effect on the progress of the illness. There are also antiviral medicines,” Elgh explained to TT.

What causes it?

Monkeypox is spread via close contact with an animal or human with the monkeypox virus. It can be transmitted via bodily fluids, lesions, respiratory droplets or through contaminated materials, such as bedding.

Recent cases of the virus in Europe are thought to have been spread through sexual activity, Klara Sondén, infectious disease physician at the Public Health Agency told newspaper Aftonbladet.

“That’s a hypothesis at the moment and it’s new compared to how the disease has spread previously,” Sondén told the newspaper.

“The classic symptoms are skin lesions which cover the body. In the European cases, the problem has been localised to the genitals. Many of those with suspected infections have also reported that they recently had sexual contact with a new partner,” she explained to Aftonbladet.

This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions. Photo: Cynthia S. Goldsmith, Russell Regner/CDC/AP

What are the symptoms?

The symptoms of monkeypox include a fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. A rash  similar to chickenpox typically develops, often starting on the face and spreading to other parts of the body, including the genitals.

Monkeypox typically has an incubation period of six to 16 days, but it can be as long as 21 days. Once lesions have scabbed over and fallen off, the person with the virus is no longer infectious.

However, Sondén explained to Aftonbladet that the incubation period for this new sort of monkeypox could be different.

“We’re unsure of the incubation period. Usually, the incubation period is one or two weeks, but now we don’t know for sure how long it is.”

Why is it in the news now?

Although cases of monkeypox have been reported outside of affected areas of Central and West Africa previously, the virus is making headlines now as this is the first time cases have been identified in someone with no recent history of travel to affected areas and no history of contact with previous imported cases.

So far, seven cases have been reported in the UK, five confirmed cases and more than 20 suspected cases in Portugal, 23 suspected cases in Spain and 13 suspected cases in Canada.

New cases have been reported in recent days in France, Italy and Australia, as well as Sweden’s first case, reported on May 19th.

Is it dangerous?

The type of monkeypox seen in affected areas of Central and West Africa can be serious and, occasionally, deadly. However, it appears that the cases detected so far in Europe have been relatively mild.

“In those countries where it is more prevalent, which is in Central and West Africa, a fatality rate between one and ten percent has been reported,” Elgh told TT newswire. “But then, you have to remember that that’s in an African context where people are not as well-nourished and there isn’t the same access to healthcare, so it can’t be directly translated.”

“There’s not that much data, especially not on how it behaves in our part of the world. There are also different genetic variants of the virus with different levels of severity, so it’s not possible to comment on [how dangerous it is] before we know more,” he further told TT.

“We don’t know of any case in Europe where the affected individual has been seriously or critically ill,” Sondén told Aftonbladet.

The Public Health Agency has asked the government to classify monkeypox as an allmänfarlig sjukdom or an illness presenting a risk to society. This may seem serious, but the Agency says that this is so they can access tools to track and contain the disease such as contact tracing, which is governed by infection control laws.

“There’s nothing you need to think about in your daily life or at work,” Sondén told Aftonbladet. “We’re announcing this because we want to raise awareness of the sexual aspect. If you, for example, start showing symptoms after you’ve recently had sex with a new partner.”

Could this cause a new pandemic?

It’s unlikely, Elgh believes. He told TT that “this is not a new pandemic”.

“The general public do not need to be worried about monkeypox,” he added. “But my belief and hope is that this will not be a pandemic like corona. The most likely scenario is that as long as we contact trace properly, it will ebb out,” he told TT.

He explained that the two viruses are different types of viruses, meaning that monkeypox cannot adapt as easily as the Covid-19 virus.

“Monkeypox is a DNA virus, while coronavirus is a RNA virus,” he explained to TT. “DNA viruses are much more stable, which means that you don’t need to be worried that they will adapt as quickly. It would take a lot and a long time before they adapt to humans.”

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WHO says European festivals should go ahead despite monkeypox risk

Most new cases of monkeypox are currently detected in Western Europe. The World Health Organisation says this is no reason to cancel more than 800 festivals scheduled to take place on the continent this summer.

WHO says European festivals should go ahead despite monkeypox risk

The World Health Organization said Friday that European summer festivals should not be cancelled due to the monkeypox outbreak but should instead manage the risk of amplifying the virus.

A surge of monkeypox cases has been detected since May outside of the West and Central African countries where the disease has long been endemic.

Most of the new cases have been in Western Europe.

More than 3,200 confirmed cases and one death have now been reported to the WHO from 48 countries in total this year.

“We have all the summer festivals, concerts and many other events just starting in the northern hemisphere,” Amaia Artazcoz, the WHO’s mass gatherings technical officer, told a webinar entitled “Monkeypox outbreak and mass gatherings: Protecting yourself at festivals and parties”.

The events “may represent a conducive environment for transmission”, she said.

“These gatherings have really close proximity and usually for a prolonged period of time, and also a lot of frequent interactions among people,” Artazcoz explained.

“Nevertheless… we are not recommending postponing or cancelling any of the events in the areas where monkeypox cases have been identified.”

Sarah Tyler, the senior communications consultant on health emergencies at WHO Europe, said there were going to be more than 800 festivals in the region, bringing together hundreds of thousands of people from different countries.

“Most attendees are highly mobile and sexually active and a number of them will have intimate skin-to-skin contact at or around these events,” she said.

“Some may also have multiple sexual contacts, including new or anonymous partners. Without action, we risk seeing a surge in monkeypox cases in Europe this summer.”

Risk awareness

The UN health agency recommends that countries identify events most likely to be associated with the risk of monkeypox transmission.

The WHO urged festival organisers to raise awareness through effective communication, detect cases early, stop transmission and protect people at risk.

The outbreak in newly-affected countries is primarily among men who have sex with men, and who have reported recent sex with new or multiple partners, according to the WHO.

People with symptoms are advised to avoid attending gatherings, while people in communities among whom monkeypox has been found to occur more frequently than in the general population should exercise particular caution, it says.

The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash.

Meg Doherty, from the global HIV, hepatitis and sexually-transmitted infection programmes at WHO, said: “We are not calling this a sexually-transmitted infection.

“Stigmatising never helps in a disease outbreak,” she added.

“This is not a gay disease. However, we want people to be aware of what the risks are.”