Monkeypox underdiagnosis makes control difficult

The report of Alert and Emergency Center of August 30 collected that Spain had registered 6,543 cases of monkey pox (MPX), nearly half of all reported cases in Europe (15,334 cases). Germany (3,422 cases), the United Kingdom (3,207 cases) or France (3,421 cases) with a greater demographic weight have presented more cases. In Spainby autonomous communities, the ones with the most declared cases are Madrid (2,324), Catalonia (1,950), Andalusia (795 cases), Valencia (432) and the Basque Country (212).

According to forecasts, “the cases will increase unless the study of contacts is properly addressed and the vaccine is administered before or after exposures,” explains the epidemiologist Peter Godoypresident of the Scientific Committee of the Scientific Meeting of the Spanish Society of Epidemiology which is being celebrated in Saint Sebastianwho moderated the round table on the Epidemiology and prevention of monkeypox.

“Cases will increase unless the study of contacts is properly addressed and the vaccine is administered before or after exposures”

Experts in Epidemiology show their concern that the disease is trivialized and not given enough attention. “There is a risk of an increase in cases and that the disease could become endemic if effective control is not achieved in the short term,” says Godoy.

The MPX virus is very similar to the smallpox virusofficially declared eradicated by the WHO in 1980, whose last known case occurred in 1977. The outbreak is not directly related to the African endemic area, although the genetic sequences of the cases are related to the West African virus, which is the one that generates a milder clinical picture. The CAES report of August 19 indicated that of the 5,463 cases with available information, 178 cases (3.3%) had been hospitalized and two people had died.

Despite this, epidemiologists stress that it is a new virus that is being transmitted outside the usual endemic area, on which strict epidemiological control must be exercised to avoid extensive transmission of the virus. This was explained at the SEE Scientific Meeting Maria Jose Sierra, coordinator of the Public Health Surveillance Working Group, “the evolution of the MPX outbreak in Spain is still uncertain and will be influenced by the success with which the recommendations reach the population.” In this sense, she has asked for “care with underdiagnosis and delayed notification.”


In the context of the current outbreak, the transmission of the virus (MPXV) from person to person is fundamentally related to close and direct physical contact with skin lesions, scabs or body fluids of an infected person, in the context of risky sexual intercourse or in other situations of continuous and prolonged physical contact.

Jordi Casabonadirector of Center for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), who has participated in the round table organized within the framework of the Annual Meeting of the SEE, has clarified that monkeypox is an STI, “in our context it is being transmitted through sexual intercourse”.

Stigma is a barrier to early diagnosis, treatment and action

Currently, the measures to control the outbreak are based on the rapid detection of cases, isolation and the identification and follow-up of contacts. In this sense, communication is essential. The stigma it is a barrier to early diagnosis, treatment and action. “Very general interventions are being carried out trying to identify cases and people contacted, something that is not easy given the group where the outbreak occurs, so we need much more precise information on the mechanisms and periods of transmissibility to be able to further refine the recommendations”, remarked Casabona.

Regarding the vaccination campaign that started at the end of July, both Pere Godoy and Jordi Casabona have referred to the shortage of vaccines, the only biomedical intervention that can be applied at the moment, administration to groups of increased risk of complications or transmission prior to any exposure (pre-exposure vaccine) or in the first days after an exposure.

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