More human cases of monkeypox have now emerged in Spain, Portugal and other countries. The disease is usually mild. The RKI also warns doctors in Germany to be vigilant.

Cases of the actually rare monkeypox are now being detected in more and more countries – now also in Spain, Portugal and the USA. A person from the state of Massachusetts in the north-east of the country was affected, the US health authority CDC said on Wednesday.

In Spain, eight infections were reported in the capital Madrid, the Europa Press news agency reported on Wednesday, citing the health authorities. In Portugal, the newspaper “Público” even wrote about 20 infected people. In the majority of the cases that have been reported so far, men are affected who have had sexual contact with other men.

Suspected cases also in Canada

In Canada, health authorities are investigating around a dozen suspected cases, according to local media. Results are expected in the coming days. The authorities had been informed of a confirmed case in the province of Quebec, the Canadian broadcaster CBC reported on Wednesday evening, citing the local Ministry of Health. There was initially no official confirmation.

Monkeypox infections in humans have so far been known primarily from some regions of Africa. In view of the first known cases in Great Britain, where the virus was detected in early May, the Robert Koch Institute (RKI) had made doctors in Germany aware of the virus infection. An article published by the RKI states that monkeypox should also be considered as a possible cause in the case of unclear smallpox-like skin changes if those affected have not traveled to certain areas. According to the RKI, men who have sex with men should “immediately seek medical care” if they have any unusual skin changes.

Usually only mild symptoms

According to the UK Health Security Agency (UKHSA), the number of cases recorded in Great Britain was seven on Monday. Connections between those affected are only partially known. In some cases it is unclear where those affected were infected. The majority of the men affected are said to have been infected in London. The first known infection is said to be due to an infection in Nigeria.

According to the UKHSA, the virus disease usually causes only mild symptoms, but can also have severe courses. Only symptomatic patients with close contact are contagious. According to the UKHSA, the first signs of illness include: fever, headache, muscle and back pain, swollen lymph nodes, chills and exhaustion. A rash can develop, which often spreads to other parts of the body, starting from the face. The rash looks different depending on the phase and can resemble chickenpox and syphilis. There is no specific therapy and no vaccination against monkeypox.

Smallpox has been considered eradicated worldwide since 1980 after a major vaccination campaign. As the RKI explains, large parts of the world’s population no longer have vaccination protection. In Nigeria, monkeypox infections in humans have been increasingly diagnosed since 2017 – and cases in connection with travel there, especially in the United Kingdom.

Monkeys as false hosts

Experts suspect that the monkeypox pathogen circulates in rodents, monkeys are considered false hosts. “Infections can be transmitted through contact with the secretions of infected animals,” says the RKI report. Transmissions from person to person through contact with body fluids or crusts are described with infection chains of up to six people. “The sexual transmission of smallpox viruses is also possible,” it said.

In a specialist article from 2019, three RKI employees stated: “Outside of Africa, monkeypox was only identified three times in humans: in 2003 in the USA and in 2018 in the United Kingdom and Israel”. Most people – over 30 cases were recorded – were therefore infected in several US states.