Health officials across the globe report an increase in the incidence of monkeypox cases in non-endemic countries as of May. Spain is the most affected country, reporting the highest number of confirmed cases. Health authorities will likely continue to report additional cases in the coming weeks as surveillance increases in non-endemic regions.
According to data through May 23, global health officials report at least 110 confirmed cases of monkeypox in countries where the disease is non-endemic. Health authorities also reported an additional 93 suspected cases. Health officials find the increase in disease incidence among patients with no recent history of travel to countries where the virus is endemic, especially worrying since this suggests that local community transmission might be ongoing.
As of May 23, health officials report confirmed cases in at least 15 non-endemic countries, with an additional three countries reporting suspected cases (map). Spain is the most affected, reporting 100 cases (41 confirmed and 59 suspected cases), followed by Portugal with 34 cases (23 confirmed and 11 suspected), Canada with 23 cases (5 confirmed and 18 suspected), and England with 20 confirmed cases. Health authorities report no associated deaths as of May 23. This represents the most complete data available as of May 23.
In contrast to sporadic cases reported in the past linked to travel to endemic countries, health officials have not confirmed the source of infection for the current spike in cases. However, suspected human-to-human transmission occurs among people in close physical contact, with clusters of cases reported in men having sex with men (MSM) population. Initial reports indicate this is the first known instance of sustained sexual transmission of the disease. Monkeypox remains endemic (present at baseline level) to tropical forested regions of West and Central Africa, with Cameroon, Central African Republic, the Democratic Republic of the Congo, and Nigeria reporting ongoing disease activity over the past five months (Dec 15, 2021-May 1, 2022).
Monkeypox is caused by a virus that belongs to the same family as the virus that causes smallpox; however, it does not have the same capacity for human-to-human transmission. Instead, monkeypox is primarily transmitted to humans through direct contact with bodily fluids of infected rodents, primates, and infected people, or through indirect contact with lesion material – such as in contaminated bedding.
Symptoms typically appear 6-16 days after exposure but can develop up to 21 days after exposure. Early symptoms include fever, headache, muscle and backaches, swollen lymph nodes, chills, and exhaustion. Within 1-3 days after fever appears, patients develop a distinctive rash characterized by lesions that progress through several stages before falling off. These symptoms typically last 2-4 weeks, and as many as 10 percent of cases are fatal.
Transmission Prevention & Short-Term Outlook
To prevent transmission, wash your hands often, especially before eating and after sneezing, blowing your nose, and/or coughing. Use alcohol-based hand sanitizer if soap and water are unavailable and avoid unprotected sexual contact. Health authorities will likely continue to report additional cases in the coming weeks as surveillance increases in non-endemic regions.
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