Monkeypox outbreak traced to sex at 2 events

Cases continue to increase across Europe, U.S.

FILE - This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak. A leading doctor who chairs a World Health Organization expert group described the unprecedented outbreak of the rare disease monkeypox in developed countries as "a random event" that might be explained by risky sexual behavior at two recent mass events in Europe. (Cynthia S. Goldsmith, Russell Regner/CDC via AP, File)
FILE - This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak. A leading doctor who chairs a World Health Organization expert group described the unprecedented outbreak of the rare disease monkeypox in developed countries as "a random event" that might be explained by risky sexual behavior at two recent mass events in Europe. (Cynthia S. Goldsmith, Russell Regner/CDC via AP, File)

LONDON -- A leading adviser to the World Health Organization described the unprecedented outbreak of monkeypox in developed countries as "a random event" that appears to have been caused by sexual activity at two recent raves in Europe.

Dr. David Heymann, who formerly headed WHO's emergencies department, told The Associated Press that the leading theory to explain the spread of the disease was sexual transmission at raves in Spain and Belgium. Monkeypox has not previously triggered widespread outbreaks beyond central and western Africa, where people are mainly infected by animals like wild rodents and primates and outbreaks have not spilled across borders.

Health officials say most of the known cases in Europe have been among men who have sex with men, but anyone can be infected through close contact with a sick person, their clothing or bedsheets. Scientists say it will be difficult to disentangle whether the spread is being driven by sex or merely close contact.

"By nature, sexual activity involves intimate contact, which one would expect to increase the likelihood of transmission, whatever a person's sexual orientation and irrespective of the mode of transmission," said Mike Skinner, a virologist at Imperial College London.

On Monday, the European Centre for Disease Prevention and Control Director Andrea Ammon said "the likelihood of further spread of the virus through close contact, for example during sexual activities among persons with multiple sexual partners, is considered to be high."

To date, WHO has recorded more than 90 cases of monkeypox in a dozen countries including Canada, Spain, Israel, France, Switzerland, the U.S. and Australia.


On Monday, Denmark announced its first case, Portugal revised its total to 37, Italy reported another infection and Britain added 37 more cases.

U.S. health officials said Monday they knew of one confirmed case in Massachusetts and four probable cases -- two in Utah, one in Florida and one in New York City. All were men who had traveled outside the U.S.

Germany has four confirmed cases linked to exposure at "party events ... where sexual activity took place" in Spain's Canary Islands and Berlin, according to a government report to lawmakers obtained by the AP.

Madrid's senior health official said Monday that the Spanish capital had 30 confirmed cases. Enrique Ruiz Escudero said authorities are investigating possible links between a recent Gay Pride event in the Canary Islands and cases at a Madrid sauna.

The monkeypox cases so far have been mild, with no deaths reported. Typically, the virus causes fever, chills, rash and lesions on the face or genitals. Most people recover within several weeks without requiring hospitalization.

Vaccines against smallpox, a related disease, are effective in preventing monkeypox and some antiviral drugs are being developed.

The U.N. agency said the fact that cases are being seen in so many different countries suggests the virus may have been silently spreading for some time. The agency's Europe director warned that festivals and parties could accelerate spread.

Still, at a public session on Monday, WHO officials described the outbreak as "containable" and cautioned against stigmatizing affected groups, saying the disease can infect anyone.

The agency said the cases appeared to be linked to a monkeypox virus that was first detected in exported cases from Nigeria to Britain, Israel and Singapore in 2018 and 2019.

Authorities in Britain, Spain and Portugal have said most of the cases identified so far were in young men whose infections were picked up when they sought help for lesions at sexual health clinics.

Heymann, who is also a professor of infectious diseases at the London School of Hygiene and Tropical Medicine, said the monkeypox outbreak was likely a random event that might be traceable to a single infection.

"It's very possible there was somebody who got infected, developed lesions on the genitals, hands or somewhere else, and then spread it to others when there was sexual or close, physical contact," Heymann hypothesized. "And then there were these international events that seeded the outbreak around the world, into the U.S. and other European countries."

He emphasized that the disease was unlikely to trigger widespread transmission.

"This is not covid," he said. "We need to slow it down, but it does not spread in the air and we have vaccines to protect against it."

EASING CONCERNS

President Joe Biden sought Monday to calm concerns about recent cases of monkeypox that have been identified in Europe and the United States, saying he did not see the need to institute strict quarantine measures.

Speaking in Tokyo a day after he said the virus was something "to be concerned about," Biden said, "I just don't think it rises to the level of the kind of concern that existed with covid-19."

Although the disease belongs to the same virus family as smallpox, its symptoms are milder. People usually recover within two to four weeks without needing to be hospitalized, but the disease occasionally is deadly. In recent years, the illness has been fatal in up to 6% of infections.

Asked whether the U.S. has enough stockpile of the smallpox vaccine to handle the monkeypox spread, Biden said, "I think we do have enough to deal with the likelihood of a problem."

Information for this article was contributed by Maria Cheng, Barry Hatton, Frank Jordans, Kirsten Grieshaber, Josh Boak and Aamer Madhani of The Associated Press.


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