Portuguese authorities said on Wednesday they had identified five cases of the rare monkeypox infection and Spanish health services are testing eight potential cases after Britain put Europe on high alert for the virus.
The five Portuguese patients, out of 20 suspected cases, are all stable. They are all men and they all live in the Lisbon and Tagus Valley region, Portuguese health authorities said.
European health authorities have been monitoring any outbreak of the disease since Britain reported its first case of monkeypox on May 7 and has found six more in the country since then.
None of the eight suspected cases in Spain have yet been confirmed, the Spanish Ministry of Health said in a statement on Wednesday.
Monkeypox is a rare viral infection similar to human smallpox, although milder, first reported in the Democratic Republic of the Congo in the 1970s. The number of cases in West Africa has increased over the past decade.
Symptoms include fever, headache, and rash starting on the face and spreading to the rest of the body.
It is not particularly contagious between people, Spanish health authorities said, and most infected people recover within weeks, although serious cases have been reported.
The disease can be spread through sexual contact: responsible
Four of the cases detected in Britain self-identified as gay, bisexual or other men who have sex with men, the UK Health Security Agency said, adding evidence to suggest there may be transmission in the community.
The UK agency urged gay and bisexual men to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.
The Spanish Ministry of Health and the Spanish health authority DGS of Portugal did not release any information about the sexual orientation of monkeypox patients or suspected patients.
Both countries have sent alerts to medical professionals to identify more possible cases.
Dr Ibrahim Soce Fall, the World Health Organization’s deputy director general for emergency response, said the spread of monkeypox in the UK needed to be studied to understand how the disease was transmitted among men with sex with other men.
Fall said health officials still need to better understand how monkeypox spreads in general, even in countries where it’s endemic.
He noted that although there were more than 6,000 cases reported in Congo and around 3,000 cases in Nigeria last year, there are still “so many unknowns in terms of transmission dynamics”.
Britain had previously reported three previous cases of monkeypox, two involving people who lived in the same household and the third someone who had traveled to Nigeria, where the disease commonly occurs in animals.
The virus has generally spread to people from infected animals such as rodents, although human-to-human transmission has been known.
Among people, the disease spreads when there is very close contact with lesions, bodily fluids, respiratory droplets, or contaminated materials, such as bedding.
Some British experts have said they will soon conclude monkeypox was spread through sexual contact, although the outbreak there has suggested that possibility.
Vaccine approved, antivirals seem effective
“Recent cases suggest a potentially new way of spread,” said Neil Mabbott, a disease expert at the University of Edinburgh, adding that related viruses were known to be spread sexually.
Keith Neal, an infectious disease expert at the University of Nottingham, said transmission may not have occurred through sexual activity, but simply “close contact associated with sexual intercourse”.
Monkeypox usually causes fever, chills, a rash, and lesions on the face or genitals resembling those caused by smallpox.
A vaccine developed against smallpox has been approved for monkeypox, and several antivirals appear to be effective as well.