what we know about the symptoms seen in the first patients in Europe

“Urgent and coordinated action is imperative if we are to change course in the race against the spread of the disease.” The director of the European branch of the World Health Organization (WHO), Hans Kluge, issued the alert on Friday, July 1, as smallpox continues to spread across the European continent. According to data from the UN agency, the region already has more than 4,500 laboratory-confirmed cases, three times more than in mid-June. The United Kingdom is the most affected country, with 1,076 cases, according to data from the European Center for Disease Prevention and Control (ECDC). France had nearly 500 as of Friday, according to Public Health France.

This WHO reminder comes asa study published in Lancet Infectious Diseases (in English), analyzes the symptoms identified in the first infected British patients. Conducted with about fifty patients, this research is one of the first to characterize the clinical specificities of the current epidemic. The sample corresponds to more than half of the patients identified in the UK in May. In them, monkeypox manifested itself differently than scientists knew.

a lower fever

Among the recurring symptoms of monkeypox, scientists identified fever. According to observations made in patients in Africa, the rise in temperature is considered to be almost systematic. It is accompanied by severe headaches, muscle aches, as well as inflammation of the lymph nodes. Back pain and fatigue may also appear.

According to the results of the British study, 57% of the patients studied had these symptoms. Fever attacks are not only less frequent, they also seem much shorter and require far fewer hospitalizations.

more targeted injuries

Another typical manifestation of the disease: skin lesions that appear “usually one to three days after the onset of fever”, says the WHO. These rashes are usually more concentrated on the face (in 95% of cases), palms and soles of the feet (75%). The oral mucosa (70%), genitals (30%) and conjunctiva (20%), as well as the cornea are also affected.

Among the fifty British patients observed, the vast majority (94%) suffered from lesions concentrated around the genitals. For the authors of the study, this specificity suggests that the first British cases were contaminated by contact during sexual intercourse. This does not mean that the disease has become sexually transmitted. The hypothesis of transmission by contact during sexual intercourse corresponds to the well-established notion that contamination is possible when touching a skin lesion on another patient. Monkeypox is transmitted by very close contact and 99% of cases currently involve young men (20 to 40 years old) having sex with other men, the WHO recalls.

No major genetic modification of the virus

These slightly different symptoms do not mean that a new version of the virus has emerged, as could be the case with Covid-19, whose variants are multiplying. “There is no major genetic modification” in viruses sequenced in current patients, pulmonologist Hugh Adler told AFP.

Most European – and American – cases so far have been in men who have had homosexual relationships, but they are not the only ones involved. More broadly, the study authors consider that their observations plead for the expansion of the definition of the disease, in order to better detect new cases. They recommend, for example, not insisting on fever so much. Hugh Adler believes that in Africa many cases, without fever or with limited lesions, may have gone unnoticed, distorting comparisons.

Most often mild, smallpox usually heals on its own after two to three weeks.

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