Elsevier

Journal of Infection

Volume 85, Issue 4, October 2022, Pages 412-417
Journal of Infection

Monkeypox outbreak in Madrid (Spain): Clinical and virological aspects

https://doi.org/10.1016/j.jinf.2022.07.005Get rights and content

Highlights

  • Throughout May 2022, an outbreak of monkeypox disease has been described in Europe, mostly in MSM.

  • The most frequent symptoms are vesicular-umbilicated and pseudopustular skin lesions, asthenia, and fever.

  • The location of the lesions in the genital or perianal area was related to the role in sexual intercourse.

  • The prognosis of the disease is good, with self-limited skin lesions without serious complications.

  • Sequencing analysis indicated this virus belongs to the western African clade and are direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017–2018.

Summary

Background

Monkeypox is the most prevalent Orthopoxvirus zoonosis infection since the eradication of smallpox. The current multi-country outbreak involves five WHO regions affecting mainly Europe. Accurate clinical and virological aspects of the disease outside endemic areas are needed.

Methods

We performed an observational study of cases diagnosed in Madrid (Spain) (May/June 2022). Confirmation from vesicular lesions swabs, Orthopoxvirus real-time PCR, sequencing, phylogenetic analysis, and direct detection by Electron microscopy was performed. In addition, a structured epidemiological questionnaire was completed systematically to gather sociodemographic, clinical, and behavioral data from all confirmed cases.

Findings

We extracted data from 48 patients, all cisgender men. The median age was 35 years (IQR 29 – 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001). Sequencing analysis indicated the virus circulating in Spain belongs to the western African clade. Like the other European cases in the outbreak, the Spanish isolates are a direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017–2018.

Conclusions

Monkeypox is an emerging infectious disease in Europe where community transmission is reported, mainly in MSM. The first symptom was skin lesions instead of classical fever and rash. The disease follows a self-limited course, and there have been no cases with a serious presentation or severe complications.

Keywords

Monkeypox
Communicable diseases
Emerging

Cited by (0)

1

Eva Orviz and Anabel Negredo contributed equally to this work

2

Juan Ballesteros; Begoña Baza; Juan Carlos Carrió; Cynthia Chocron; Giovanni Fedele; Cristina García-Amil; Laura Herrero; Reynaldo Homen; Alberto Mariano; Teresa Martínez-Burgoa; Francisca Molero; Maria Luisa Navarro; Maria José Núñez; Juncal Perez-Somarriba; Teresa Puerta; Javier Rodríguez-Añover; Esperanza Pérez Pastrana; Mercedes Jiménez; Leticia de la Vega; Jorge Vergas; Isabel Zarza

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