Within a few days, all of a sudden the UK, Spain, Portugal, USA, Sweden Y Canada Although it has been known for 50 years, a few very rare cases of diseases that have never caused such an epidemic before have been announced. ‘Monkey flower’ has entered the international public debate to make one thing clear: how little we have learned from the pandemic. This is what we know about the epidemic and, above all, what is beginning to worry us.

What is ‘monkey flower’ and why does it concern us? A disease caused by a virus of the smallpox genus (variola viruses). Despite its name, as we found it in macaques in 1958, it is usually transmitted not by monkeys but by other small mammals (such as rodents). As far as we know, transmission requires direct contact with blood, fluids or open injuries.

But so far, transmission in humans has always been (self) limited. We’re talking about “fever, myalgia, inguinal lymphadenopathy (swollen glands), and a chickenpox-like rash on the hands and face.” But first of all, we are talking about a relatively low mortality rate of 1% and a very low contagiousness. Generally speaking, no one paid attention to the monkey flower. Until now.

The situation is getting more and more serious. The striking thing about this epidemic is that we have seen many cases of human-to-human transmission so far, yes; but we have not seen “continuous cycles of virus infection in humans,” and everything indicates that we are dealing with one of these.

But where did this disease come from? It is common to say that ‘monkey pox’ is a very rare disease, and it is precisely for this reason that one wonders where the virus came from. That’s when we realize that As Sergio Ferrer points out“The Democratic Republic of the Congo reported more than 700 cases (and 37 deaths) in the first two months of 2022 alone.” These are the types of epidemics that do not attract the attention of the international public until we finally have fifty cases in ten countries.

Why is this happening? The last two years have been clear proof that our world is so interconnected that it becomes an ideal breeding ground for infectious disease outbreaks. This is not just a ‘feeling’ produced by the pandemic. Rather, in 2014 researchers at Brown University identified all infectious outbreaks that occurred between 1980 and 2010. As we can see in the chart below, the annual number of epidemics worldwide has tripled in these 30 years, and the diseases causing it have almost tripled. doubled.

This emerging phenomenon meant that in 2007 the World Health Organization began to implement new international health regulations, thanks to its increased capacity to formulate international policies against international diseases. What interested us was the emergence of “public health emergencies of international importance”. It has since declared five (the last one, that of COVID, went a step further and became a “global epidemic”).

But what strikes me most is that, with the exception of the novel coronavirus, none of these emergencies are caused by a new, unknown infectious agent, but by a subtype of the influenza virus (or at least a virus we’ve known for a long time). 2400 years). For example, we’ve known about Monkeypox since 1958.

and it gets worse. In 1995, Stephen Morse identified the key factors causing the global emergence of infectious diseases. There are two vectors that are particularly important: on the one hand, environmental changes (something that can be seen when changes in aquatic ecosystems lead to the growth of diseases such as Argentine hemorrhagic fever, schistosomiasis or Rift Valley fever) and increased movement, on the other hand, of goods and people around the world. The emergence and spread of HIV, Balance or Zika, or the emergence of airport malaria are good examples of the latter.

However, that doesn’t explain everything.. It is true that these factors have only deepened since 1995, but by themselves they do not explain what is happening with monkeypox. The drop in cross immunity that smallpox gives us is an important factor, yes; but for us to be in this situation, there had to be a change in the dynamics of virus transmission. In other words, something has changed that has allowed it to ‘become independent’ from animal shelters and facilitate its incorporation into human populations. The question we now have to answer (and in a hurry) is, what else has changed?

Image | HCM