Nacho de Blas is a specialist in Veterinary Epidemiology and a researcher at the University of Zaragoza
A specialist in Veterinary Epidemiology, Nacho de Blas is a full professor in the Department of Animal Pathology at the University of Zaragoza and is closely following the evolution of the international outbreak of monkeypox. The chain of contagion, he predicts, can be contained with the tools available, but we must prepare ourselves better to respond to emerging pathogens like this one. “We don’t know which one is going to be next, but I know there are going to be others.”
- Do you think there will be an epidemic of monkeypox in Europe?
- I honestly think not. I know there is going to be an outbreak of relative importance, depending on the time and the measures that are put in place. Cases will continue to appear for a few weeks, but I think transmission will be cut off. In my opinion, this situation will not last much longer than a month.
- Was this emerging virus already in the crosshairs of researchers?
- The first human cases appeared in 1970. We know that there are two lineages of the virus, one from Central Africa and one from West Africa. In recent years, cases had increased in Africa, but outside there there had been sporadic cases, always of the Western variant. The most relevant occurred in 2003, in the USA, due to the importation of animals from Ghana. They imported a type of Gambian rat, squirrels, porcupines and dormouse and these animals were raised alongside prairie dogs who became infected and were later sold as pets. Those animals infected 47 people in several states, but there was no second-generation transmission between people.
- What has changed in this outbreak? Why are there so many cases, so many infections and in so many countries?
- There are several issues that could have influenced. On the one hand, what the sequencing carried out quickly by countries like Portugal, which have given a lesson in their way of acting, is showing that the virus has taken a phylogenetic ‘jump’ with respect to the variant from which it comes. It is being investigated whether these mutations could give it a certain ability to be more transmissible, although this would not be enough to explain the outbreak. The importance of superspreading events is also investigated, such as the Maspalomas festival that has been mentioned, which may have contributed significantly to the international spread of the pathogen.
- Why are there more cases in men?
- The disease has an incubation period of up to 21 days. The initial massive contagion probably occurred between May 7 and 12, coinciding with the massive party in Maspalomas, which was attended by about 80,000 people, mainly young men. If it had been a big party with more women, cases would probably also have been detected in women. It is not a sexually transmitted disease nor is it related to homosexuality. The virus is transmitted by close contact with the lesions, with oral, vaginal or anal mucosa, and also by the respiratory route. I believe that in second-generation infections, cases will begin to appear not only in male adults. In fact, there is already a case of a positive child in the UK.
- Is there a risk that the situation will get out of control?
- The disease has been identified, there is a health alert, the population knows the symptoms and the health personnel know how to act. We have diagnostic tools and we know that the smallpox vaccine protects against the disease, so it could be used. I believe that the situation can be controlled as soon as all the cases that occurred when we were not aware of what was happening are brought to light. The main risk will occur if the virus manages to find a reservoir in Europe. It is necessary to control that pets and, above all, wild fauna, do not become infected.
- What animals are susceptible?
- There is still no absolute certainty as to which species are receptive to the virus. In principle, all mammals are susceptible to infection, so the indication is the isolation of possible infections until it is determined whether or not the infection exists. There is no need to be alarmed, but care must be taken to contain the pathogen, which is capable of surviving very well in the environment. The main risk is that it manages to reach a wild species and find a reservoir there.
- SARS, bird flu, monkey pox… why are we dealing with so many emerging viruses now?
- We are giving them all the facilities in the world to jump to humans and we are going to increasingly confront these emerging pathogens. There are two factors that favor their arrival: globalization and the increasingly common invasion of the territory by wild species. In the world we live in, in six hours it is possible to be on the other side of the world. There is a great speed in the movements and a large number of people moving. If we add to this that the need to search for food is causing more and more incursions into wild territories and that we come into contact with wild animals, there is a propitious environment for emerging viruses. We don’t know which one will be next, but I know there will be others.
- Have we learned lessons from the pandemic and are we better prepared to face an emergency of this type?
- Some countries have done so. As I mentioned before, Portugal has sequenced the DNA of the identified monkeypox virus in less than 24 hours. When they already had all the details, in Spain we were still waiting for the confirmation of the suspected cases. Our reaction mechanisms are slower. Lack of coordination and clear leadership. There is the example of Covid. After more than two years, each autonomous community continues to give the data in a different way. There is a lack of plans and coordination in Spain, but also at a European level.
- What the veterinary world can contribute is left aside?
- The model that has been proposed for 15 years is the ‘one health’ concept that combines human, animal and planet health. Thanks to the efforts of veterinarians, many infectious diseases in humans have disappeared. 60% of human diseases come from animals, they are zoonoses. Decades ago people died mostly from infectious diseases. The control of diseases such as rabies, brucellosis or cholera has meant that, at least in the developed world, infectious diseases have started to cause fewer deaths than problems such as cancer or cardiovascular disorders. It is evidence that the different spheres involved in global health have to go hand in hand.
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George is Digismak’s reported cum editor with 13 years of experience in Journalism