The Valencian Community has registered the first two suspected cases of monkeypox, a zoonotic viral disease that, according to data handled by the World Health Organization, already affects 92 people in twelve non-endemic countries, in the first outbreak that it occurs in alternate locations without being linked to trips to Africa.

The Ministry of Universal Health and Public Health reported this Monday two infections compatible with the disease. The first in Castellón, from a person who has visited an endemic area and a second, in Valencia, in this case not imported. As for the situation at the national level, Spain already has 67 suspected cases of monkeypox.

It is an endemic zoonosis in Central and Western Africa where it circulates in unknown hosts, probably rodents, and has caused outbreaks in primates and sporadically cases in humans.

It should be noted that transmission between humans is scarce, since the only outbreak so far in the West occurred in 2003 in the United States from prairie dogs, infected after contact with other African rodents in a warehouse. Of the 47 cases, none were from person-to-person transmission.

Three years ago, in the context of a large monkeypox outbreak in Nigeria, two travelers from the UK, one from Israel and one from Singapore, all with a history of travel to Nigeria, were diagnosed with the infection. After that, a British health worker who was treating one of the cases became secondarily infected. This was the first time travelers had been associated with virus transmission outside of an outbreak setting.

The incubation period for monkeypox is five to twenty-one days, although most cases range from seven to fourteen days. The transmission of the disease is generated in contact with an animal, person or infected material through broken skin, mucous membranes and the respiratory tract.

Likewise, the spread of the virus through direct or indirect contact with live or dead animals is considered to be the main factor in human infections. Person-to-person transmission occurs primarily through large respiratory droplets during direct and prolonged face-to-face contact, although it can occur through bodily fluids from an infected person or with contaminated objects such as bedding or clothing.

The main symptoms of monkeypox are as follows:

-Fever, chills, headache, myalgia and asthenia.

-Presence of lymphadenopathy (unlike in smallpox).

-Days after the onset of fever: centrifugal maculopapular rash with palmoplantar involvement that evolves into vesicles, pustules and crusts.

-Three days after the onset of fever, the patient develops a rash, which tends to appear first on the face and then spread to other parts of the body, including the hands and feet.

-The presumptive diagnosis is made by clinical and epidemiological background and confirmation by isolation of the virus or its genomic material in tissue samples (vesicles, pustules or nasopharyngeal smear).

For most people it is a self-limited illness, usually lasting two to four weeks and resulting in a full recovery. However, immunosuppressed people may experience complications such as respiratory distress, secondary bacterial infections, and encephalitis.

Patients should isolate themselves by wearing a surgical mask and staying in a single room. Any injury to the body surface will be covered. The patient is contagious until all the scabs have fallen off. At the moment, there is no specific treatment available, although the smallpox vaccine offers protection against monkeypox.