Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022

Abstract

Up to 27 May 2022, Portugal has detected 96 confirmed cases of monkeypox. We describe 27 confirmed cases (median age: 33 years (range: 22–51); all males), with an earliest symptom onset date of 29 April. Almost all cases (n = 25) live in the Lisbon and Tagus Valley health region. Most cases were neither part of identified transmission chains, nor linked to travel or had contact with symptomatic persons or with animals, suggesting the possible previously undetected spread of monkeypox.

Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022

“…It is therefore essential to establish the distribution of the incubation period in the recent outbreaks. Whereas cases in previous outbreaks of monkeypox in non-endemic areas had travelled to endemic countries or had contact with infected animals [ 5 ], the 2022 outbreaks [ 1 ] affect many cases with no documented history of travel to endemic countries and who identify as men who have sex with men (MSM) [ 6 , 7 ]. Close contact during sexual activity may play an important role in transmission during the current outbreaks.…”

When a Neglected Tropical Disease Goes Global: Knowledge, Attitudes and Practices of Italian Physicians towards Monkeypox, Preliminary Results

“…Fifth, the General Knowledge test may also require further revision and adjustments, as the early epidemiological reports suggest that the ongoing pandemic may be associated with specific clinical features and a CFR that is far lower than previously reported, even from Western African (i.e., below 0.1%) [ 28 , 63 , 87 ]. For instance, skin lesions are often inconsistently pronounced in number, size, and density, being possibly confounded with chickenpox [ 16 , 89 ], and cervical lymphadenopathy, that was previously acknowledged as a nearly constant clinical sign, has been reported by less than 20% of early incident cases [ 16 , 89 , 90 ], and by 27% of cases notified to ECDC by 6 July 2022 [ 26 ]. On the contrary, first reports have suggested an increased prevalence of inguinal lymph node involvement (35.3% to 48.1%) [ 16 , 89 , 90 ], anal and genital ulcers (18.5% to 57%) [ 89 , 90 , 91 ], that have been collectively explained through sexual route of transmission.…”

“…For instance, skin lesions are often inconsistently pronounced in number, size, and density, being possibly confounded with chickenpox [ 16 , 89 ], and cervical lymphadenopathy, that was previously acknowledged as a nearly constant clinical sign, has been reported by less than 20% of early incident cases [ 16 , 89 , 90 ], and by 27% of cases notified to ECDC by 6 July 2022 [ 26 ]. On the contrary, first reports have suggested an increased prevalence of inguinal lymph node involvement (35.3% to 48.1%) [ 16 , 89 , 90 ], anal and genital ulcers (18.5% to 57%) [ 89 , 90 , 91 ], that have been collectively explained through sexual route of transmission.…”

A viewpoint: The 2022 monkeypox outbreak

“…The vast majority of cases described are in men between the ages of 20–59 years. 16 It would not be surprising to see monkeypox filling in the ecological niche left after smallpox eradication in 1980, with the general population becoming increasingly more susceptible to it, with each passing generation that has not been vaccinated. 17 …”