A 2003 photo of the arms and legs of a 4-year-old girl infected with monkeypox in Liberia.
Enlarge / A 2003 photo of the arms and legs of a 4-year-old girl infected with monkeypox in Liberia.

A growing outbreak of monkeypox cases has spread across several countries, suggesting that the disease has been quietly spreading undetected in forested areas of Central and West Africa.

The US has reported one case in a Massachusetts man who recently traveled to Canada, and 17 suspected cases in Montreal. One of the nine cases identified by the United Kingdom is connected to recent travel to Nigeria, where monkeypox is endemic. The other cases are not related to the travel-related case by contact or timing. Italy and Sweden have each reported at least one case, while Spain is said to be investigating 23 cases.

Disease origins

The symptoms of monkeypox are similar to those of smallpox, but it causes a milder disease. The West African clade is one of the two clades of monkeypox. The milder of the two is the West African clade. It can cause severe disease in some cases, though it is usually a self-limiting infection. The case fatality rate is estimated to be about 1 percent. There is an estimated fatality rate of as high as 10 percent in the Congo Basin clade. Both clades have children who are at high risk of severe disease and infections that can be dangerous during pregnancies.

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Monkeypox is not a disease that can easily be spread among humans. According to the World Health Organization, the longest documented chain of transmission in humans is just six generations, meaning that the last person to get sick in an outbreak was just six links away. Humans are often found at the interface of tropical rainforests with the virus. According to the World Health Organization, animals that can harbor the virus include squirrels, dormice, and other monkeys. The main source of the virus is thought to be rodents.

Humans can get the virus from an animal through contact with its blood, body fluids, or skin. The main risk factors are hunting and bush meat. People can become sick if they eat meat or animal products that are not cooked to the correct temperature.