Researchers are racing to understand the latest monkeypox outbreaks—from their origins to whether they can be contained
It’s been three weeks since public-health authorities confirmed a case of monkeypox in the United Kingdom. Since then, more than 400 confirmed or suspected cases have emerged in at least 20 non-African nations, including Canada, Portugal, Spain and the United Kingdom — the largest outbreak ever seen outside Africa.
How did the current outbreaks start? Since the latest outbreaks began, researchers have sequenced viral genomes collected from people with monkeypox in countries including Belgium, France, Germany, Portugal and the United States. The most important insight they have gained so far is that each of the sequences closely resembles that of a monkeypox strain found in West Africa.
But other explanations cannot be ruled out, says Gustavo Palacios, a virologist at the Icahn School of Medicine at Mount Sinai in New York City. It’s possible that the virus was already circulating, undetected, outside Africa in humans or animals, having been introduced during earlier outbreaks. This hypothesis, however, is less likely because monkeypox usually causes visible lesions on people’s bodies — which would probably be brought to the attention of a physician.
Another reason, Palacios says, is that few resources have been dedicated to genomic-surveillance efforts in Africa, where monkeypox has been a public-health concern for many years. So virologists are in the dark, because they have few sequences to which they can compare the new monkeypox sequences, he says. Funding agencies have not heeded scientists, who have been warning for more than a decade1 that further monkeypox outbreaks could occur, he adds.
Can the outbreaks be contained? Understanding whether there is a genetic basis for the virus’s unprecedented spread outside Africa will be incredibly difficult, says Elliot Lefkowitz, a computational virologist at the University of Alabama at Birmingham who has studied poxvirus evolution.
Although the risk is low, Moss says the main concern is that scientists wouldn’t know if such a spillover event occurred until it was too late, because infected animals typically don’t show the same visible symptoms seen in humans.
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