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four questions about recent deaths in Brazil, Spain, India and Peru

Five people died within a few days. After Spain, which confirmed the death of two patients with monkeypox this weekend, India and Peru announced on Monday August 1 the death of a person carrying the virus in their country. Thursday, Brazil had launched the alert, announcing the first death of a person with the disease, outside the African continent.

These deaths occur in a context where the virus, whose strain originates from West Africa, is spreading throughout the world. The World Health Organization (WHO) triggered its highest level of alert, the Public Health Emergency of International Concern (USPPI), on July 24 to step up the fight against monkeypox. Franceinfo returns in four questions on these recent deaths of patients with the virus.

1Where have the recent deaths been announced?

The five deaths in recent days are the first deaths of monkeypox patients outside Africa, AFP reports. A total of ten deaths have been recorded worldwide since May, with the first five reported on the African continent, where the disease is endemic and was first detected in humans in 1970.

The first death outside Africa was recorded in Brazil on July 28. He is a 41-year-old man who died in Belo Horizonte, in the south-east of the country. According to the country’s Ministry of Health, Brazil has so far recorded nearly 1,000 cases of monkeypox, most of them in the states of Sao Paulo and Rio de Janeiro, located in the same region. The first case was detected on June 10, in a man who had traveled to Europe.

Spain recorded the second death of a monkeypox patient on Saturday. He is a 31-year-old man who was hospitalized at the Queen Sophia Hospital in Cordoba, in the south of the country, according to a press release from the Andalusian authorities. The day before, the country announced the first death of a patient with this disease ever recorded in Europe.

With nearly 4,300 people infected as of July 29, according to figures provided by the Spanish Ministry of Health (in Spanish), Spain is the European country with the highest number of recorded cases of monkeypox. In the country, 120 people affected by the virus have been hospitalized.

A 22-year-old man also died on Saturday July 30 in India, a week after being hospitalized on his return from the United Arab Emirates, according to Indian authorities. Tests carried out on the 22-year-old victim showed that he had monkey pox. India has recorded at least four cases of the disease, the first of which was on July 15 in another man who returned to Kerala after a trip to the United Arab Emirates.

In Peru, an HIV-positive patient who had abandoned his HIV treatment and was infected with monkeypox also died on Monday. The 45-year-old man “Arrived at the hospital in a very serious condition with monkeypox. His health had deteriorated after he abandoned his HIV treatment”, said the director of the National Hospital Dos de Mayo, Eduardo Farfan on a local radio. Over 300 cases of monkey pox have been recorded in the country.

2Has the link between monkeypox and the death of patients been established?

For the two patients who died in Spain, this is not yet the case. evoking “two young men”, the Spanish Ministry of Health did not provide further details on the profile of these patients. He referred to “analyzes that may take place later to be able to determine the cause of death”.

For the 41-year-old patient who died in Brazil, monkeypox should not be the only factor to consider, authorities say. He “was being followed in hospital for other serious clinical conditions”said the authorities of the state of Minas Gerais, located in the south-east of the country. “It is important to point out that he had serious comorbidities, so as not to cause panic in the population”also said the Secretary of Health of Minas Gerais, adding that the patient was undergoing treatment for cancer.

Further tests are also to be carried out on the man who died in India. The death of the Peruvian patient would have been caused by a weakened immune system according to medical teams. “He didn’t die of monkeypox but of sepsis”said the director of the Dos de Mayo National Hospital in Lima.

3What are the mortality risks from monkeypox?

According Imad Kansau, doctor specializing in infectious diseases at the Antoine-Béclère hospital in Clamart (Hauts-de-Seine) interviewed by franceinfo, these deaths among people carrying the virus are rare. “These are the complications that occur in immunocompromised patients, therefore patients who are at the stage of diseases that give immunosuppression, that is to say a significant drop in defenses. These patients can die from neurological complications or respiratory”he explains.

In African countries where the disease is endemic, the mortality rate varies from 1 to 10%, according to the WHO. But, “with proper care, most patients recover”, specifies the organization. In its frequently asked questions, it recalls that “dn most cases, the symptoms of monkeypox disappear on their own within a few weeks.”.

The European Center for Disease Prevention and Control specifies that the viral strain detected in Europe, originating from West Africa, has an average fatality rate of 3.6% (in English), based on studies in African countries. Severe cases usually occur in newborns, children and people with immune deficiency. Among the possible complications, the WHO cites superinfections of the skin, pneumonia or even eye problems.

“We do not know to what extent this rate is transposable to us: we generally have relatively little information on the characteristics of infected patients in epidemics in Africa and our health systems are very different from those of the countries concerned”commented for franceinfo the infectiologist Paul Loubet.

4Why does WHO Europe predict an increase in the number of deaths linked to the epidemic?

Despite this low case fatality rate, health authorities are already expecting more deaths, “given the continued spread (of the virus)”justified in a statement Catherine Smallwood, an emergency manager for WHO Europe.

“The reporting of monkeypox-related deaths does not change our assessment of the epidemic in Europe. We know that, although self-limiting in most cases, monkeypox can lead to serious complications”she noted, recalling the objective “to quickly interrupt the transmission of the virus in Europe”.

More than 18,000 cases have been detected worldwide outside of Africa since early May, the majority of them in Europe. In detail, the disease has been reported in 78 countries and 70% of cases are concentrated in Europe, WHO director Tedros Adhanom Ghebreyesus said on Wednesday.

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