Spain confirmed seven cases of monkeypox and Portugal confirmed 14 cases on Wednesday night, as authorities continue to investigate at least 24 more suspected infections.
All confirmed and suspected cases were found in men in the regions of Lisbon and Madrid. They all remain in stable condition, according to the health authorities.
Earlier this month, the UK alerted about its first small outbreak of monkeypox.
And for the first time on record, the virus is now spreading widely outside of Africa. Canada, Spain, Portugal and the US all reported their first cases on Wednesday.
The virus is believed to be difficult to spread, but this novel pattern of transmission suggests more investigation is needed.
In Spain, authorities are also providing contradictory messages.
“Viral transmission for monkeypox is commonly through the respiratory system, but the characteristics of the 23 cases in Madrid suggest that it may be spread through mucosal contact during sexual relations,” said Madrid health director Elena Andradas on Wednesday night.
In the UK, recent cases have been predominately found in gay or bisexual men.
Without confirming the sexual orientation of the victims of the disease in Spain or Portugal, authorities emphasized that no cases have been found in women.
However, Spanish Health Minister Carolina Darias said in an interview Wednesday night that monkeypox “is a virus” and “therefore, is not a sexually transmitted disease.”
Her remarks were heavily criticized, with many pointing out that herpes and HIV are also viral infections that can be transmitted through sexual contact.
According to the World Health Organization, several of the monkeypox cases discovered in the UK belong to the Western African clade of the virus.
While that clade can sometimes lead to severe illness, the disease is usually self-limiting and the case fatality ratio has been documented at around 1%. That is much lower than for the Congo Basin clade, which may be as high as 10%.
Monkeypox can spread when someone is in close contact with an infected person, according to the UK Health Security Agency.
The US Centers for Disease Control and Prevention said the symptoms of monkeypox begin with fever, headache, muscle aches, and exhaustion. After a few days, patients can develop a rash that goes through different stages before scabbing.
The illness typically lasts between two to four weeks./aa
