By Jennifer Rigby

LONDON (Reuters) -A handful of cases of monkeypox have now been reported or are suspected in Britain, Portugal, Spain and the United States.

The outbreaks are raising alarm because the viral disease, which spreads through close contact and was first found in monkeys, mostly occurs in west and central Africa, and only very occasionally spreads elsewhere.

Here is what scientists know so far.

‘HIGHLY UNUSUAL’

Monkeypox is a virus that causes fever symptoms as well as a distinctive bumpy rash. It is usually mild, although there are two main strains: the Congo strain, which is more severe – with up to 10% mortality – and the West African strain, which has a fatality rate in about 1% of cases. The UK cases have been reported as the West African strain.

“Historically, there have been very few cases exported. It has only happened eight times in the past before this year,” said Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine, who said it was “highly unusual”.

Portugal has logged five confirmed cases, and Spain is testing 23 potential cases. Neither country has reported cases before.

The United States has also reported one case.

TRANSMISSION

The virus spreads through close contact, both in spillovers from animals and, less commonly, between humans. It was first found in monkeys in 1958, hence the name, although rodents are now seen as the probable main animal host.

Transmission this time is puzzling experts, because a number of the cases in the United Kingdom – nine as of May 18 – have no known connection with each other. Only the first case reported on May 6 had recently traveled to Nigeria.

As such, experts have warned of wider transmission if cases have gone unreported.

The UK Health Security Agency’s alert also highlighted that the recent cases were predominantly among men who self-identified as gay, bisexual or men who have sex with men, and advised those groups to be aware.

Scientists are now carrying out genomic sequencing to see if the viruses are linked, the World Health Organization (WHO) said this week.

WHY NOW?

One possible scenario behind the rise in cases is increased travel as COVID-19 restrictions are lifted.

“My working theory would be that there’s a lot of it about in west and central Africa, travel has resumed, and that’s why we are seeing more cases,” said Whitworth.

Monkeypox puts virologists on the alert because it is in the smallpox family, although it causes less serious illness.

Smallpox was eradicated by vaccination in 1980, and the shot has since been phased out. But it also protects against monkeypox, and so the winding down of vaccination campaigns has led to a jump in monkeypox cases in areas where the disease is endemic, according to Anne Rimoin, an epidemiology professor at UCLA in California.

She said urgent investigation of the new cases was important as “they could suggest a novel means of spread or a change in the virus, but this is all to be determined”.

Experts urged people not to panic.

“This isn’t going to cause a nationwide epidemic like COVID did, but it’s a serious outbreak of a serious disease – and we should take it seriously,” said Whitworth.

(Reporting by Jennifer Rigby; Editing by Lisa Shumaker and Tomasz Janowski)