A picture of a man on a packed train potentially infectious with monkeypox, has caused concern and calls for people to take the disease seriously.
The viral photo has been labelled "really concerning" by an Australian infectious disease expert as health authorities try to dispel a common misconception about the spreading virus.
The picture of the allegedly contagious passenger was taken on July 15 and later shared on Twitter by a doctor who spotted him.
While it cannot be verified whether the man in the picture has monkeypox, the doctor has since gone on to speak on Spanish news channels after the picture was widely circulated online.
In the photo, lesions and bumps can be seen on the man's leg and the doctor claimed he was "riddled with injuries from head to toe".
The doctor said he witnessed the man on the subway in Madrid, Spain's capital. He cautiously approached the man and asked why he was on the subway if he had monkeypox.
The man said his doctor did not tell him to stay at home and isolate, but he did instruct him to wear a mask.
The doctor said he tried to explain to him the lesions on his body are the most contagious and suggested perhaps he did not understand his doctor's instructions.
A lady who was close to the man was asked if she was concerned about getting sick and her response was just as worrying.
According to the doctor, the lady said she wasn't concerned because she was not gay and that the government had said straight people did not have to be concerned.
On Friday, Spain's health ministry reported 4298 people were infected with the virus, making it the leading European country for monkeypox cases.
Of the cases identified in Spain, 3500 were men who had sex with other men and only 64 were women. The country also reported the first monkeypox death in Europe over the weekend.
Subway monkeypox case 'really concerning'
Paul Griffin, Director of Infectious Diseases at Mater Health Services, Associate Professor of Medicine at the University of Queensland said this account was disappointing.
"It's really disappointing, isn't it? I mean, it's actually really concerning," he told Yahoo News Australia.
Prof Griffin said because monkeypox is generally visible, transmission should be easy to control, with infectious people being asked to isolate to eliminate further transmission.
"But if people don't take that seriously and don't isolate themselves, well, that can certainly facilitate the spread and make something that we should be able to control much more challenging," he said.
There's also clearly been some misinformation surrounding monkeypox, especially concerning how it spreads.
Monkeypox relies on close skin-to-skin contact with infected blood or body fluids, Prof Griffin explained.
He questioned whether this man understood the virus and the advice he received from his doctor, adding that if you are infectious with monkeypox, wearing a mask is going to do little to prevent the spread.
Prof Griffin acknowledged there is a relatively low risk of spreading the disease in this particular situation, however, the risk still wouldn't be zero.
Importance of not stigmatising monkeypox
The other concern the doctor in Spain witnessed was the belief that monkeypox only spreads among men who have sex with other men.
Anyone can get monkeypox, so long as they have that close physical touch with an infectious person.
Prof Griffin stressed it is important to not stigmatise the disease.
"While it's really important, we identify who is at greatest risk and we try and modify that risk by approaching those groups and giving them the right advice, we need to be really careful that we don't be discriminatory or stigmatising," he said.
While monkeypox is not a sexually transmitted disease, men who have sex with men do make up the bulk of cases, which is why there is an emphasis on educating that particular community.
"We need to make sure that people understand that while there are certain groups that are at greater risk, the virus isn't exclusively in those groups and everybody needs to do the right thing," he said.
"I think perhaps some have been a bit too eager to say it's one group that's involved and then we hear comments like that [what the lady said on the subway in Spain] and I think it's really disappointing."
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