The virus, unlike Sars-CoV-2, is not easily transmitted from human to human. WHO: festivals and major summer events could lead to an amplification of cases
A little less than a month ago, several countries began reporting cases of monkeypox (Mpx). In Italy the first infection dates back to 20 May and today there are about twenty. Over 550 worldwide, in about thirty countries where the disease is not endemic. But this could only be “the tip of the iceberg”, according to the World Health Organization, a fraction of the real infections. However, the virus “has significant differences compared to Sars-CoV-2, starting from the fact that it is not easily transmitted between humans,” he said. Marco Cavaleri, head of the vaccine strategy of the European Medicines Agency (Ema) -. An increase in cases is likely, but there is currently no health emergency. The focus should remain on the identification, monitoring and management of new infections “. Furthermore, “although the epidemic is unusual, including its wide geographical spread, it is reassuring that most patients experienced mild symptoms and recovered without the need for treatment “. So far none of those infected have died.
Endemic to Africa
Monkeypox is a viral zoonosis (the virus is transmitted to humans by animals), with symptoms similar to those seen in the past in patients with smallpox, although the one present today is clinically a less severe disease. Smallpox was easily transmitted and was more lethal: about 30% of patients died. With the eradication of the disease in 1980, mass vaccination of the population was suspended. Today monkeypox is endemic only in Central and West Africa, in areas of tropical rainforests, but increasingly also in urban areas. Animal guests are some rodents and primates. The pathogen (Mpxv) is a double-stranded DNA virus envelopedwhich belongs to the genus Orthopoxvirus of the family Poxviridae.
The epicenter in Europe
Although the situation is not comparable to the Covid pandemic, Hans Kluge, director of the World Health Organization (WHO) Regional Office for Europe, stressed that “WHO European Region remains the largest and most geographically widespread epicenter of the monkeypox epidemic never reported outside the endemic areas of Africa “. According to the European Center for Disease Prevention and Control (ECDC), it is the first time that transmission chains without links to West or Central Africa have been reported in Europe. «We now have a fundamental opportunity to act quickly, together – added Kluge – to quickly investigate and control this rapidly evolving situation. The virus has already spread in several mass gatherings. In the next months, festivals and major events they will be contexts in which further amplification of infections could occur “. It is therefore necessary to «engage with young, sexually active and mobile people globally to raise awareness and strengthen individual and community protection ».
How the contagion happens
Transmission occurs through close contact with infected material coming from skin lesions, droplet (respiratory droplets), in case of prolonged face-to-face proximity, and “fomites” (clothing, towels, sheets, dishes and other contaminated objects). Healthcare professionals, family members and other close contacts of confirmed cases are at greater risk. The virus can be transmitted for direct contact with the body fluids of an infected person, with open exanthematous lesions or indeed contaminated objects. In the current outbreak the nature of the injuries suggests that transmission occurred primarily through physical contact, mainly sexual type. Transmission through contact with intact skin is less likely but cannot be ruled out. In endemic areas in Africa, the circulation of Mpxv occurs through bite or other direct contact between infected humans and animals. Various animal species have been found susceptible to the monkeypox virus, such as squirrels, Gambian rats, dormice, some primates.
Sexual transmission
On the basis of the clinical cases recorded to date, confirms the WHO, “this outbreak is largely transmitted through sexual activity, mainly of men who have intercourse with men (MSM, males having sex with males). The general risk estimated by the ECDC is moderate for people who have multiple sexual partners, while it is considered low for the rest of the population. We must remember, however – concludes the WHO – that monkeypox is caused by a virus that can infect anyone and is not intrinsically associated with any specific group of people “. So far, the World Health Organization points out, “we predict that most people who contract monkeypox will have a mild, self-limiting illness, but unpleasant and potentially painful, which can last up to several weeks. We still don’t know what impact this will have on individuals who can have severe outcomes from monkeypox, in particular young children, pregnant women and immunocompromised people“. To date, the most serious cases have been observed in children. In Italy all cases of monkeypox have concerned so far male persons and it is “plausible” that the transmission of the virus occurs during sexual intercourse: the confirmation comes from an article published by the researchers of the National Institute for Infectious Diseases “Lazzaro Spallanzani” on Eurosurveillancethe scientific journal of the ECDC.
Injuries in the genital area
The first symptoms of the disease are usually fever, muscle pain, weakness, headache, swollen lymph nodes. They appear 6-13 days after infection and can last up to three weeks after exposure. Within 3 days of the onset of general symptoms, the rash begins at the site of the infection and tends to spread rapidly to other parts of the body. Genital lesions predominate in the current outbreak, but the palms of the hands and soles of the feet are also involved in cases of disseminated rash. Lesions, ranging from a few to hundreds, often first present as flat red spots that rise and evolve into blisters, pustules, and scabs, filling with pus. The oral and ocular mucous membranes may also be involved. The disease generally resolves spontaneously in 2-4 weeks, without specific therapies. According to the Italian Clinical Microbiologists Association, which has set up a study group on the MPX virus, the strain involved in the epidemic appears to be that of West Africa, which is more benign. Furthermore, historically, smallpox vaccination has been shown to be protective against monkeypox in 85% of cases but in Italy 60% of the population is not vaccinated (almost all under 50). Today, two vaccines are available, improved compared to the one administered until the 1980s, and a drug recently approved also in Europe (tecovirimat). However, stocks, both of vaccines and of the drug, are limited and the European Union is working on a centralized purchase of vaccines and antivirals. In Italy, said the Undersecretary of Health Andrea Costa, “we have more available 5 million doses of smallpox vaccinetherefore we are prepared to proceed if the need arises ».
What to do in case of contagion
The recommendation plan to stay home if you have a fever and seek medical attention if blisters or other skin manifestations appear. As a prevention, it is important avoid close contact with people with symptoms (fever, swollen lymph nodes, skin lesions and especially blisters or scabs). According to the latest circular from the Ministry of Health, «contacts must be monitored daily for the onset of signs / symptoms referable to MPX for 21 days. Signs / symptoms include headache, fever, chills, sore throat, malaise, asthenia (weakness), myalgia (muscle pain), back pain, rash and lymphadenopathy. Asymptomatic contacts should not donate blood, cells, tissues, organs, breast milk or sperm while they are under surveillance. Furthermore, they must avoid attending immunosuppressed people, pregnant women and children under 12 years of age ». In the United Kingdom, the Health Security Agency (Ukhsa) has issued guidelines to contain the spread of the epidemic: those infected must isolate themselves at the first symptoms, refrain from sexual intercourse and close contact until the lesions are completely healed e use a condom in case of sexual intercourse for at least 8 weeks after recovery.
The first case in 1970
Monkeypox is nothing new: it was identified in monkeys in a Danish laboratory in 1958. The earliest known human version dates back to to 1970 and concerned a 9-year-old boy in the Democratic Republic of the Congo. Since then, most cases have been reported in rural rainforest regions. Human cases of MPX have occurred in 11 African countries since 1970: Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ivory Coast, Liberia, Nigeria, Republic of Congo, Sierra Leone and South Sudan. In 2017, Nigeria suffered a large epidemic, with over 500 suspected and over 200 confirmed cases and a lethality rate of around 3%. “It is sad that it takes a global epidemic to draw attention to those suffering from monkeypox in 7 African countries (which have a toll of almost 1,400 cases since the beginning of 2022)»Is the bitter reflection, via Twitter, of Rosamund Lewis, technical manager of Monkeypox virus in the program for health emergencies of the World Health Organization. In 2003, the first MPX outbreak outside of Africa hit the United States and has been linked to infected prairie dogs: the animals had been in contact with rats and dormice imported from Ghana. Monkeypox has been reported from 2018 onwards in Israel, the United Kingdom, Singapore, and the United States.
June 3, 2022 (change June 3, 2022 | 13:29)
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