Monkey pox, symptoms and how it is transmitted: what we need to know –

from Laura Cuppini

Vaccination indicated for healthcare professionals and individuals with multiple partners. Almost 500 infections in Italy and there are the first four deaths outside Africa

A week ago the World Health Organization declared monkeypox an international public health emergency (Pheic, public emergency of international concern): infections are on the rise in many countries and there are the first deaths. In the latest WHO report (data updated to 22 July) 16 thousand cases of MPX are reported (monkeypox) in 75 countries, of which almost 12 thousand in Europe. In Italy, today, there are 479 official infections, of which 146 related to trips abroad. In recent days there have also been the first deaths outside the African continent, where the disease is endemic: a 41-year-old in Brazil, two young men in Spainwhere there are over 4 thousand cases, and a 22 year old in India. In the United States, where about 5 thousand are infected, San Francisco and the State of New York have declared a state of emergency for public health.

Who gets sick the most?

The new infections confirm the identikit of the patient, who is almost always young (average age 37 years) and above all of male sex: out of the 479 cases registered in Italy, only three are women. The worst region there Lombardy (216), followed by Lazio (101), Emilia Romagna (55), Veneto (33) and Piedmont (18). The situation is under constant monitoring and is not believed to cause particular alarmism, as underlined by Gianni Rezza, Director General of Prevention at the Ministry of Health.

How is the disease recognized?

Symptoms of monkeypox usually include fever, intense headache, body aches, back pain and general weakness. The most frequent signs are swollen lymph nodes and skin rashes or lesions. The rash occurs within three days of the onset of fever. The lesions may be flat or slightly raised, filled with clear or yellowish fluid; they can crust, dry out and fall off. The rash tends to focus on the face, palms, and soles of the feet, but can also appear on the mouth, perigenital area, and eyes. Symptoms last for 2 to 4 weeks and in most cases disappear spontaneously, without treatment. WHO has suggested evaluating the use of vitamin A supplements, under close medical supervision, to promote wound healing and ocular health. Monkeypox can cause a more serious disease, especially in some particularly fragile groups such as children, pregnant women and immunosuppressed people.

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Homo or bisexual males

According to an English study published in the British Medical Journalthe symptoms of monkeypox in the current epidemic are partly different from the previous ones: the infection seems to spread mainly among homosexual or bisexual males, with symptoms that mainly affect the genital mucous membranes, where lesions are formed. Some of the ailments reported by patients today, including rectal pain and penile swelling (edema), do not show up in previous outbreaks. According to the study authors, patients with confirmed infection, extensive penile lesions or severe rectal pain should be considered for ongoing follow-up or hospital management. Andrea Gori, director of the Infectious Diseases Unit of the Polyclinic of Milan, clarifies: Information and prevention must focus on populations at risk, but it is very important not to stigmatize and above all not to reduce the disease to a problem of a single group. there is no doubt that the onset of the epidemic took place within the gay community, but the heterosexual population could be affected in the same way if the virus continues to spread.

Should we be afraid of contagion?

Someone said: monkeypox is not a problem because nobody dies. Yes, but the lesions that mainly affect the genitals are highly disabling – he adds Matteo Bassetti, director of the Infectious Diseases Clinic at the San Martino Polyclinic in Genoa -. They are injuries that can last 2 or 3 months and are likely to leave long-term effects. We must not only look at mortality, but also at the morbidity and damage that this virus can leave behind. For Bassetti, urgent a campaign for safe sex. Initially it was not clearly stated that this disease was affecting men, who are typically sexually infected. It is very urgent to try to address prevention campaigns both from a behavioral point of view, for example onuse of condomboth with regard to vaccination.

How is the virus transmitted?

The contagion occurs through a close contact with a symptomatic case. The rash, body fluids (such as fluid, pus, or blood from skin lesions), and scabs are particularly infectious. Mouth ulcers, lesions, or sores can be a source of contagion and the virus can spread through saliva or mouth droplet
(respiratory droplets), in case of prolonged face-to-face contact. Monkeypox can also be transmitted by direct contact with injuries during sexual intercourse. Virus-contaminated clothing, bedding, towels, or dishes from an infected person can infect other people. In a circular of 25 May, the Ministry of Health recommended self-isolation for confirmed and suspected cases. Anyone with symptoms related to monkeypox should contact their doctor immediately. The incubation period can vary from 5 to 21 days (typically around 12 days). An infected person remains contagious for the duration of the symptomatic illness, which is 2 to 4 weeks.

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Who can get the vaccination?

The World Health Organization has recommended targeted vaccination for those who have had contact with sick people and for people at high risk of exposure, such as health care workers, some laboratory workers and those with multiple sexual partners. At the moment we do not recommend mass vaccination against monkeypox said WHO director general, Tedros Adhanom Ghebreyesus. On 22 July, the Human Medicines Committee of the EMA (European Medicines Agency) recommended extending the use of the vaccine Imvanex
(MVA-BN), authorized in the EU since 2013 against human smallpox, also for the immunization of adults against monkeypox. Post-exposure vaccination (within four days) may also be considered for high-risk contacts. It is possible that people who have been vaccinated against smallpox in the past (vaccination abolished in Italy in 1981) are at lower risk of infection, due to the similarity of the smallpox virus with MPX: some studies estimate that the protection could be 85%.

Does the vaccine give immediate protection?

The MVA-BN vaccine, manufactured by Bavarian Nordic A / S, contains a weakened form of the modified Ankara virus, which belongs to the same family as the smallpox virus but does not cause disease and cannot reproduce in human cells. The vaccine has a good safety profile and side effects are mild to moderate. The vaccine has also been approved in Canada and the United States against MPX and to date, around the world, there is the availability of about 16 million doses (mostly in bulk form, i.e. still to be filled). The European Union bought 160 thousand doses and is preparing two procedures for the joint purchase of new vaccine doses and antiviral treatment Tecovirimat. The latter, developed for smallpox, was recently authorized by EMA for the treatment of monkeypox, but not yet available on a large scale. Two other vaccines, LC16 and ACAM2000, are being tested against monkeypox; however, data on their effectiveness are still lacking. WHO Director General Ghebreyesus recalled that vaccination does not guarantee immediate protection: antibodies can develop after a few weeks. This means that vaccinated people should continue to take measures to protect themselves, avoiding close contact, including sex, with others who have or are at risk of contracting monkeypox.

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What is monkeypox?

a zoonotic infection (transmitted from animals to humans), caused by a virus from the same family as the one that causes smallpox (Poxviridae), but which differs from the latter for the lower transmissibility and severity of the disease it causes. The name comes from the first identification of the virus, discovered in monkeys in a Danish laboratory in 1958 (there are those who propose to change the name of the disease, since it does not concern only monkeys). widespread in particular among primates and small rodents, mainly in Africa. In endemic areas transmitted to humans through a bite or direct contact with the blood, meat, body fluids or skin lesions of an infected animal. The virus was first identified as a human pathogen in 1970 in the Democratic Republic of the Congo. Since its discovery, human cases have been reported in several African countries. Currently the disease is endemic in Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ghana (only in animal cases), Ivory Coast, Liberia, Nigeria, Republic of Congo, Sierra Leone and South Sudan.

What are the recommendations?

You should stay home in case of fever and seek medical attention immediately if blisters or other skin manifestations appear. As a prevention, important avoid close contact with people with symptoms (fever, swollen lymph nodes, skin lesions, and especially blisters or scabs). The Circular of the Ministry of Health reads: Contacts must be monitored at least daily for the onset of signs / symptoms referable to Mpx, for a period of 21 days from the last contact with a patient or with its contaminated materials. Signs / symptoms include headache, fever, chills, sore throat, malaise, asthenia (weakness), myalgia (muscle aches), back pain, rash and lymphadenopathy (swollen lymph nodes). Contacts need to monitor their temperature twice a day. Asymptomatic contacts should not donate blood, cells, tissues, organs, breast milk or sperm. During the 21 days of surveillancecontacts of subjects with Mpx must also avoid contact with immunosuppressed persons, pregnant women and children under the age of 12 years.

July 30, 2022 (change July 31, 2022 | 19:09)



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