Monkey pox: rapid transmission and unexplained infections, that’s what’s worrying

from Cristina Marrone

Three viral genomes sequenced and deposited that appear similar to those isolated in 2018. The disease, known for years, is spreading to the community like never before

What are the symptoms of the monkey virus?

Monkeypox causes a number of flu-like symptoms such as fatigue, body aches, headaches, fever, swollen lymph nodes but also has a distinctive rash: lesions on the palms of the hands. Skin injuries are often described as very painful, regardless of where they occur. However, in these new outbreaks, according to reports from the European Center for Disease Prevention and Control, most cases presented lesions on the genitals or perigenital area, indicating that transmission likely occurs during close physical contact during sexual activities. Also report many oral ulcerations.

Among the rare complications are reported: bronchopneumonia, secondary shock to diarrhea and vomiting, corneal scarring that can lead to permanent blindness, encephalitis especially in patients with secondary bacterial infection and septicemia, with the formation of scars on the skin as a long-term sequela.

Most people recover within a few weeks, but the virus has had a death rate of around 3.3% in Nigeria, with children, young adults and immunocompromised people more susceptible.

How is monkeypox transmitted?

The virus can spread with close contactsthrough i body fluidsthe contact with skin and respiratory droplets as a result, health care workers, family members and sexual partners are more at risk of infection. Injuries in the oral cavity or on the skin of an infected individual are contagious, as are the sheets or clothes that have been in contact with the pus emitted by the blisters. However, a study dating back to 2013 conducted by scientists from the Tulane National Primate Research Center in the US also speaks of aerosol transmission: Research has shown that monkeypox virus (respiratory virus) can remain in the ain aerosol for up to 90 hours, keeping itself infectious. The study was conducted in the laboratory and there is no confirmation from the real world for now, but it is clear that the rrisk of airborne transmission should be studied not to repeat the mistakes made with Covid.

When the contagion occurs?
The communicable disease from the moment they appear or signs and symptoms and during the entire course of the disease, ie until all injuries have healed and the scabs have been replaced by a new layer of skin. There is not much information on the rate of transmissibility and the few that exist relate to the lineage of the Congo, which is more aggressive, while the one coming from West Africa, which is milder, has spread to Europe. However, there is talk of an R0 lower than 1. The period of incubation usually between 5 and 21 days

Has the virus been sequenced?

Yes, the first viral genomes have been isolated and deposited in Portugal, Belgium and the United States. The three sequences appear to be similar to each other and suggest derivation from a single cluster of infections. The sequences are very close to those isolated in Nigeria and the UK in 2018 during a previous outbreak. At the moment, no mutations seem to emerge that would justify increased transmissibility, although more specific sequencing data is needed and is still ongoing. Each country that has identified at least one case will have to file the viral genome in the database.

Have there been any outbreaks before?

Monkeypox generally does not lead to major outbreaks and only a handful of cases have occurred outside Africa over the years. The largest outbreak outside the endemic countries occurred in 2003 in the United States with 70 cases linked to infected dogs and other animals. In Africa, 11 countries have reported cases since 1970: the first involved a 9-year-old boy in the Democratic Republic of the Congo. Over 500 suspected and 200 confirmed cases have been reported in Nigeria since 2017. However, to date, outbreaks have rarely been reported and have been poorly described.

Why are health authorities worried?

According to the European Center for Disease Prevention and Control this is first time that transmission chains have been reported in Europe without links to West or Central Africa: that is, a transmission in community occurs. To date, out of 52 subjects on which the information is available, 41 have not traveled recently and this would confirm the local circulation of the virus and human-to-human transmission. At the moment the traced individuals are almost all not epidemiologically linked apart from the case of a family unit consisting of six people, the cluster born in a sauna in Madridand possible links between some patients who participated in the gay Pride in Gran Canaria from 5 to 15 May on which the Spanish health authorities are investigating.

The World Health Organization studies this virus for years precisely because of its proximity to human smallpox, but what worries her today transmission speed: all the cases recorded in Africa have produced few secondary cases and all easily traceable to an index case. In recent episodes, however, apart from a few more exceptions difficult to find connections between the various patients, as if there was an as yet unidentified Community transmission. As with all viruses, the more they run and spread, the greater the risk of mutation. In the end, most of the unvaccinated world population against human smallpox, and thus billions of people today are susceptible.

Susan Hopkinschief medical officer of the United Kingdom Health Safety Agency (Ukhsa) described monkeypox as a new infectious disease which is spreading in our community with cases that have no identified contact with an individual from West Africa, where the disease was previously present.

Do skin lesions itch like chickenpox?

No, typically up to the scabbing stage, monkeypox injuries are usually painful, while chickenpox is itchy. only during the healing phase, when scabs are forming and the skin is regenerating a little, that monkeypox patients mention itching. The number of lesions varies from individual to individual, and people with dark skin may have lighter areas on the skin where the lesions were after healing.

Who are the people most at risk?

People with a previous vaccination against smallpox have some protection against monkeypox (estimated at 85%) and this part of the population (over 50) is expected to possibly contract a milder disease even if it needs to be verified today. effective protection years later (investigations are ongoing). They would seem then young people who have not been vaccinated are more at risk (vaccination was stopped in the 1980s after smallpox eradication). This is in line with the data available so far: the infected are between 20 and 40 years old. There are no known cases over the age of 55. However, it cannot yet be ruled out that precarious health conditions typical of old age may not represent a risk factor, but the data at the moment are still preliminary.

How is the diagnosis made?

The Bambin Ges Pediatric Hospital writes: The diagnosis of monkeypox in humans is mainly clinical, with the typical skin lesions that lead to diagnostic suspicion. Adequate clinical history evaluation, including travel area, occupation, and contacts, are essential for distinguishing between various types of rashes. Establishing a definitive diagnosis requires viral isolation and culture, immunohistochemistry for viral antigen detection, enzyme-linked immunosorbent assay for antibody (IgG and IgM) detection, and detection of specific viral DNA by the PCR.

Is it true that the disease mainly affects men?

At the moment, out of 105 cases for which information is available, un female individual only. The ECDC, also sparking controversy, wrote in its report that most of the cases occurred in young men, many who identified themselves as men having sex with men (MSM). To date, there are no data on the virus in semen or vaginal fluids. We know that transmission requires close contact, and what happens during an intimate relationship. In anal intercourse the risk of laceration of the mucous membranes is higher and precisely through these lesions, if the individual is contagious, it can transmit the virus to the partner. This could explain the high incidence of contagion among men. However, it should be remembered that inter-human contagion can also occur through saliva, respiratory droplets, contact with contaminated clothing or sheets.

May 23, 2022 (change May 23, 2022 | 09:36)

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