Smallpox of monkeys, the infectious disease specialist: “Ensuring the diagnosis without reservation. Evaluating vaccination for those at risk” – Il Fatto Quotidiano

The 18 thousand cases registered in 78 countries and the 5 deaths, up to a week ago, prompted the director of theWHO to declare – even with the negative opinion of the committee – the global health emergency for the monkeypox or monkeypox. At present, 99% of cases concern males with an average age of 40 who have had unprotected sex in the majority of cases multiple and with other men and that is why one of the appeals was to contain risky behaviors and restricting sexual partners. The monkeypox however, it begins to scare because it has gone beyond the borders where it is usually registered: the US has appointed a coordinator for the national response and yesterday also in Italy a circular was issued by the ministry with a series of recommendations. But this virus can really become the next one pandemic to fight? According to Professor Marco Rizzi, Pope John XXIII’s infectious disease specialist, the answer is no. But it is necessary to “guarantee and facilitate diagnoses, even without a doctor’s prescription” and monitoring.

In the last two months, cases have increased and so has the alarm. Where are we at?
We are obviously more anxious than the news regarding infectious diseases. Now this is new, but it doesn’t seem like an explosive problem to me. It should be monitored to decide whether it will be worthwhile to vaccinate those at greatest risk. Between 2016 and 2017 we had a hepatitis A epidemic, but after the peak with cases in Europe and the rest of the world, it returned. In that case, by vaccinating, we reduced circulation.

About the vaccine, the WHO invited to report the effectiveness. But does a really effective compound exist?
The only one that is registered by the EMA has good evidence of efficacy and proven safety. On a global level, the problem, in the case of a recommendation, could be large numbers because we don’t have many.

The theme of prevention is accompanied by the guarantee of anonymity given that there are fears that the contagion could create a stigma
In the beginning there was this reluctance to be explicit in communication starting with the World Health Organization. However, we are at the point where 99% of cases are attributable to males with an average age of 40 years: and that it is an infection that is essentially circulating in the MSM community is a fact. Cases outside this context are sporadic: women and children are rare. Easy access to diagnosis must be ensured for those who believe they have been infected. You have to work with associations to have a fluid communication channel. There is no rule, there is a network for sexually transmitted diseases that works well and other parallel channels can also be created. The problem was that the communication was not very explicit from the start. We need to work on low-threshold programs that allow both anonymity and access to diagnosis without reservation and without a doctor’s prescription. We need these paths.

But compared to two months ago, are there any substantial changes?
No, that’s the circuit. The disease in the vast majority of cases involves few systemic symptoms and rare severe cases, often even few lesions in the genital areas that are atypical compared to the classic monkeypox. It is a self-limiting disease with no consequences in most cases.

But is there a real risk of spreading to children who will return to school?
At this moment we do not have any signs that we are exiting this circuit. Obviously there are sporadic pediatric cases and clearly it is a disease that is also transmitted by prolonged close contact. The aerosol transmission, if it exists, is marginal otherwise we would have other numbers. Those who became infected confirmed the absence of protections and multiple sexual relations even with strangers.

If a child is infected and arrives in a class is there a risk?
Theoretically yes, if the lesions are on an uncovered part of the skin. I mean injuries on the face, on the hands. So play, hug, school life in younger children can lead to transmission. But we see few broadcasts even in households so it’s not that easy. Diffusion is supported by something else.

Can the use of condoms guarantee protection from the disease?
Not entirely, the protection is not as complete as it is for other sexually transmitted diseases because the lesions can be at various levels, in other parts of the body. The condom reduces the risks but does not solve the problem.

In the circular of the ministry, reference will also be made to the correct disposal of dressing materials and to contact with animals
In theory, this is what should always be recommended beyond this circumstance. These are necessary rules. We know that there are susceptible animals, the recommendation is to be careful of contact in the presence of lesions and positivity for the potential circulation of different species.

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Smallpox of monkeys, the infectious disease specialist: “Ensuring the diagnosis without reservation. Evaluating vaccination for those at risk” – Il Fatto Quotidiano


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