Monkeypox, what we know

Iss - May, 19th 2022 - UPDATED MAY, 25TH

What is monkeypox?

Monkeypox (MPX) is a zoonotic disease (transmitted from animals to humans) caused by a virus of the same family of smallpox but different therefrom insofar as the disease that it provokes is less transmissible and less severe. The name derives from the first identification of the virus, which was discovered in monkeys in a Danish laboratory in 1958. It particularly spreads among apes and small rodents, prevalently in Africa. In endemic areas, MPXV is transmitted to humans through a bite or direct contact with an infected animal’s blood, meat, bodily fluids, or cutaneous/mucosal lesions. The virus was first identified as a human pathogen in 1970 in the Democratic Republic of Congo. Since its discovery, cases in humans have been reported in several African Countries. The disease is currently endemic in Benin, Cameroon, Central Africa Republic, Democratic Republic of Congo, Gabon, Ghana (only in animals), Ivory Coast, Liberia, Nigeria, Republic of the Congo, Sierra Leone, and South Sudan.

What is the current situation?

From 13 to 21 May 2022, cases of monkeypox in humans were reported to the World Health Organization in 12 Member States in which the disease is not endemic. A few dozen cases were reported in European Countries, including Italy. Epidemiological studies are currently underway to identify the transmission chain/s. On the basis of the information available, to date the cases have mainly, but not exclusively, been detected among youths that define themselves as MSM (men who have sex with men). The overall risk assessed by the ECDC is moderate for persons having multiple sexual partners and low for the rest of the population.

Can it be transmitted from person to person?

The virus is not easily transmitted from person to person. Human transmission is principally linked to a close contact with the body fluids or with the cutaneous lesions of an infected person. It is also possible to be infected through droplets in a prolonged contact face-to-face or with contaminated objects (sheets, clothes, etc.). The data available to date and the nature of the lesions observed suggest that the virus can be transmitted through sexual intercourse.

What are the symptoms?

In humans, it sets on with fever, muscle aches, headache, swollen lymph nodes, exhaustion and skin rashes with spots, blisters, or little scabs. The symptoms clear up spontaneously after 2-4 weeks of appropriate rest and without specific treatment; patients can be administered antivirals if necessary. Up to now, most cases have shown mild symptoms and a benign course. However, monkeypox may cause a more serious disease in particularly frail population segments such as children, pregnant women, and immunosuppressed subjects.

Does the smallpox vaccine protect me? Should I get vaccinated?

It is possible that persons who have not been vaccinated against smallpox (a vaccine that was abolished in Italy in 1981) are at a greater risk of being infected with monkeypox because of the absence of antibodies that, because of the similarity between smallpox and monkeypox, could also prove effective in combating this viral infection. Postexposure vaccination (ideally administered within four days from exposure) may be taken into consideration in the case of high-risk contacts of healthcare workers, including laboratory personnel, following a careful risk-benefit assessment. (See the Circular Letter of the Ministry of Health of 25/05/2022).

What recommendations are there?

The recommendations include staying at rest at home after the onset of fever and turn to your medical officer in case of the appearance of blisters or other skin rashes. As part of prevention, it is important to avoid close contact with persons with symptoms (fever, swollen lymph nodes, skin lesions such as blisters or scabs). This behavior is useful to avoid not only monkeypox but also other infections. According to the latest Circular Letter of the Ministry of Health: “Contacts must be monitored at least once a day to detect signs/symptoms referrable to MPX over a period of 21 days from the last contact with a patient and his/her contaminated materials during the period of infection. Signs and symptoms include headache, fever, chills, sore throat, feeling sick, asthenia, myalgia, backache, skin rash and lymphadenopathy. Contacts must check their temperature twice a day. Asymptomatic contacts should not donate blood, cells, tissue, organs, breastmilk, or sperm while under surveillance. During the 21-day surveillance, the contacts of a case of MPX must avoid having contact with immunosuppressed subjects, pregnant women, and children under 12 years of age.”

What does the ISS do?

On the basis of the events in Italy, the ECDC, concertedly with the Ministry of Health, has raised the surveillance activation level. The ISS and its team of experts contribute to constantly monitor the infection throughout the national territory.

References

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385

https://www.ecdc.europa.eu/en/publications-data/risk-assessment-monkeypox-multi-country-outbreak