It is not yet a well-founded certainty. But the hypothesis that smallpox vaccination protects against the more severe course of monkeypox is solid. And if so far it has laid the foundations on what has been found in previous epidemics in Africa, today it is starting to find confirmation in Italian hospitals.
Those over 40 already vaccinated against smallpox and who in recent weeks have come into contact with Monkeypox have not been able to avoid the infection. But they faced an asymptomatic or otherwise mild infection. Without ever having to resort to hospitalization in an infectious disease ward. Although the study sample is small, this is the message that emerges from a work just published in the “Journal of Medical Virology” by a group of specialists from the Sacco hospital in Milan and the Gemelli hospital in Rome.
Does smallpox make monkeypox less severe?
The article describes the course of infection in six patients, aged 41 to 64 years: all vaccinated with both doses during childhood. Men who, following the appearance of nonspecific symptoms – fever, headache, diarrhea, asthenia – or contact with positive people have been subjected to the molecular swab and discovered that they have been infected with the virus that causes monkeypox. In four cases, the disease also manifested itself with skin blisters, in different parts of the body. But none of them needed hospital treatment.
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“These are preliminary evidences, which, pending more robust data, seem to confirm a protective effect caused by vaccination against smallpox – he says. Davide Moschese, medical director of the infectious disease clinic 1 of the Sacco hospital -. Four patients had very vague and mild symptoms and only sought health care because they were certain they had had close contact with an already positive person. This in all likelihood confirms a protective effect caused by vaccination. “Prophylaxis, which, in some cases, dates back to over 45 years ago. A sign that protection remains adequate for a sufficiently long period of time.
Vaccination in progress (but not for everyone)
In the past, other studies had already confirmed an efficacy of 85 percent of Imvanex – this is the name of the smallpox vaccine – against other viruses of the same family of smallpox. The benefit, in the absence of tests capable of measuring the amount of antibodies released by vaccination, is currently difficult to quantify. But about its opportunity for certain categories of people – homosexuals, bisexuals and all those who have relationships with a high rate of promiscuity – there seems to be no doubt.
“In the current epidemic, the infection from man to man has become prevalent – adds the specialist, the first signature of the publication -. And among the various possible modalities, the sexual one is determining the greatest number of cases. This hypothesis is also consolidated in our work, through the detection of the viral genome in urethral swabs carried out in two patients. That is why, through associations and clinics that treat sexually transmitted infections, we are trying to reach those who represent the most sensitive target for this type of infection “.
An important step to stem cases, since the greatest number of infections is being recorded among men between the ages of 35 and 40. Individuals who, as he remembers Spinello Antinoridirector of the 1 del Sacco infectious disease clinic, “were born after 1980 and consequently are not vaccinated against smallpox”.
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Among them also some women, to whom vaccination is not precluded: as long as they fall within the categories listed in the circular of the Ministry of Health of 5 August. The possibility of a recall is also foreseen for those who, although already vaccinated with Imvanex, belong to one of the groups indicated by the ministry.
Few cases that require hospitalization
In general, the current monkeypox epidemic does not appear to lead to particularly serious infections. In another study published in the “Journal of Infection”, the same specialists of the Milanese infectious disease center described the course of the infection in 32 patients. Complications involved seven of them: four of which were forced into hospitalization. Currently, most infections are managed at home, using drugs to relieve symptoms.
“On the basis of what we have seen so far, we can say that hospitalization is becoming necessary only in the presence of bacterial superinfections, severe pain reported by patients or the difficulty of isolating oneself at home – concludes Antinori -. In all other cases, the course of the disease is generally benign. And the infection tends to vanish within 15-20 days “.
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