Smallpox of monkeys, the fourth case in Italy confirmed today. It is a young man from Arezzo who discovered he contracted the virus after a trip to the Canaries. The Tuscan patient is added to the first three confirmed cases, admitted to the Spallanzani hospital in Rome. “The three patients – explained the Lazio health councilor Alessio D’Amato – remain in good clinical condition. While there are 15 people in solitary confinement in our region».
At the moment, there are 92 overall cases in the world in 12 countries (Australia, Belgium, Canada, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, the United Kingdom and the USA). But what are the symptoms to watch out for? And what therapy to adopt in case of infection? We talked about it with Matteo Bassetti, director of the Infectious Diseases Clinic of the San Martino Polyclinic in Genoa.
Prof. Bassetti, what is monkeypox?
Monkeypox, first isolated in 1958, is a virus that affects not only monkeys but other primates and rodents as well. In the 70s the human version is also described, with transmission from animal to human. And now the last man-man leap. This last phase is characterized by human-to-human transmissions, globally distributed. Which with difficulty we manage to place in a single initial cluster. The two outbreaks reported so far are the sauna in Madrid and Gay Pride in Gran Canaria. But beyond these two specific episodes, there are other unrelated ones. To contain the phenomenon, it is necessary to understand where the cases come from. And if this fails, it can cause concern.
What are the symptoms to watch out for?
Symptoms are nonspecific such as fever, headache, fatigue, swollen lymph nodes near the site of the lesions. But the main symptom is skin lesions that can be located anywhere on the body. There is a centripetal distribution from the face to the limbs. Also close to the genitals. The pustules are larger than those of chickenpox, resemble those of syphilis.
How is monkeypox transmitted?
It is transmitted by contact with lesions, therefore also by sexual contact. Or with saliva. Transmission is more difficult than that of Covid. It occurs above all in continuous and very close relationships.
When to call the doctor and what is the therapy to be adopted?
There is no specific therapy, non-specific symptomatic medications are used for monkeypox. The course of the disease can be characterized by two phases: the first milder in which, in fact, symptomatic therapy is used. But in some rarer cases, there may also be a more severe phase, with lung or other organ involvement. In this case, antiviral drugs such as cidofovir can be used. But there must be a careful diagnosis from the doctor.
Today fourth case of monkeypox in Italy, is there an emergency?
It is right to raise awareness and make them understand that if they have abnormal lesions they should immediately contact specialists. There is no emergency, but the numbers will grow. In the coming weeks we will have many more cases, we are facing an attentive situation. This virus is less transformable than Covid, so there is less risk of variants. But it is always a living entity and we must make sure that it does not pass from one person to another. It is therefore necessary to contain its spread, by isolating the infected at home or in hospital. Among other things, the incubation times are longer than those of Covid, up to two weeks. For this reason, cases will triple in the next 15 days.
Does the smallpox vaccine protect? Who has not received it, will he have to undergo the vaccination?
The smallpox vaccine offers 85% coverage against contagion and excellent coverage against serious illness. Around 50% of people in the world are vaccinated against smallpox. If the number of cases were to increase, we could think about the vaccination strategy to follow: for example for young health professionals who are not vaccinated and the frail. But at the moment it is still premature to talk about the vaccine.
Is there a risk of a new pandemic? Belgium has reintroduced the quarantine for the infected.
There is currently no risk of a major pandemic, but it is a situation to be watched for. I think that even those who have had certain contact with an infected person must remain in isolation and be attentive to relationships. It is a disease that worries but does not frighten. We are not facing a new problem, Covid was a new virus, here we are facing something known.
What is the difference with “traditional” smallpox?
Traditional smallpox is a different, more aggressive disease with 30% mortality. With monkeypox, the lethality rate is around 1%.
Why are new viruses emerging?
These problems have always been there. But the world has made a mistake, in the last 40 there has been little focus on the research of infectious diseases. Modern technology was not interested in viruses, diagnostics lagged behind. Thanks to Covid, diagnostics and skills have improved. And today there is greater media attention on these issues and of doctors themselves.