Two days ago, Monday 8 August, the vaccination campaign against Smallpox of monkeys. Although the Ministry of Health does not require or suggest vaccination, there are categories that are more at risk than others. Professor Pierluigi Vialedirector of the Infectious Diseases department of the Sant’Orsola Polyclinic and professor at the University of Bologna, explained to Bologna Today what kind of disease it is and which categories are most at risk.
What are we talking about when we talk about monkeypox?
A disease transmitted by a virus that is in the family of poxvirus. Inside this are all the smallpox viruses: that of humans that no longer exists, of dogs, cats, monkeys, cattle. This is a virus that made the leap in species from apes to humans in the 1970s and has always given some sporadic cases exclusively in Africa. In the 90s there were then some cases in the United States and now it has an epidemic trend in Europe as well. It is nothing even remotely comparable to Covid in terms of numbers, but in short, let’s say that it is a virus that has evolved and adapted to humans already fifty years ago and which has now become a disease with an easier transmissibility. It is basically transmitted like all smallpox viruses, therefore by close contact, even if the Spallanzani in these days has shown its presence also in the sperm. We can therefore say that it is a sexually transmitted disease: it is linked to the close and intimate contact that occurs during sexual intercourse and perhaps also through the sperm.
And the comparisons with Covid?
None, at least in terms of transmissibility. Covid is transmitted by air, this is transmitted with a type of contact that we can define as sexual. In terms of dangerousness, then, we can say that it is not a disease with a risk of death. It tends not to give serious cases. But it is a contagious and transmissible disease, so any case is potentially an alarm because one patient can infect many. There is therefore a question of social conscience: at the first symptoms you have to be examined because you are potentially contagious for a sexual partner or for a cohabitant with whom you have close relationships.
Who is the vaccine for?
There is an important issue to consider. All the population born after ’72 -’73 did not vaccinate against smallpox, because since 1981 that vaccine was repealed in Italy as human smallpox had disappeared. That vaccination there gives a lot of coverage against Monkeypox. There is therefore an indication to give the vaccine to all people who are at risk of transmission. Throughout Italy there are about six hundred cases: five hundred and ninety of these occurred in MSM (In English: Men who have Sex with men, or men who have sexual relations with other men, ed). It is clear that, having to start distributing the vaccine, we start with the MSM category.
How many cases are there in Bologna and how many vaccines are available in the area? Which subjects to vaccinate as a priority?
In Bologna there are currently about thirty cases and about two hundred vaccines available. We started vaccinating the first subjects yesterday. We, the subjects to be vaccinated, pick them up among the patients who belong to the divisions of infectious diseases that ask for HIV prophylaxis. People who come to our centers and ask to be able to adhere to the pre-exposure prophylaxis for HIV, the so-called PrEP, are people who tend to have more risky sexual behaviors, because they intend to have unprotected intercourse. Being people who already belong to infectious disease clinics, there is the possibility of making a selection among the most promiscuous ones. Everyone knows their sex life and of course there is no exam for it. However, if a patient asks for PrEP we assume that he is a person who has unprotected sexual activity. At that point, we ask if he thinks he needs to get the Monkeypox vaccine. They are followed patients, so it is easier to be able to interview the patient’s sex life. When asking for PrEP, the patient accepts being asked why. Our goal is to broaden the scope: when we have not only two hundred doses of vaccine but two thousand, then we will ask all patients who ask for PrEP and those who go to clinics for sexually transmitted diseases. These are the people most at risk right now. Apart from that, there is also the category of laboratory workers. For example, if a person shows up who has a Monkeypox vesicle and that vesicle is ruptured and a swab of the leaking liquid is made, that swab will then be handled in laboratories. The staff of these laboratories work in safe conditions, but it can always happen that a glove breaks or that there is a break in control measures. These people are offered the opportunity to get vaccinated against Monkeypox.
Of course, this is an evolving situation.
At the moment, a few thousand doses of the vaccine have been distributed and only in four regions. As it is seen that selection works and that there is acceptance of the vaccine by these people, increasing the doses will also fall the selection barriers. In a few months, when it goes up to speed, an offer of Monkeypox vaccination will be made for MSM people who have promiscuous sexual behavior. It will work normally: the citizen will show up and ask to be vaccinated, each according to his conscience.