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Monkey pox, how to avoid contagion

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Monkey pox, how to avoid contagion

That the guard against the monkeypox epidemic is high is shown by the green light of the European Commission for the vaccine Imvanex, already authorized against smallpox in 2013. A decision taken on the eve of the decision of the World Health Organization that spoke for the first time of a global health emergency. Worrying is (above all) the spread in Europe.

In Europe, 80% of new cases

It should be noted that there are no points of contact between monkeypox and Covid-19. “There are many aspects of this epidemic still to be clarified, but it is to be excluded that another tsunami such as the one from which we are still struggling to get up”, is one of the few certainties with which he reckons. Elio Manzillo, director of the department of infectious diseases and infectious diseases of the Cotugno hospital in Naples. For the rest, it is almost everything to discover. Hence the need to take all necessary precautions. A maximum alert, especially for the countries of Europe. Where monkeypox was the exception, 80 percent of new cases are now registered.

Why the global health emergency?

But why was it necessary to raise the guard? “When an epidemic crosses the borders of a certain geographical area and cases of the disease spread in a relatively short time to other countries causing thousands of cases, the declaration of the global alert is a serious invitation to all states to act. promptly to contain and if possible control the cases – he explains Maria Chironna, head of the molecular epidemiology laboratory of the Bari university hospital -. Even before Saturday, the nations most affected by monkeypox had given precise indications on surveillance, case definition, assessment and control measures. From now on, however, all these actions will be structured in a more capillary and systematic way to identify any possible contagion, to prevent them from increasing: thus leading the epidemic to have significant health consequences.

The situation in Italy

Of greater concern is the risk of monkeypox transmission in Europe, where over ten thousand cases of infection have occurred. That is 80 percent of infections: a high rate compared to that recorded in the rest of the world. A sign that an infection normally reported in few circumstances and the result of importation from countries where “Monkeypox” was already endemic, is now a widespread reality. The guard is high, even in Italy where 407 cases have been recorded so far. With a tendency to stabilize.

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In Italy reporting system

“At the moment it is believed that these numbers should not cause particular alarmism – he says Gianni Rezza, director of prevention of the Ministry of Health -. Together with the Regions and the Autonomous Provinces, we have however set up a reporting system for individual cases. “Adds Manzillo:” Fortunately, we are observing minor cases, similar to those found in some West African countries. ” common symptoms detected so far in patients are those of a systemic infection: fever, lethargy, pains in muscles and joints, headache. These are rather general manifestations, but they must become a source of concern at a later time. That is when skin lesions appear. : vesicles which are found mainly in the genital areas, on the limbs and on the face.

What do we know about the infection?

But how is this disease transmitted? “To date we know that the virus can be transmitted in a fairly heterogeneous way: through direct contact with skin lesions, inhalation of respiratory secretions during prolonged close face-to-face contacts, through sexual activity, contact with surfaces contaminated by skin lesions and vertically: that is, from the pregnant woman to the fetus, through the placenta “, points out Chironna, who is also professor of Hygiene at the University of Bari.

The sexual infection (but not only)

Of all these avenues, the most suspected at the moment is the sexual one. Basically for two indications of an epidemiological nature: the low number of infections among women (just two, in Italy) and the high number of cases recorded among men who have sex with men. Out of a total of 528 people infected in Europe during the spring, according to what emerges from a study published in the New England Journal of Medicine 517 were gay or bisexual. “If smallpox was transmitted mainly through saliva droplets, that of monkeys appears to be mostly a sexually transmitted disease”, explains Manzillo. But woe betide – also on the basis of the experience with HIV – to speak of a risk that only concerns homosexuals.

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The greatest number of infections among gays

“Creating risk categories, at this stage, is wrong. And it can be harmful, inducing all those who do not belong to you to consider themselves safe.” Considering that at the moment there is no clear evidence of transmission of the virus through seminal fluid and vaginal secretions, only hypotheses can be made to explain the greater number of infections among gays: from the greater tendency to promiscuity to the practice of anal sex, which more frequently (compared to vaginal intercourse) creates lesions in the mucous membranes. Access doors that the virus uses to make its way into another organism.

Tips for the summer

The current season is not the most suitable to put a stop to the infections. In fact, summer is the time of the year when sexually transmitted infections spread. An awareness that must apply to all these diseases, to which this year we must add monkeypox. How to behave in sight or during the holidays? “There is no indication to limit travel – the two experts agree -. But it is necessary to pay attention to sexual activity, paying attention to intense and promiscuous relationships. And avoiding having it with people who show injuries or symptoms that do suspect this disease “.

Prevent with a condom

The tool for prevention exists: it is the condom. Given the possible other ways of transmitting the virus, alone it may not be enough. But it is still the most effective barrier available against sexually transmitted diseases. “Since the risk is to underestimate some clinical manifestations, it is good to contact your doctor or infectious disease centers in the presence of suggestive symptoms – specifies Chironna -. It could be something else. Given the alert, however, it is better to investigate through a epidemiological investigation and some specific tests. No stigma, but correct information for citizens can make the difference in controlling the disease “.

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How will the epidemic evolve?

Autumn will represent a first litmus test of the epidemic, returning a clearer picture of six months of infections in the Old Continent and the extent of the impact determined by the summer season. At that point, with more information available, it will be necessary to decide whether to give the green light to an ad hoc vaccination campaign. Strategy already recommended by Germany, France and Great Britain to those who have come into contact with infected people. Those who are already immunized against smallpox – in fact almost all the over 45s – are currently considered more protected than the younger ones.

Will prophylaxis be needed?

The extent of these defenses, however, is another aspect that epidemiologists intend to verify over the months. And of the infections. Should prophylaxis be necessary, the production and distribution of the vaccine should be stepped up. In this sense, the decision adopted by the European Commission testifies to the desire to be ready for a possibility no longer considered remote.

The effectiveness of an antiviral

On the therapy front, new evidence of efficacy will be sought for tecovirimat, an antiviral used in veterinary medicine in the treatment of monkey and bovine pox. It was authorized a few weeks ago – first by the European Agency and then by the Italian Medicines Agency – in the most serious cases of infection in humans. In a study published in recent weeks in the journal The Lancet Infectious Diseases the drug was shown to reduce the time span in which infected people exhibited symptoms of monkeypox and the period of contagiousness. An indicator, the latter, whose duration is still unknown.

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