It was published by the researchers of the National Institute for Infectious Diseases Lazzaro Spallanzani, in the latest issue of Eurosurveillancethe scientific journal of the European Center for Disease Prevention and Control (Ecdc), the article describing the first four cases observed in Italy of monkeypox (Monkeypox) all in male persons. The Infectious Diseases Unit of the San Donato hospital in Arezzo also collaborated in describing the cases, where one of the patients affected by the disease was hospitalized in recent weeks. The person then returned home in late May. To date, Sunday 5 May, 780 cases have been registered in 27 distinct countries.
What the study says
From the analysis of epidemiological and clinical data and from the study of the various biological samples in which the virus was identified, – explains theberaking latest news – the hypothesis of transmission by direct contact during sexual intercourse is considered plausible. The characteristics of these four patients “reflect those described in other European countries in the current outbreak. The phylogenetic characteristics of the virus could support the hypothesis of a recent introduction of the West African clade of MPXV in the community of non-endemic countries. In addition, the characteristics of the population involved. , as well as reported exposure to multiple sexual contacts without condoms, suggest that human-to-human transmission through close physical contact in sexual networks plays a key role in the current outbreak. Further studies are needed to evaluate the presence, persistence and the contagiousness of Mpxv in various body fluids “we read in the conclusions of the article. “We have to consider – the researchers clarify – that many other viruses that cause viraemia can be found in semen without direct evidence of sexual transmission. Indeed, viral seeding in the male reproductive tract can frequently occur in the context of viraemia, as blood-testicular barriers are imperfect for viruses, especially in the presence of systemic or local inflammation. Since the testes are an immunologically privileged sanctuary (…) the virus can persist even if it is unable to replicate within the reproductive tract. “
In essence – continues the agency – the study represents, together with two other rapid communications by British and Portuguese researchers published in the same issue, the first detailed description of the disease, in the context of the outbreak that is affecting several European and non-European countries. “The clinical description, to our best knowledge, of the first four monkeypox cases detected in Italy deserves further investigation for several reasons. First, it has been suggested that the MPxv in the current epidemic is transmitted. human-to-human, although this route of transmission has been reported as poorly efficient in previous outbreaks caused by the West African clade. – reads the article – the clinical picture appears to be different from the information available in the literature because the skin lesions in our patients were asynchronous, ranging from single spot or cluster to umbilicated papules with progressive central ulceration and, finally, to crusting. The lesions were mainly located in the genital and perianal sites. Finally, individuals affected by monkeypox are mostly men. In endemic areas, most cases have been observed in men, possibly related to hunting practices, while in the current outbreak most individuals are MSM (men who have sex with other men), people with multiple sexual partners or people who have sex without a condom. “
The sexual behavior of the cases in this series and the initial appearance of lesions mainly in the anal and genital areas “suggest that close contact during sexual intercourse was important for transmission of the virus. Semen obtained from three monkeypox patients within the closest time (5-7 days) to onset of symptoms was positive for the Mpxv DNA in all four patients, with a cycle of quantification (Cq) range from 27 to 30. The correlation between Cq value and infectious viral load in Mpxv infections is not yet known, but the range of values of Cq that we measured in semen makes viral isolation unlikely. However, the detection of viral DNA in the three semen samples we analyzed excludes the hypothesis of contamination of the biological sample. Although these results cannot be considered definitive evidence of infectivity, demonstrate a viral spread whose efficiency in terms of transmission cannot be excluded. It has been observed that it is probable that MPxv can be transmitted through substances of human origin – conclude the Spallanzani scholars – and it should be emphasized that the Cq values in the seminal fluid of our patients were in the range of those measured in their nasopharyngeal swabs “.