Nearly 17,000 cases in 74 countries in three months are too many for an epidemic. The World Health Organization (WHO) has declared that monkeypox is a “global emergency”.
Experts gathered in Geneva since Thursday to discuss the virus that mainly causes fever and skin lesions had actually failed to reach a consensus. The general director Tedros Adhanom Ghebreyesus then he intervened with his own decision: the circulation of the virus which began in May corresponds precisely to a “global emergency”.
What does “global emergency” mean
The definition was recently used by the WHO for the Zika virus (it was 2016), which mainly affected Latin America, and for the major Ebola outbreak in 2014 in West Africa. The coronavirus, before rising to pandemic level, had also gone through this stage.
The announcement by the Geneva Organization does not mean that monkeypox is particularly dangerous or lethal. Out of over 16 thousand cases so far there are 5 victims, all in Africa. Sometimes patients are given an antiviral that is not too effective, but in general the disease regresses on its own without particular problems.
In Italy so far there have been 407 cases. “The situation is under constant monitoring, but it is not considered to cause particular concern” said the director general of prevention of the Ministry of Health. Gianni Rezza. In Europe, where 80% of cases are concentrated, the risk of contagion is considered by the WHO to be “high”.
Because the virus has become more contagious
A more dangerous strain of monkeypox exists in Congo and Nigeria than has spread elsewhere. But what took place outside Africa in May was a qualitative leap in the broadcast that surprised many experts. In fact, the traditional disease has been known since 1970 and in African countries it is transmitted mainly due to direct contact with animals: small rodents are more dangerous than monkeys.
The virus that has spread considerably outside Africa in the last three months is instead capable of spreading efficiently from one individual to another, not only due to animal contact.
The analysis of the microorganism’s genome has shown about fifty mutations: it is possible that they are the origin of this change of pace in contagiousness. Currently, the replication index R is estimated at around 1.5. If the calculation were correct, it would mean that the epidemic is still growing.
Outbreaks among men who have sex with other men
Another peculiarity of monkeypox was highlighted yesterday by the WHO: “99% of those infected are males and 98% are MSM”. The acronym indicates men who have sex with other men (men who have sex with men).
No reasons have been identified why the virus should infect one gender more than another, nor types of sexual intercourse more at risk than others. The causes of this spread are probably epidemiological, linked to the network of relationships that the infected had among themselves.
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“Although I am declaring a global emergency of international concern,” Ghebreyesus explained today, this is a concentrated epidemic among men who have sex with other men, especially those with many partners. He means that the epidemic can be stopped if we use the right strategies aimed at the right groups ”.
The question of sexual transmission
The main mode of transmission of smallpox appears to be contact with lesions on the skin. The disease causes papules that last a couple of weeks and contain viruses. In the original outbreak they were spread throughout the body. In the cases observed from May outside Africa, the blisters are concentrated in the genital areas.
The virus was also found in saliva and semen. Despite this, the definition of smallpox as a sexually transmitted disease is still controversial. Skin contacts and droplets (the famous droplets that also transmit the coronavirus) are enough to infect. Among other things, this means that the condom does not protect during sexual intercourse.
Some countries, primarily Great Britain and the United States, have started offering vaccination to people at risk: MSMs who have promiscuous sex and health workers who treat infected patients.
The vaccine for monkeypox does not really exist: there are only small quantities of the vaccine against normal smallpox, produced in small quantities as a precaution despite that virus has been eradicated (thanks to immunization). The only industry involved – the Danish Bavarian Nordic – is working at full speed to answer the sudden demand.