According to the latest bulletin of the World Health Organization, there have been more than 44,000 cases of monkeypox registered outside Africa since last May, an increase of 26 percent compared to seven days earlier. In Italy there are 714 cases, that is 52 more than in the previous week. Symptoms of monkeypox (in English monkeypox or Mpx) are among others fever, headache, swollen lymph nodes, muscle aches and, a few days after the first symptoms appear, a rash with lesions that develop into blisters, pustules and scabs. Treatments are mainly symptomatic and supportive, but symptoms usually resolve spontaneously in 2-4 weeks. Cases of death from MPX are extremely rare and almost always concern people already suffering from other diseases.
At the moment, people affected by the virus outside Africa continue to be overwhelmingly men who have sexual relations with men (from English men who have sex with men, msm). The fact that the virus is currently circulating mainly among queer men has generated some confusion in public opinion from the beginning about how it is transmitted: MPX, which was discovered in the 1970s, is not a sexually transmitted disease. . It is a virus present in African rodents that can be transmitted from person to person mainly through contact: close skin-to-skin contact, wounds and lesions or through the exchange of body fluids and respiratory secretions. The rashes that characterize the evolution of the disease, and the subsequent scabs, are particularly infectious.
Sexual intercourse is therefore only a type of close contact that can promote infection, but in the same way that close contact between a mother and her daughter could, for example. At the moment, the fact that the virus is circulating among men who have multiple sexual partners does not depend on a specific characteristic, but is only one of the possible transmission channels. In the case of transmission through sexual intercourse, the rash is concentrated in the genital and anal area, which can make the disease extremely painful.
Perhaps mindful of the poor management of the AIDS epidemic in the 1980s and 1990s, in the first weeks of the MPX outbreaks outside Africa, medical personnel and the media showed a certain embarrassment and sometimes even difficulty in finding a balance between the will. not to create a stigma around the homosexual community and the fact that that group of people was actually the one almost exclusively affected (of the current 714 cases in Italy, 704 are men).
Effective vaccines
Today, vaccination campaigns in the United States and Europe, including Italy, are rightly focusing on the population group most susceptible to contracting the disease. Vaccination against smallpox (practiced in Italy until 1981) seems to have good efficacy also against MPX, but at the moment there is no specific vaccine for this disease. However, the efficacy of the latest generation smallpox vaccine, MVA-BN, marketed as Imvanex in Europe and Jynneos in the United States, has been demonstrated. The problem is that the only pharmaceutical company in the world that produces it, the Danish Bavarian Nordic, was not ready for the sudden increase in demand and for now cannot produce enough vaccines. And given the scarcity of available doses, many countries have therefore decided to give priority to those most at risk. In the United States, in addition to direct contact with an MPX positive person, the criteria for being declared eligible for the vaccine are being a man who has sex with men, having multiple sexual partners in the past few weeks, and living in a geographic area. where the virus is actually spreading.
In Italy, however, as in most European countries, in addition to laboratory personnel with possible direct exposure to the virus, the vaccine request form identifies gay, transgender, bisexual and other MSM men who fall within these risk criteria:
– Have you had a recent history (last three months) with multiple sexual partners?
– Did you participate in group sex events?
– Did you participate in sexual encounters in clubs / clubs / cruising / saunas?
– Have you had a recent sexually transmitted infection (syphilis, gonorrhea, chlamydia) with at least one episode in the past year?
– Are you used to the practice of associating sexual acts with the consumption of chemical drugs (chemsex)?
Without answering yes to at least one of these questions, you are not considered eligible to receive the vaccine (and its booster a few weeks later). The questions posed on the form, however, could create some problems: although the pragmatic and not pruritic approach to the question is appreciable, there is the doubt that the request so detailed for sexual practices that many consider private could be a deterrent to requesting the vaccine. The form does not specify in any way who will have access to this information and where it will be stored. As much as one might imagine that they fall into the category of sensitive information between doctor and patient, many may not feel comfortable putting pen to paper – and sending to a generic email address – that they participate in group sex meetings where it is used. of drugs.
However, the problem does not arise at the moment: so far the vaccine doses reached Italy have been five thousand, distributed among the regions in proportion to the diagnosed cases, which have all been booked within a few days. For now, therefore, the vaccination campaign is almost symbolic, given the very low number of people who have benefited from it. By the end of the month, however, another 12 thousand doses are expected in our country and, in the coming weeks it will be crucial to be able to convince the highest possible number of men who have sex with men to get vaccinated to stem the spread of the virus.
“At this moment the infection is amplifying in the community of males who have more male partners, but it can escape from that circle of people and infect families,” wrote the virologist Ilaria Capua on 2 August in Corriere della Sera. “People living in contact with currently infected people could be infected, including children, who will go to school from September. And there we know that it is really difficult to control infections ”.