What we know so far about monkeypox – Massimo Sandal

Since May 7, when a British traveler returning from Nigeria was diagnosed with monkeypox, at least three hundred cases have been recorded in 22 non-African countries including Italy. The first of these was diagnosed on May 19 at the Spallanzani Institute in Rome, in a young man who had returned from a holiday in the Canary Islands. The Italian cases quickly rose to ten.

Monkeypox has been a known virus since the 1950s, and had already appeared in Europe in 2018. But it is the first time that it has spread sustainably outside West and Central Africa, where it has been endemic since 1970. contracted by animals – not just monkeys, despite the name, more often African rodents and dormice – while it is more difficult to pass from person to person.

It is not yet known why the virus is spreading right now. The virus appears similar to known strains and in any case poxviruses, the family to which both monkeypox and human smallpox belong, in general tend to mutate less easily than rna viruses such as sars-cov-2. But some virologists, including Trevor Bedford of the Fred Hutchinson Institute in Seattle and Stefan Rothenburg of the University of California, do not rule out that it is a strain more capable of being transmitted from person to person, and argue that poxviruses can evolve rapidly. However, these are hypotheses yet to be proved.

The virus is transmitted through close physical contact, including sexual intercourse, but also through contaminated objects, such as bed sheets, which can still be infectious after many months. It does not appear to be transmitted by air. In any case, the ministry of health recommends wearing the ffp2 mask for health workers in contact with the infected. According to the European Center for Disease Control, there is a suspicion that the infection has spread through sexual intercourse with multiple partners.

The current epidemic is due to the mildest endemic virus strain in West Africa, with a lethality of 1-3 percent. In Western countries, which have better health facilities, the risk is likely to be lower and there are currently no reports of deaths outside Africa. However, monkeypox is bothersome and potentially debilitating.

After an incubation of 5 to 21 days, the first symptoms are fever, body aches, fatigue and headache. Within three days, the formation of pustules begins: a typical sign is their appearance on the soles of the hands and feet. The disease usually resolves in 2-4 weeks; in some cases the lesions can leave permanent scars on the skin or damage to the cornea, and therefore damage to vision. The disease tends to be more severe in children, HIV-positive people and pregnant women, as well as those who are immunosuppressed.

The good news is we already have a vaccine. In fact, human smallpox vaccines are about 85 percent effective against monkeypox. In Italy, people born before 1977 are already vaccinated against smallpox. There are indications that the vaccine may immunize for decades, but officially full protection is only guaranteed for 3-5 years.

The European Medicines Agency (EMA) in 2013 approved a new smallpox vaccine, Imvanex, much safer than the vaccines historically used in the 1960s and 1970s, now no longer authorized. It will serve as a prophylaxis for close contacts and healthcare professionals if administered within four days of exposure to the virus.

In case of emergency, however, Italy, according to sources of the Higher Institute of Health, has five million doses of the vaccine available, which can rise to twenty-five million if diluted. As for drugs, the only one that exists is tecovirimat, approved in January 2022 by the EMA.

Many questions still remain, but unless new discoveries are made, it seems unlikely that the virus will cause a new pandemic. Unlike covid-19, monkeypox is hardly transmitted, has identifiable symptoms, and vaccines already exist.