Scientists are beginning to learn more about monkeypox and can now identify specific symptoms, several months into the outbreak. They confirm one thing: monkeypox is transmitted mainly during sexual intercourse.
Three months after the start of the epidemic, nearly 28,000 cases have been confirmed worldwide and the first deaths are beginning to be reported. In this context, it is essential to better understand the disease in order to better combat it.
Who are the most affected people?
Monkeypox has certainly been known for several decades in some ten African countries. But the current epidemic has many peculiarities, the first of which is the profile of the patients. It is mainly adult men who maintain homosexual relationships, unlike what is observed in Africa, where the disease affects many children in particular.
In recent weeks, three studies, published in the main medical journals of reference -the British medical journal (BMJ), the Lancet and the New England Journal of Medicine (NEJM)-, drew a clinical picture of the current epidemic, although it is only an initial work and carried out from a few hundred cases. They confirm that the disease mainly affects men who have homosexual relationships. In each study, they represent almost all patients.
How is monkeypox spread?
The prevalence of this profile is not surprising because, largely documented by initial observations, it has largely guided the recommendations of health authorities. Above all, it leads to another question. Given that the common point of the patients refers at the moment to their sexual activity, is the disease transmitted by it?
The issue is sensitive because some public health specialists fear stigmatizing gay people by attacking their sexual relationships. But recent studies are clear. “Our work supports the idea that body contact during sexual activity is the dominant mechanism of transmission of monkeypox” in the current epidemic, summarizes the Lancet study, carried out in several Spanish hospitals. This conclusion is based in particular on the fact that the viral load was much higher in the patients’ skin lesions than in their respiratory system.
Thus, the observation seems to undermine the idea, proposed by some researchers, that airborne transmission also plays a role in contamination. However, this does not mean that the disease is transmitted through semen. The hypothesis is not excluded, but current research is far from proving it.
What are the symptoms?
The three studies also confirm that the current epidemic is distinguished by its symptoms. “They differ from those observed in populations affected by previous epidemics” in Africa, this is how the BMJ study summarizes, whose observations were made in the United Kingdom. It is true that two central elements of the disease are still largely present: a bout of fever, sometimes accompanied by muscle pain, and lesions on the body, which later turn into scabs.
But the details vary and the question is surely linked to that of transmission because, in recent patients, certain physical manifestations associated with contamination during sexual intercourse appear. In each study, the lesions were often concentrated in the anus, penis, and mouth. To this are added complications very little observed until now: inflammation of the rectum or edema of the penis.
What about the severity of the disease? About 40% of cases were subject to complications, according to the Lancet study, and a fifth were hospitalized according to the NEJM study. However, in the latter, “no serious complication has been identified”, clarifies this latest work, evoking “reassuring” data.
Although this work provides a better understanding of the disease, many questions remain unanswered. This is particularly the case with the effectiveness of vaccines. The Lancet study shows that a significant proportion (18%) of patients had received a smallpox vaccine, which supposedly protects against monkeypox. But the delay between vaccination and disease, sometimes several decades, may explain this lower protection.
Ultimately, it remains to be seen whether you are at higher risk when you have another disease. Almost half (40%) of the patients studied in The Lancet were infected with HIV. But it is impossible to know if there is a direct link or a simple correlation.
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