Men under the age of 40 who have sex with men bear the brunt of the monkeypox virus in the first few months since cases began to spread around the world.
Experts warn that this does not mean, however, that other individuals are free from the threat: as the virus spreads around the world, it tends to infect more and more people than do not fit this initial profile.
In the United States, for example, the first two cases of this infection in babies have already been detected.
“It is a matter of weeks before we begin to see more cases in other groups, such as heterosexuals or children,” predicts the doctor Nésio Fernandes, president of the National Council of Health Secretaries of Brazil.
“This is the expected natural history of the disease,” he adds.
Current profile of those most affected by monkeypox
One of the major studies evaluating this question was recently published in The New England Journal of Medicine.
In it, experts from Queen Mary University of London, in collaboration with several other British institutions, evaluated 528 cases of monkeypox that occurred between April and June in 16 different countries.
The numbers show that 98% of the patients declared themselves homosexual, bisexual or men who have sex with other men. Three quarters of them said they were white and 41% were HIV positive.
The mean age of the individuals evaluated was 38 years and 95% had sexual intercourse as the main suspicion of contact with monkeypox.
As for symptoms, the study found that 95% had skin irritation (two-thirds had fewer than ten lesions).
In 73% of the participants, the location of the sores was in the region of the anus and the genitals, while 41% presented irritations in the mucosa of the mouth.
Among the general symptoms, 62% of the patients presented fever. Other common signs were swollen lymph nodes or “lumps” (occurring in 56% of participants), lethargy (41%), muscle pain (31%), and headache (27%).
The average incubation period, or the time between contact with the virus and the appearance of symptoms, was seven days. But some people took anywhere from three to 20 days to get the first signs of monkeypox.
Inform without stigmatizing
Specialists consulted by BBC Brazil clarify that it makes no sense to see only men who have sex with other men as a risk group for this virus.
“The concentration of cases in these individuals is a thing of the moment and each disease has its own dynamics,” highlights doctor Alexandre Naime Barbosa, vice president of the Brazilian Society of Infectious Diseases.
“We already have at least 70 or 80 children in the world diagnosed with monkeypox and half of them are under four years old,” calculates the specialist, who is also a teacher at the Paulista State University.
The main mode of transmission of monkeypox is direct contact with the wounds of someone infected. That is why it has been shown that sexual intercourse, where there is skin-to-skin friction, is one of the most frequent sources of infection.
But this virus can also be transmitted through droplets of saliva or through contaminated objects such as dishes, towels and sheets.
A fourth way to contract monkeypox is through close proximity to animals that carry the pathogen; this, incidentally, is one of the main forms of transmission in regions of Africa where the virus has been endemic for decades, especially in wilderness areas.
The World Health Organization (WHO) describes that this mode of infection can occur through direct contact with blood, body fluids and skin lesions of infected animals, such as rodents and primates.
In the opinion of the infectologist Mirian Dal Ben, from the Sirio-Libanés Hospital in São Paulo, all these forms of transmission (especially sex, saliva and contaminated objects, which spread the disease to several countries) mean that “sooner or later, monkeypox will create chains of transmission in other subgroups.”
“It is not a disease restricted to one profile or another,” he says.
“And it seems that we are so afraid of stigmatizing some groups that we are not able to offer adequate guidance to those who are most at risk at the moment,” says the doctor.
How to protect yourself and others
The first step is to be aware of the symptoms and seek medical evaluation if they appear.
“Any lesion that begins with an edema or a small redness and evolves into a stain, has fluid, forms a wound and scabs, it could be monkeypox”, describes Barbosa.
These manifestations can appear in the anus, genitals, face and hands.
“This lesion can also be acne, herpes, shingles, or a host of other things. But when in doubt, it is important to seek medical attention and get tested,” he adds.
If the examination confirms the presence of this infectious agent, health professionals recommend isolation and avoid close contact with other people until the wounds are completely healed (even their scabs still carry the virus).
By limiting interaction, the patient reduces the risk of transmitting the virus and avoids the creation of new chains of contagion in the community.
In most cases, the condition progresses well and the person recovers after a few weeks. The British study revealed that 13% of the patients in follow-up required hospital admission, the main reasons for admission being severe pain in the anus and rectum, opportunistic infections and, more rarely, pharyngitis, ocular trauma, acute renal failure and myocarditis (a type of inflammation in the heart).
Some countries, such as the United Kingdom, Spain and the United States, have already started a vaccination campaign against monkeypox.
For now, it is not clear if condoms help protect against this virus, although their use remains essential to prevent the transmission of various sexually transmitted diseases (STDs), such as HIV, syphilis, gonorrhea and some hepatitis.
In a recent press conference, WHO director-general Tedros Adhanom Ghebreyesus also advised that groups where the disease is most common at the moment temporarily limit the number of sexual partners.
“For men who have sex with men, that means making safer decisions for themselves and for others,” he said.
Andy Seale, WHO adviser on HIV, hepatitis and STDs, said he hoped this guidance would only be valid for a short time. “Our hope is that this outbreak will not last long.” (YO)