What the latest studies say about how monkeypox is transmitted

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Smith Collection/Gado/Getty Images As more studies have been published, knowledge of the monkeypox epidemic is beginning to mature. And the idea of ​​transmission during sexual intercourse becomes clearer (microscopic photo taken from a clinical sample and digitally colored). Smith Collection/Gado/Getty Images As more studies have been published, knowledge of the monkeypox epidemic is beginning to mature. And the idea of ​​transmission during sexual intercourse becomes clearer (microscopic photo taken from a clinical sample and digitally colored). HEALTH – This is a question that inevitably has an impact on how world governments deal with the monkeypox epidemic: How is the disease transmitted? More than three months after the appearance of the first cases in Spain, 28,000 patients have been counted worldwide, the first deaths have been recorded and large-scale scientific studies are beginning to give their conclusions. In recent days, three reference scientific publications, the Lancet, the British Medical Journal and the New England Journal of Medicine have thus published some initial analyzes that allow us to learn more about the profile of infected people, the symptoms they suffer and how they can to have contracted the disease. The physical relationship, “dominant mechanism of transmission”? All these studies outline the same typical portrait of the patient: an adult man who maintains homosexual relationships. A novelty compared to this disease already known in Africa, but which mainly affects children there. Thus, The Lancet study, carried out in medical structures in Madrid and Barcelona, ​​speaks of 92% of the 181 patients as men who have sex with men against 8% of women (3%) and heterosexual men (5% ). ). Proportions found in comments from Public Health France. In its August 4 report, the National Agency evoked an immense majority of men who have sex with men among patients (96% of cases for which sexual orientation is reported). The other noteworthy element of the study of the British magazine is the mode of transmission. Because if, from the beginning of the epidemic, scientists fear reaching hasty conclusions and stigmatizing homosexual men, the Lancet researchers talk about an important role of sexual relations in the transmission of the disease. This is in line with the recommendations of the World Health Organization, which has officially invited gay men to reduce their number of sexual partners. “Our study supports the idea that skin-to-skin contact during sexual intercourse is the dominant transmission mechanism for monkeypox, with significant consequences for how the disease should be approached from a health perspective. health”, we can read especially in the study. It is clear that the idea that it is a sexually transmitted infection (STI) is not mentioned at this stage; it is mainly about reducing prolonged skin-to-mucosa contact, which is especially likely during sexual intercourse. What about semen and aerosols? This observation is found in areas of the body affected by physical symptoms: if all patients in the survey had skin lesions, 78% were affected in the anogenital area and 43% in the mouth. The same in Public Health France that evokes 75% of patients with a “genito-anal rash”, in addition to the attacks of fever and muscle pain caused by the disease. Studies also cite rare but never-before-seen complications: inflammation of the rectum or penile edema. Consequently, the question of the relevance of the measures adopted to protect populations (especially isolation) is raised. And the Lancet authors say it clearly: “The remarkable difference in viral load between lesion readings and throat readings deserves further study to better guide the decision whether or not to isolate people. “At present , in France, the sick are forced to isolate themselves for 21 days as an example. Thus, the trail of airborne transmission loses credibility. In an exchange with the journal Science, the author of the study summarizes the conclusions of his team as follows: “The viral load is very high in skin lesions and very low in the respiratory tract, which explains that sexual transmission is likely to continue.” @TheLancet @oriolmitja Also had a brief exchange with @oriolmitja about the paper and said key messages for him w… https://t.co/Iq9Dyv2AQS — Kai Kupferschmidt (@kakape) See the obscurity of the tweet, which only delves into a larger sample of patients will shed light.Based on a hypothesis that, if not is excluded, it is at the moment less accredited by research, that is to say, that of transmission by spermatozoa. A doubt about the effectiveness of the old vaccination Another uncertainty is related to the effectiveness of the old vaccination. In fact, in the Lancet study, 18% of patients were vaccinated during childhood against smallpox, a virus similar to monkeypox and whose vaccines are supposed to be effective ). This leads the authors to say that “more research is needed to better understand the protection afforded by (old, ed) vaccination in the context of the current epidemic.” This despite noting, however, that this vaccination against smallpox, which was generalized by the WHO in the late 1960s until the disease was eradicated, can go back decades, which could explain a drop in effectiveness. Still on vaccination, researchers published by The Lancet warn: “Due to a short incubation period (seven days on average, editor’s note), vaccination of at-risk groups before exposure to the disease is probably more effective than after vaccination if health authorities want to control the epidemic. A final point raised by the data from the various studies: the link between being infected with monkeypox from another disease. Indeed, without knowing whether it is a simple correlation or whether there is a direct link, the study in The Lancet points out that 40% of patients are also infected with HIV. In France, according to the figures of Public Health France, it is 26% in the same case, and 5% of patients are immunocompromised. See also HuffPost: Faced with monkeypox, why is the gay community worried? You cannot view this content because you have declined cookies associated with third-party content. If you would like to view this content, you can approx submit your choices.
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