Not just “very close interpersonal contacts between people”. At the origin of the growing number of cases of monkeypox that is alarming international health authorities “there could also be another possibility: that there is an infection in some animal that is no longer only African, but also ‘local’, for example a rodent “. A hypothesis that “at the moment can only be ventured”, but which appears realistic to the virologist Pasquale Ferrante, professor at the Temple University of Philadelphia in the USA, medical and scientific director of the Città Studi clinical institute in Milan. In an interview with Ruetir Health, the expert invites us to “investigate”, with the involvement “of veterinary colleagues, as well as virologists who are experts in human viruses”.
“It is certainly a trail to follow”, Ferrante warns in the aftermath of the alarm launched yesterday by the ECDC, the European Center for Disease Prevention and Control: “If human-to-animal transmission occurs, and the Monkeypox spreads to an animal population, there is a risk that the disease could become endemic in Europe, “experts warned yesterday in a ‘monkeypox’ risk assessment. Could it have already happened that ‘our’ animal has been infected and has become a reservoir? “If it happened, I don’t know”, replies the specialist who, however, believes the EU warning to be correct. “I know for sure, in fact, that we have a previous episode”.
“In 2003 – remembers Ferrante – in the United States 47 cases of monkeypox were observed among humans, both confirmed and suspected, and at the time it happened that in some areas of the USA rodents had been imported directly from Africa, subsequently entered in close contact with local rodents. The monkeypox thus came to the so-called prairie dog, a large mouse that lives in the desert and semi-desert areas of the south, southwest of the States, and passed to men “. Also in the light of this precedent, “it would be appropriate to begin collecting elements – urges the virologist – and to verify the possible involvement of local rodents. The ECDC’s concern is great – Ferrante specifies – because we have many animals that are potentially susceptible to smallpox. monkeys, even dogs. It may be something to be taken into account, but it must be studied by making the appropriate investigations. “
SEXUAL TRANSMISSION – “No to stigma” towards social groups or sexual habits. If there is “a fixed point” from which to start in analyzing the cases of monkeypox that are increasing in an increasing number of countries, it is this according to Ferrante.
“Sexual intercourse favors the transmission of many agents, even those not known to be sexually transmitted – explains the expert – because clearly, if a person has an infection in progress, especially with the virus in the blood, at the level of the mucous membranes it can be transmission. In this case, however – he specifies – it is quite evident that the main source of infection are the notorious ‘droplets’, the droplets of saliva also quite full-bodied that we emit in aerosol format while we speak, when we sneeze or cough, while we kiss So it may also be “, Ferrante is keen to point out,” that it is a coincidence without any particular significance that of having observed the cases of ‘monkeypox’ in these groups of people “, mainly males having sex with males.
“In other words – says the specialist – I do not believe that sexual transmission is the predominant cause. Here, even if it is all to be investigated and for now it is a matter of hypotheses – he points out – in my opinion we are faced with a zoonosis that has started from animals that became infected, perhaps pets, and then spread for reasons of closeness and close contact between people. Beyond sexual intercourse, even talking, living together, can be a factor of transmission. No to stigma “, reiterates the virologist.
IS THE VIRUS MUTED? – “Anomalous cases”: this is how the World Health Organization defined the monkeypox infections that are increasing in several countries. But can the virus be mutated as some believe possible, perhaps by assuming a greater human-human transmission capacity? Ferrante considers it unlikely. “Before hypothesizing changes in the genome of the virus and in its surface molecules, I would say that we have to wait, and a lot”, warns the expert. And in fact, according to the first analyzes conducted by the Inmi Spallanzani of Rome on the viral sequences of Italian patients, the viruses are “all results similar to the West African strain”.
The main reason why caution is needed, explains Ferrante, is the fact that “the ‘monkeypox’ virus, as well as that of human smallpox, is a double-stranded DNA virus, among other things very large in size”, he explains. the specialist, recalling that “at the time of smallpox the virus could almost be observed under an optical microscope, however large the particle was”.
This characteristic “also means something from a biological point of view: it means stability. Being a double helix DNA virus, moreover of considerable size – insists Ferrante – that of monkeypox, as well as herpesviruses including chickenpox, is one of those viruses that do not easily undergo mutations, but which have actually proved absolutely stable so far. Unlike coronaviruses such as the Sars-CoV-2 of Covid-19, RNA viruses prone to mutation “due to absence of ‘proofreaders’, ie the mechanisms that during replication limit the risk of random errors from which the variants originate.
VACCINATION – “A light supply” of monkeypox vaccine could already be a good idea, a possibility to be evaluated also in Italy. “But these decisions must be taken by the Government in agreement with the Regions, on the basis of the evolution of the numbers. If progressively the cases should increase, and I hope not, even if for now I absolutely do not feel like daring to make estimates, yes will be able to move in this direction “according to Ferrante.
“Monkeypox – recalls the expert in an interview with Ruetir Salute – is a disease caused by a virus closely related to that of human smallpox, so much so that being vaccinated against the latter, and many people until a few years before 1981 they were immunized in Italy, confers 85% protection even against ‘monkeypox’ “.
But “in addition to the possibility of using the smallpox vaccine that we know – specifies Ferrante – there is an even more specific vaccine, tested directly for monkeypox and at the same time for humans, which seems to protect against both infections. This is an innovative vaccine called Jynneos, it has already been approved by the American FDA and can be used for close contacts with infected people or in the prodromal stages of infection, to reduce the possible severity of the disease “.
“Like human smallpox, also monkeypox is characterized by an exanthematous disease – describes the specialist – which presents with fairly characteristic skin lesions, very similar to chicken pox. These manifestations start from the head and then spread towards the limbs; with macules that subsequently become papules, a little in relief, after which a vesicle forms inside which there is liquid that contains the virus. The vesicle persists for a few days, then breaks and in its place remains a small The same trend as chickenpox “, Ferrante repeats.
THE SYMPTOMS AND WHAT TO DO – “The recommendations, also from the World Health Organization – remarked the virologist – first of all provide to carefully observe all the people who manifest a rash of the specified type, preceded by fever, sore throat, back pain , other pains, in short, the one that usually accompanies fevers. When a rash of this kind develops, it is a good idea to visit the doctor immediately. In case you go to an emergency room, it is recommended to perform a test for evaluate whether or not it is chickenpox. Someone suggests adding the test for anti-measles antibodies, in order to exclude both pathogens. If these tests are negative, then a case of monkeypox may be suspected; fluid from the vesicles with a swab and also perform an oral-pharyngeal swab, to try to isolate the virus and analyze it “.
“The diagnosis of this disease – concludes Ferrante – is favored by the fact that the infection can be seen on the skin, that there is something evident that is easy to identify. investigation, because the virus can be eliminated through the droplets of saliva even before the rash appears. Therefore all previous contacts must be studied or at least monitored “.