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MONKEYPOX

EXPLAINED: How is Italy dealing with rising monkeypox cases?

As monkeypox cases rise across Europe, Italy's health ministry has released guidelines for containing the outbreak. Here's what they say.

Italy has outlined its plans for containing the monkeypox virus that is spreading rapidly throughout Europe.
Italy has outlined its plans for containing the monkeypox virus that is spreading rapidly throughout Europe. Photo: CDC handout

Italy has far fewer recorded cases of monkeypox than some of its European neighbours, with ten infections confirmed as of Thursday afternoon.

READ ALSO: Italian monkeypox cases rise to ten

That puts it significantly behind Spain and the UK, whose health ministries as of Wednesday recorded 59 and 78 cases respectively.

But with the virus spreading across Europe, Italy’s government has started taking precautions, outlining its plans for containment and the treatment of patients in a circular published on Wednesday evening.

The proposals feature a combination of contact tracing, post-exposure vaccinations for health professionals, and antivirals for immunosuppressed people and those with severe symptoms.

Those who come into contact with an infected person will be monitored for symptoms for 21 days from the moment of exposure, during which period they are advised to avoid any contact with pregnant women, children under the age of 12, and immunosuppressed people, the document says.

The circular says that contact tracing will enable the “rapid identification of new cases, to interrupt the transmission of the virus and to contain the epidemic”, as well as allowing for “early identification and management of any contacts at a higher risk of developing a serious disease”. 

Healthcare workers and laboratory staff who are considered at high risk may be offered a vaccine “ideally within four days of exposure”, following a “careful evaluation of the risks and benefits”.

The document makes a brief reference to the possibility of quarantine requirements, saying only that self-isolation could be required “in specific environmental and epidemiological contexts, on the basis of the assessments of health authorities”.

Monkeypox, il vaiolo delle scimmie in Italian, is a rare viral infection that’s endemic to West and Central Africa, and unlike human smallpox, it hasn’t been eradicated. 

Monkeypox is not as contagious as Covid-19 and as of yet there have been no deaths associated with this outbreak, but the virus, a milder version of the eradicated human smallpox, isn’t fully understood yet. It has a fatality ratio of 3 to 6 percent according to the World Health Organisation.

As of Tuesday, the organisation had recorded 131 confirmed cases and 106 suspected cases since the outbreak was first reported on May 7th.

Its symptoms are similar but somewhat milder than smallpox’s: fever, headache, muscle aches, back pain, chills, exhaustion, although it also causes the lymph nodes to swell up.

Within one to three days, the patient develops a rash with blisters, often beginning on the face then spreading to other parts of the body. 

Monkeypox typically has an incubation period of six to 16 days, but it can be as long as 21 days. Once lesions have scabbed over and fallen off, the person with the virus is no longer infectious.

Although most monkeypox cases aren’t serious, up to one in ten people who contract the disease in Africa die from it, with most deaths occurring in younger age groups.

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MONKEYPOX

Semen ‘a vehicle’ for monkeypox infection, say Italian health experts

Researchers in Italy who were first to identify the presence of monkeypox in semen are broadening their testing, saying early results suggest sperm can transmit infection.

Semen 'a vehicle' for monkeypox infection, say Italian health experts

A team at Rome’s Spallanzani Hospital, which specialises in infectious diseases, revealed in a study published on June 2nd that the virus DNA was detected in semen of three out of four men diagnosed with monkeypox.

They have since expanded their work, according to director Francesco Vaia, who said researchers have found the presence of monkeypox in the sperm of 14 infected men out of 16 studied.

READ ALSO: EXPLAINED: How is Italy dealing with rising monkeypox cases?

“This finding tells us that the presence of the virus in sperm is not a rare or random occurrence,” Vaia told AFP in an interview.

He added: “The infection can be transmitted during sexual intercourse by direct contact with skin lesions, but our study shows that semen can also be a vehicle for infection.”

Researchers at Spallanzani identified Italy’s first cases of monkeypox, found in two men who had recently returned from the Canary Islands.

The latest results reported by Vaia have not yet been published or subject to peer review.

Since early May, a surge of monkeypox cases has been detected outside of the West and Central African countries where the disease has long been endemic. Most of the new cases have been in Western Europe.

More than 3,400 confirmed cases and one death have now been reported to the World Health Organisation from more than 50 countries this year.

The vast majority of cases so far have been observed in men who have sex with men, of young age, chiefly in urban areas, in “clustered social and sexual networks”, according to the WHO.

It is investigating cases of semen testing positive for monkeypox, but has maintained the virus is primarily spread through close contact.

Meg Doherty, director of the WHO’s global HIV, hepatitis and sexually-transmitted infection programmes, said last week: “We are not calling this a sexually-transmitted infection.”

Could antivirals curb the spread of monkeypox?

Spallanzani researchers are now trying to ascertain how long the virus is present in sperm after the onset of symptoms.

In one patient, virus DNA was detected three weeks after symptoms first appeared, even after lesions had disappeared – a phenomenon Vaia said had been seen in the past in viral infections such as Zika.

That could indicate that the risk of transmission of monkeypox could be lowered by the use of condoms in the weeks after recovery, he said.

The Spallanzani team is also looking at vaginal secretions to study the presence of the virus.

A significant finding from the first study was that when the virus was cultured in the lab, it was “present in semen as a live, infectious virus efficient in reproducing itself”, Vaia told AFP.

Vaia cautioned that there remained many unanswered questions on monkeypox, including whether antiviral therapies could shorten the time in which people with the virus could infect others.

Another is whether the smallpox vaccine could protect people from the monkeypox virus.

“To study this we will analyse people who were vaccinated 40 years ago before human smallpox was declared to have disappeared,” Vaia said.

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