(Translation of op-ed published in Corriere Della Sera Aug 2nd, 2022)

Despite the growing number of worrisome domestic and global issues, I must draw your attention to another issue that I am sure that you do not want to hear about: it is another disease. Even though you might not want to hear about it, I hope to convince you that this disease will give us a tough time if we do not intervene now.

I am talking about the Monkeypox virus (MPX). I am sure that by now, you have already heard some pieces of the story, but many of you probably think that it is somebody else’s problem and that it has a low chance of affecting your life. I really hope so – but I cannot exempt myself from preparing for you a summary to bring some of those pieces together.

MPX usually hides in African rodents. Occasionally, following contact with other animals such as monkeys or human beings, it spills over to another species. As far as the Homo Sapiens species is concerned, until recent times, MPX infects children who, especially in African countries, as they are more likely to come into contact with rodents. The disease can then spread from person to person; however, human outbreaks are generally self-limiting unless there is a continuous source of infection. However, in more recent times, MPX has found a new avenue for spreading which mainly involves men with promiscuous sexual behaviors, especially with other men. Sadly, as long as this new avenue of spread happened only in Africa, nobody seemed to care.

From a few cases out of Africa reported in early May, we have reached about 20,000 cases of MPX infections outside the African continent. The demographics and risk factors are clear: men who have intimate relations with multiple male partners are, currently, the principal victims and potential spreaders of this disease that is not only very painful and debilitating but also burdened by stigma and judgment. The result is that at-risk individuals are reluctant to report the disease to a physician, except in the most extreme circumstances.

I feel that I should share with you one thing: actually, two things. The first one is that this is not a sexually transmitted disease like HPV or HIV. It is a disease usually transmitted by close contact (including sexual intercourse) and, in some cases, can also be airborne. At this time, infection occurs in the specific demographic of men with multiple male partners, but it can spill out of this population and start infecting family units. Here, MPX finds two additional means to perpetuate its existence by spreading to other populations. People who live in contact with people who are currently infected could become infected as well, including children who will be returning soon to school, an environment in which we know that it is really difficult to control infections.

But there is more. Urban rodents could get infected through contact with infected plasters or gauze thrown in the trash, thus creating a permanent reservoir that could perpetuate the infection in new areas.

The truth is that we need to act on several fronts in a coordinated way by understanding the circularity of the problem. Medical facilities should allow anonymous assistance and public health organizations should promote awareness and prevention campaigns. Moreover, information about vaccination must be openly communicated and, following the US example, vaccines should be administered to anyone requesting it.

Last, but absolutely not least, it is also essential to dispose properly of any material that has come in contact with skin lesions (e.g., disinfecting it and placing it in a double sealed bag or disposing of it as special waste). In addition, and in this regard, active surveillance programs in rodents should be put in place to discover and eradicate the infection as soon as it occurs.

In Italy, there are currently just over four hundred cases, and only through appropriate and synergistic behaviors, we can hope to stop the spread of this virus that has jumped out of its ordinary rails and may well cause the suffering of many people. There is even more, however: MPX may overload national health services. The latter, as we know are already exhausted from the effects of another virus, which by the way- has also jumped out of its rails.

By: Dr. Ilaria Capua | One Health Center Director

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