Awareness, vigilance and caution are the keys to dealing with the mostly unknown smallpox in monkeys, which appeared in early March in countries beyond Africa, where the disease is endemic, causing concern and putting health systems on alert. «People should not be worried but should be careful,» Athina Linou, professor of Epidemiology at the School of Medicine of the University of Athens, told APE-MPA, considering it «unlikely that a case will not appear in Greece.» That is why she emphasizes the modes of transmission, symptoms and protective measures, stressing that the tracing of contacts, the rapid detection of new cases and isolation are the factors that will break the chain of transmission.
A total of 19 countries outside Africa have confirmed at least one case. The total number of cases identified by the ECDC has increased almost fivefold since its first count on 20 May, rising from 38 to 219 cases, with 191 detected in Europe.
«Its appearance in Europe is not a common occurrence, we have no explanation why it happened, there are speculations and therefore it is reasonable to be concerned until we know how it happened,» she says.
He thinks it is «unlikely that we will have no cases in Greece unless we can eradicate the disease in the next few days, but it is now in 19 countries. How will these countries be able to find the contacts of the 200 cases they have?» he asks.
Regarding infectiousness, he stresses that «we still do not know the infectiousness of this form that is currently circulating in Europe. We see that every 2 to 3 days the number of cases doubles, so we need to take immediate action,» he stresses. He estimates that «there are more cases», as he says «monkeypox, like human smallpox, takes about two weeks to have visible symptoms. So those who are infected today will see these cases in the next two weeks.».
Ways of transmission
The main modes of transmission are through the respiratory route (coughing, sneezing, prolonged face-to-face contact), through contact with infected people, their clothes, their linen or their bodily fluids. The virus enters the body through skin lesions (visible or invisible) of the mucous membranes (eyes, nose, mouth).
«There will be a problem if we are face to face with someone who is coughing heavily, as the droplets can get on our face. If we sit somewhere or touch where someone was sitting before with pimples open on their body, which are highly infectious,» says Linou. We don't use the same towel, wear someone else's clothes, lie in a bed where we are 100% not sure the sheets have been changed and sit in places with bare feet and hands.
Particular attention should be paid to surfaces that are frequently touched (e.g. doorknobs) and in toilets.
In Greece, says Ms Linou, we have no cases, so we believe that no surface is infected. But if a case is detected then we have to be particularly careful.
The basic rule is to wear a mask when you are very close to someone, wash your hands with soap and water regularly or use an alcohol-based antiseptic. «Masks and antiseptics help, but if we have uncovered body parts, because of the summer we have to be careful the virus is also transmitted through the skin,» underlines the professor.
What are the symptoms
«Transmission does not occur during incubation, but when the first pimples appear, sometimes the first ones appear in the mouth and face. Then we have transmission,» notes Ms Linou. In fact, as she says, the marks on the face never go away. Any rash must mobilise the patient. The symptoms also include a very high fever and swollen lymph nodes, which distinguishes monkeypox from chickenpox. Ms Linou stresses that it is not a simple disease, it has a mortality of 1 to 10%, depending on the conditions.
Isolation of cases and selective vaccination
If there are any cases, they must be isolated immediately in special places and all people who have been in contact must be vaccinated, because the vaccine works even after two to three days, says Ms Linou.
He adds that people who have not been vaccinated are clearly more at risk. «Even if you were vaccinated 50 years ago you have some form of immunity,» but he makes it clear that the general population does not need to be vaccinated. A specific vaccine against the monkeypox virus does not currently exist however, the smallpox vaccine is expected to provide protection. We need to be vigilant and prepared, the professor notes, as «people do not know how to protect themselves from this disease and no modern doctor has seen a case of monkeypox.».
It proposes fast-track seminars for all doctors who will be called upon to deal with such cases, registration of negative pressure units so that we know where to safely hospitalise patients, and the supply of vaccines in small quantities for groups that will need vaccination immediately. Vaccination can be done, after exposure to people who have had close contact with a case and medical staff. The vaccine should be administered within 4 days of exposure.
Efi Fouseki
