Pustules in the genital and anal area, inflammation of the glans penis and rectum, tonsillitis... Monkeypox is a disease that in the vast majority of cases is manifesting itself mildly, but often painfully.
Four out of 10 patients need medical treatment to manage complications such as those described, according to a Spanish study published this Tuesday in
The Lancet magazine
,
which also reinforces the hypothesis
direct skin contact as the main route of transmission of the disease.
The observational study comes to reinforce the knowledge that there was about the manifestations of monkeypox and adds some nuances that until now had not come to light, thanks to its large sample: 181 confirmed cases.
"There is a greater clinical impact than was assumed," says Oriol Mitjà, coordinator of the study.
Beyond the pain that the pustules themselves can cause, the study has observed that the inflammation of the rectum, caused by receptive anal sex, causes great pain when defecating.
Tonsillitis, caused by oral sex, great problems swallowing.
"So much so that one of the hospitalized patients studied had to be admitted because he could not eat food," says Mitjà, an expert in infectious diseases at the Germans Trias Hospital.
Hospitalizations, however, are not frequent in this outbreak of monkeypox, which in Spain adds a total of 4,942 affected, according to the latest data from the Ministry of Health.
In the investigation of
The Lancet
, in which the 12 de Octubre University Hospital, the Germans Trias University Hospital, the Fight Against Infections Foundation and the Vall d'Hebron University Hospital have participated, they counted three admissions.
According to Health, around 3% of all those infected require hospital care.
At the moment in Spain two people have died from the disease.
The PCR data of the patients studied indicate that the viral load is higher in the lesions than in the samples extracted from the pharynx.
From this it follows that the airway is less relevant for contagion than direct contact, which would explain why sexual encounters are being the main route of transmission: 80% of cases, according to ministry statistics.
In previous outbreaks of monkeypox, explains Mitjà, it was assumed that saliva droplets were the most common form of contagion, something that had also been seen in animal models.
“The new data makes us presume that infections through the respiratory tract are very low.
Now there is a local inoculation and surely also a local replication [in the surroundings of the area that comes into contact with the virus]”, explains the researcher.
The low viral load in the respiratory tract leads the study authors to propose further research to determine the possibility of transmission by this means.
"Such prolonged home isolation may not be necessary," says Eloy Tarín, another of the authors of the research carried out among patients from Madrid and Barcelona, who accumulate most of the cases in Spain.
Investigate virus mutations
What has changed in the virus so that it now modifies its way of spreading?
On the one hand, explains Tarín, it will be necessary to study whether the pathogen has undergone mutations that facilitate the mechanism of direct contact over the respiratory one.
“It is possible that it has found a new population niche [men who have sex with men, which account for 98% of cases in the world and more than 80% in Spain] and in the sexual route a new form of transmission” , Add.
Another of the data that this study confirms is the incubation period of the virus, which is around seven days and not between 15 and 22 that was supposed to occur in previous outbreaks of monkeypox in the Dominican Republic. Democratic of the Congo.
One week is, according to the researchers, too little time for the post-exposure vaccine in contacts of confirmed cases to take effect.
At the moment, it is still one of the groups that is now being vaccinated in Spain, something that the researchers consider unnecessary with their data in hand.
“It makes more sense to focus on the pre-exposure inoculation of risk groups [something that is already done in parallel to the previous ones]”, underlines Tarín.
The truth is that the doses that have arrived in Spain are still insufficient to vaccinate risk groups, understood as men who have several male sexual partners.
At the moment, 5,300 vaccines have arrived in Spain, which have been distributed among the communities, especially between Catalonia and Madrid.
Health announced that another 7,000 would arrive last week, but they have not yet been received.
This is causing great difficulties in getting an appointment for vaccination.
And that for the first dose, which is estimated to be around 30% effective.
To reach the estimated 80% for these injections, it is necessary to receive a second puncture a few weeks later.
