Interview with Dr. Tomás Orduna | 07 JUN 22
The doctor emphasized that the first reserves of vaccines and antivirals should go to Africa, today the most affected continent. And he explained the main differences from classic smallpox.
Just over 30 days ago, the first positive case of monkeypox or monkeypox in the United Kingdom, in a person with a history of travel to Nigeria, Africa. Today, according to CDC map, there are more than 900 confirmed cases in 29 countries, plus others under study. What is not known is why this widespread and ongoing outbreak is now occurring globally.
Suppositions are not lacking: at first there was talk of a possible mutation of the virus that would have made it more transmissible. However, the doctor Thomas OrdunaHead of Tropical Medicine and Travel Medicine at Hospital Muñiz, explained that for now there does not seem to be a genetic change because “the first studies link the variant that circulates today with the West African one, associated with pre-pandemic cases imported from that continent between 2017 and 2019”.
https://www.youtube.com/watch?v=D2ohlefjxyA
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Of course the investigations will continue. The only thing that is known for now is that there were events that facilitated the close contract necessary for the transmission of the monkeypox. “It is important to clarify that monkeypox can affect Anyone, men and women of any sexual orientation, children and the elderly. Although today 85% of patients are made up of men who have sex with men, members of the LGTB+ community, including bisexuals, we must be very clear and not stigmatize, since this occurs due to an epidemiological history of attendance at events that favored contact,” he remarked.
“One of those events was a big party for the gay community in the Canary Islands, Spain, attended by more than 80,000 people, who danced, sang and had fun. Then there was another small but powerful group associated with a gay community sauna in Madrid. And then there was a third, a gay fetish party in Antwerp, Belgium. These events have been multiplied by close skin-to-skin contact in crowds or community transmission of saliva from coughing, sneezing, and singing. Even in sexual intercourse, it can be contracted by the close contact inherent in a sexual relationship and not by sperm and vaginal fluids, ”explained the infectious disease doctor.
Many questions remain that still need answers, such as the time it takes for the disease to be transmitted or the effectiveness of post-exposure vaccines. All will be answered as the investigations progress. To get closer, IntraMed interviewed Dr. Thomas Orduna, who spoke about what is known and what is still unknown, in addition to the possible strategies that should be planned worldwide to face this and other emerging diseases. here your words
Main differences between classical smallpox and monkeypox.
The last case of smallpox, of a minor variant, occurred in Somalia in 1977. The last case of the major variant, which had caused some 300 million deaths worldwide, was in 1972. For this reason, in 1980 its eradication was declared. Classic (or major) smallpox was a disease that could reach at least 30% mortality. In principle, monkeypox is expressed in a more attenuated way, more similar to minor (minor or alastrim).
The lethality in monkeypox ranges from 3 to 10% depending on which of the two subspecies the person contracts
The lethality in monkeypox ranges from 3 to 10% depending on which of the two subspecies the person contracts (one from central Africa that can reach 10% against 3% of the western variant). But of the current cases that occurred in the West of the Central African variant, there have been no deaths. This could be explained in part by the immunogenetics (how certain population groups or ethnic groups respond to certain pathogens), but also due to the hypothesis of nutritional status, which has been excellent in those affected in Europe, while one could suspect that in Africa there is greater malnutrition, beyond the multiple pathologies. The truth is that there is still no concrete explanation as to why the new cases did not cause deaths.
Specifically, the difference between classical and simian smallpox is the picture, the severity and, together with it, the lethality. But the expression is similar: fever, nausea, lack of appetite, skin lesions (papules, which become vesicles, then pustules, then an umbilication is generated around that pustule and finally a crust forms). Something to take into account in monkeypox is the pain during the umbilication of the lesions, something not so frequent in the descriptive literature of classical smallpox.
Contagions, what is known and what is ignored: time, forms and discussions
The patient can infect in contact with active lesions, until the scabs completely fall.
Oropharyngeal lesions, present in both smallpox, can also be contagious, as well as saliva in coughs and sneezes, in heavy or fat drops.
Finally, although not with the same weight as COVID, airborne transmission is viable in closed environments, without ventilation. That is why the use of a chinstrap is recommended in isolated patients and aerial protection in health teams.
As for the close contactit is difficult to quantify the exact time that the contagion takes, no studies have yet been seen that determine if 5 minutes or 15 are enough, but the truth is that the more contact time there is, the probability will increase.
When the person presents lesions that are in the stage of pustules, vesicles and scabs that have not fallen, the virus is present and can spread. As an example, isolated and painless lesions could appear on the penis that could be confused with herpes and during sexual intercourse the disease can be transmitted (but by contact with lesions and not transmission by sperm).
There are currently discussions about when a person stops spreading monkeypox. What is said is that there must be a total fall of scabs, with which what remains is a completely healed lesion. That’s when the person no longer infects.
Can viral DNA persist in droplets, even after scabs fall off?
In COVID-19, we saw people with a positive PCR even 60 days after suffering from it. Why? Because there were genomic remains of what was the active and reproducible presence of the virus. But to be able to say that the rest of the DNA is infective, I first have to be able to cultivate the virus. In this we have to be cautious and learn from the experience of when we had to determine when a person who had COVID stopped infecting. That time was not more than 10 days, except for immunocompromised people, who, because they cannot defend themselves well, take longer to put a stop to the multiplication of the virus. I believe that this learning must be extrapolated and be very cautious, because for now it is still accepted that with the fall of the scab, the person stops infecting.
What is known about the transmission by surfaces, such as towels, clothes, lasers and the chances of contagion in public transport?
I have not read studies on transportation, but suppose that I have 20 non-visible injuries (which in the pox, the initial ones usually appear in the genitalia, anal, perianal, perineal areas), I do not have a breakdown in my general condition and I get on public transport, I can be contagious, because in addition to the skin lesions, I can have them on the mucosa and the virus can be excreted through saliva. So hypothetically I can spread it by coughing and sneezing. That is why the immediate isolation of a suspected or confirmed person is important.
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