Stigmatization of patients makes tracing monkeypox difficult

Vaccination against monkeypox in Washington (USA). / Reuters

Most cases continue to occur in men who have sex with men, but Spain reports the infection of one child and eight women

Alvaro Soto

The fight against monkeypox is running into an unexpected enemy: the difficulty in tracing the contacts of those infected. Since the beginning of the outbreak, in mid-May, the explosion of cases among men who have had sex with men has stigmatized the disease, which has been perceived in society as a virus that only affects homosexuals. The health authorities have detected that many people who suffer from symptoms are reluctant to go to their health centers, which prevents the chains of transmission from being broken.

The concern for the surveillance of the disease already alarms the specialists. Last week, the European Center for Disease Prevention and Control (ECDC) called on "civil society" to "build trust in contact tracing and ensure that these strategies and the accompanying risk communication are suit affected groups, while reducing stigmatization.

European experts are aware that the vast majority of infections continue to occur among men who have sex with men, but at the same time, they find more cases among other population groups. Thus, they encourage people at risk to "keep the data of their sexual contacts to facilitate tracking" and ask the organizers of events in which anonymous sexual activities are carried out to inform the participants if in the following days they detect that has produced an outbreak. But they also claim to use "respectful language that does not relate the transmission of the disease to sexual orientation or sexual practices" because, they remember, monkeypox can become a dangerous disease, especially for immunosuppressed people, the elderly and children.

The magnitude of the outbreak is bringing the disease to other groups. The World Health Organization (WHO) warned on Friday that in the last two weeks, infections have tripled in Europe to reach 4,500. "Cases must be found and investigated by a laboratory, and contacts must be identified quickly so that the risk of spread is reduced," warned the WHO regional director for Europe, Hans Kluge. "The outbreak is rapidly evolving," the expert recalled, "and every hour, every day and every week it is expanding its reach to groups and areas that were previously unaffected."

Last Tuesday, the Ministry of Health registered the first case of a three-year-old child (it did not provide more information), and there is also at least one 67-year-old infected, but the main age range of those affected is between 31 and 44. In its latest report, the department of Carolina Darias registers 800 cases in total, although it admits that there are delays in the National Epidemiological Surveillance Network (Renave). According to the count of the communities, the figure already amounts to about 1,500 patients.

Health ensures that it has data on the transmission mechanism of 273 of the 800 infections recorded. In them, 93.4% of infections were caused by close contact in the context of high-risk sexual relations and 6.6% by close non-sexual contact. By sex, 792 have been registered in men and eight in women and all the autonomous communities, except La Rioja, already have one. Regarding symptoms, the majority presented anogenital rash (change in skin color or irritation) (65.8%) and in other locations (53.9%), fever (55.9%), asthenia (41.4 %) and localized lymphadenopathies (enlarged lymph nodes) (40.6%).

The Professor of Microbiology at the University of Salamanca Raúl Rivas agrees that, throughout the world, one of the great problems that researchers are encountering has to do with the lack of reliable information. "A part of those infected is not giving information about their partners or about the people with whom they have sex and if this data is not offered, new obstacles may appear, for example, in vaccination," Rivas stresses.

This week, Spain received the first 5,300 doses of the Inmanex (marketed under the name Jynneos) smallpox vaccine, which is also highly effective against monkeypox. The protocol approved by the Vaccine Committee establishes that people considered close contacts will receive the compound, in this case, those who have been in contact with a positive in the previous four days.

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