What does monkey smallpox mean for people living with HIV?

A new epidemic of smallpox continues to spread in the UK and around the world, mainly affecting men who have sex with men. Some of the monkeys infected with smallpox live with HIV, but so far no worse results. Although someone can become infected through close personal contact, experts and advocates urge gay and bisexual men, in particular, to be careful and cautious of symptoms during the Pride season.

Although smallpox is not a new disease, the current epidemic is unusual. Smallpox is found mainly in Central and West Africa and has traditionally been thought to be uncommon among humans.

The UK’s health agency (UKHSA) said in a recent update that 287 cases had been confirmed in the UK, 10 in Scotland, three in Wales and two in Northern Ireland. On June 7, the UKHSA announced that smallpox was an infectious disease that should now be reported to health authorities.

glossary

wounds

Small tissues, wounds or tears in the tissues. Vaginal or rectal ulcers can be the entry points for HIV.

rashes

Baking is an irritated or swollen area that affects the color, appearance, or texture of the skin. It is located in one part of the body or can affect the entire skin. Most rashes are caused by inflammation of the skin, which can have many causes, including an allergic reaction to the drug.

lymph nodes

Immune cells are bean-sized structures of the body’s lymphatic system that are assembled to fight infections. Groups of lymph nodes are found in the armpits, groin, and neck.

Sexually Transmitted Infections (STIs)

Although HIV can be sexually transmitted, the term is often used to describe chlamydia, gonorrhea, syphilis, herpes, scabies, trichomonas vaginalis, and more.

weakened immune system

Weakening of the immune system reduces the ability to fight infections and other diseases.

As of June 2, the World Health Organization (WHO) reported 780 laboratory-confirmed cases of monkey disease in non-endemic countries. After the United Kingdom, the highest number of cases was registered in Spain, Portugal, Canada and Germany. Global.health estimates that the number of unofficial data confirmed or suspected is more than 1,300.

Most, but not all, men are gay, bisexual or other men who have had sex with most of them. Many men said they had recently embarked on an international trip, and some had been linked to a gay pride event in the Canary Islands, a fetish festival in Belgium, and saunas in Spain and Canada. Of the confirmed cases, only three were women.

“According to current reports, the epidemic now affects men who have sex with men, primarily through social media, which is associated with sexual activity. Many, but not all, cases report short-term and / or multiple sexual partners in connection with large events or parties, ”said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe.“ But we need to keep in mind, As we have seen in previous epidemics, apes produce a virus that can infect anyone and not be associated with any group of people. “

The monkey smallpox virus is transmitted through close human contact, including skin-to-skin contact, kissing, clothing or linen that comes in contact with wound fluid, and short-distance respiratory droplets. However, like the coronavirus that causes COVID-19, it cannot be transmitted over long distances through the air. It is not yet known whether monkeys contract directly through sperm, but they can be transmitted through sores during sexual intercourse.

monkey chicken background

Monkey smallpox is close to smallpox, but less severe. It usually causes flu-like symptoms, swollen lymph nodes, and rashes ranging from small red bumps to fluid or pus-filled blisters. The rash can appear on the face, mouth or anywhere on the body.

However, clinicians say that the current epidemic does not always follow the classical model. Some people often have only one or more sores on the genitals or anal area, which resemble sexually transmitted diseases such as herpes or syphilis. Some people did not have symptoms such as fever, fatigue, or swollen lymph nodes.

The incubation period for the monkey virus is up to three weeks, and the disease usually lasts two to four weeks. Humans can be infected when they have symptoms and remain infected until the ulcers are completely healed and the scabs have subsided.

Most people with smallpox can be cured without treatment. The prevalence of the Ape smallpox strain in Europe is about 1%, and no deaths have been reported so far.

Smallpox, on the other hand, can cause more serious illness in children, pregnant women, and people with weakened immune systems. Complications may include pneumonia, sepsis, encephalitis, and corneal infection leading to vision loss. Antiviral drugs used to treat smallpox can also be used for smallpox, including tecovirimate (tpoxx), cidofovir (to visit) and brincidofovir (tembexa).

Monkey smallpox and HIV

Data on people living with smallpox and HIV are limited. Previous studies in Africa have shown that people living with HIV are worse off, including larger and longer-lasting ulcers, complications, and multiple deaths.

“There are limited data among people living with HIV, but those taking antiretroviral drugs and those with strong immune systems do not report a more severe course,” the WHO said. “People living with HIV, untreated or immunosuppressed may have a more severe course, as reported in the literature.”

“Currently, we do not recommend any specific interventions for people living with HIV without being vigilant about the clinical manifestations and history of infection.”

Speaking at aidsmapCHAT on May 23, Dr. Claire Duisnap, president of the British Association for Sexual Health and HIV, said there was “no risk” for people living with HIV undergoing antiretroviral therapy, suppressing the virus and having a CD4 count of more than 200. it’s getting worse. ”

The British HIV Association (BHIVA) agrees that HIV itself is not resistant to monkeys or can lead to more serious illnesses.

“Currently, we do not recommend any specific interventions for people living with HIV without being vigilant about the clinical manifestations and history of infection,” BHIVA said in a statement. However, the organization believes that people with a low CD4 count of less than 200, who have a stable viral load, or who have recently had an HIV-related illness should be at higher risk.

In the latest report Eurosurveillance He described four monkey diseases in Italian gay men. Two on HIV-positive and effective antiretroviral therapy, two on HIV-negative and PrEP. Three of the men attended the Canary Islands event, and one said they went for a sexual service; All reported having unprotected sex with various male partners during the trip.

Three of the men had systemic symptoms. All were recorded in different parts of the body, including three in the genitals and two in the anal area. However, unlike the classic monkey smallpox presentation, they all had asynchronous ulcers, so not all ulcers were present at the same time. All the men were cured without treatment. Examination revealed that the seeds of three of them had very low levels of the ape smallpox virus DNA, two had a positive sample of feces and one had a positive sample of saliva.

Another story in the same issue Eurosurveillance Describes 96 cases of smallpox in Portugal, with detailed information on some of the 27 cases. All are men, most of them in their twenties and thirties. Fourteen of them are infected with HIV. Only four reported that they had recently traveled internationally and that only one had been in contact with people with similar symptoms, but most reported that they had recently had sex with several partners and that several had gone to the sauna. About half reported systemic symptoms, including fever and swollen lymph nodes. Six had genital ulcers and five had anal ulcers.

Prevention of monkey smallpox

Vaccination against smallpox also prevents monkeys, but since smallpox was eradicated worldwide in 1980, people under the age of 50 have not been vaccinated.

Vaccine against the old live vaccine virus (ACAM2000) can cause side effects, especially in people with weakened immune systems and people with skin diseases. However, the recently approved non-replicating smallpox and monkey smallpox vaccine (imvanex to eat Jyneos) tested and found to be safe for people living with HIV. For those taking antiretroviral drugs with high CD4 levels, “If you are offered a smallpox vaccine, you should take it,” Duasnap advised.

Infection with monkey smallpox can be through ring vaccination or targeted vaccines for close contact with an infected person. Because of the long incubation period of smallpox, vaccination within a few days of illness serves as a post-infection prophylaxis. Several countries are now introducing vaccines to high-risk and health care providers in certain cases. Canada recently announced that it will offer vaccines to men who have had more than two male sexual partners in the last 14 days. However, experts say that at present the general population is not vaccinated against smallpox.

Health workers encourage people with unusual rashes or sores on any part of the body, especially the genitals, to see a health care provider or sexual health clinic. However, people should seek advice before visiting.

People who test positive for smallpox should be isolated until the rash is completely cured. Those who think they may be exposed are advised to monitor their symptoms, abstain from sexual intercourse, and avoid close contact for three weeks. Although it is not known whether the virus is transmitted through genital secretions, the UKHSA recommends that people with monkey pox use a condom for eight weeks after infection to prevent it.

In addition, it is important for people who have been tested positive for monkey smallpox and for those who think they may be exposed to it to work with contact-seeking efforts. Fortunately, men who have sex with men and their providers have experience managing outbreaks of sexually transmitted diseases that can be used to catch monkeys.

“Gay and bisexual communities have a high level of awareness and strive for faster health when it comes to the sexual health of themselves and their communities,” said Dr. Kluge. “In fact, we should thank them for recommending them to health services early.”

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