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We just lacked smallpox!

ci mancava il vaiolo

(Warning. Although many points will recall behaviors that we adopted during the COVID pandemic, SARS-CoV-2 is a completely different virus than that of smallpox, having had COVID, having had anti-COVID vaccinations, having negative swabs for COVID, having high antibodies against COVID, ... HAS NO WAY TO DEFEND US FROM ANY CONTACT WITH THE VIRUS OF THE MONKEY FLY)

In these days the news of a case of "monkeypox" (monkeypox) also in Italy, even if the infection would have occurred in the Canary Islands. One infected family and 4 other cases in the UK. 5 in Portugal and 23 in Spain.

Human smallpox, with plague, tuberculosis, malaria, cholera was for about 1500 years one of the most serious diseases for humanity.

Disease transmitted by a virus, whose family includes, as always for viruses, variants: cowpox ( "vaccine", from which the terms vaccine and vaccination derived, when Jenner in 1796 inoculated his gardener's son a purified dilution of the liquid of cowpox pustules, a step forward compared to the variolation by scarification that has been practiced in India since 1000 AC), but also monkeypox.

The smallpox vaccination practiced from XIXth till XXth centuries was made compulsory : in Italy all children aged 2 years and 6-8 years old were vaccinated. This made the disease to disappear.

In 1970 the last case of human smallpox was recorded in Somalia and since 1980 the WHO declared the smallpox disappeared. Small quotas of smallpox virus samples are in some specific laboratories such as the CDC in Atlanta, the VECTOR in Russia. The University of Birmingham also had some, but due to an accidental escape that resulted in the last worldwide death from human smallpox - Janet Parker 11 September 1978 -, that laboratory was closed and the samples destroyed.

In the meantime, Italy suspended the smallpox vaccination from 1981, so all Italians born before 1979 are vaccinated against smallpox, while youngers one are not.

Monkeypox, the one we are talking about in these days, has been identified in Central Africa since 1970: since then reported few cases of transmission from animals to humans.

The Central African variant is a little more serious and lethal in 11% of cases, the West African variant a little less severe with lethality at 6%.

In Congo since 2005 there have been about 1000 cases per year.

From 2018-19 the first cases outside the African continent were recorded: Israel, Singapore, United Kingdom, United States ... mostly in travelers. In these days the last outbreak.

It is a virus. How is it transmitted?

Handling infected animals (mice, squirrels, some hamsters and of course monkeys ...), coming into contact with the blood, feces, secretions of these animals, eating badly cooked meat of these animals …

Can the infected man transmit the virus?

The routes are well known to us from the recent pandemic, even if we are talking about a virus completely different from SARS-CoV-2, it can pass

  • exchanging respiratory droplets,

  • handling contaminated objects,

  • by contact with the lesions of the infection in the patient.,

  • maybe contact for close relationships such as sexual ones.

How can I reduce this transmission?

With devices - masks, ventilation - to reduce the exchange of droplets, washing hands, washing objects at risk of contamination, wearing gloves if there is a risk of contact with skin lesions of the patient.

How does monkeypox manifest itself?

In 5-21 days from the possible infection - like any viral disease -

  • with a period of invasion, with fever> 38 °, headache, "swollen glands" *, back pain, muscle aches, fatigue

  • And a skin rash that appears 1-3 days after the onset of fever, starting from the face, palms and soles of the feet, oral mucous membranes, genitals and sometimes conjunctivae and corneas, and then spreads to the trunk and to the flanks

  • Synchronously (all together) the patches of the rash become macules, then papules, vesicles and crusts that last at least three weeks.

The lesions, few but often very many, are painful. * In particular the lymph nodes ("the glands") swell markedly, usually before the rash begins.

The disease typically lasts 4 weeks and is more severe in children.

It can be confused with chickenpox and measles: the WHO diagram shows us the differences.

Diagnosis is a PCR test of nucleic acids in the liquid from the lesions

The patient must be isolated and all isolation measures must be taken to protect the health professionals and the subject himself

  • Maintain effective spacing

  • Wash your hands

  • Wear gloves, gowns, masks

  • Avoid direct contact with the sick subject as much as possible

Adults previously vaccinated with anti-smallpox vaccine are generally protected also from monkeypox.

A new monkeypox vaccine was in place in 2019 but for adults.

The greatest risk remains for adults born after 1980 and in particular children


acute illness with fever over 38 °,

swollen and painful lymph nodes, back pain, muscle aches, profound fatigue,

and in 1-3 days a rash that spreads from the face to the body, to the palms of the hands and to the soles of the feet.


Tip: let's remember the prevention measures (distance, hand hygiene, breathing hygiene) already used during the COVID pandemic.

Do not touch small animals, especially if they are wild (squirrels, monkeys, hamsters ...) in zoos or while we are traveling to exotic countries

Dr Rosamund Lewis Health Emergencies Program World Health Organization, Geneva

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