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People wait in line at a monkeypox vaccination clinic run in Montreal, Canada. Alamy Stock Photo

'Not the only transmission route': Calling monkeypox an STI may create false sense of security

Speaking to The Explainer podcast, Dr Cillian de Gascun said it should not be overlooked that household contacts and healthcare workers are also at risk.

THERE IS A DANGER that commentary around the current global monkeypox outbreak could cause a false sense of security about the level of risk posed by the virus, a leading Irish virologist has said.

There have now been over 100 reported cases of monkeypox in Ireland since the start of the outbreak in May. Around 30,000 cases have been reported across 80 countries where monkeypox is not endemic and the World Health Organization (WHO) has declared the outbreak a Public Health Emergency of International Concern (PHEIC).

While the majority of cases in this outbreak have been among gay and bisexual men and other men who have sex with men (gbMSM), experts have cautioned against linking transmission solely to sexual activity and have warned that messaging, if not managed correctly, risks stigmatising people. 

Speaking to The Journal‘s The Explainer podcast this week, Dr Cillian de Gascun, Director of the National Virus Reference Laboratory said the terminology around the outbreak can be “challenging”, with some referring to it as a sexually transmitted infection (STI).

The Explainer / SoundCloud

“Traditionally, we wouldn’t have considered it an STI because when we think about sexually transmitted infections we often think about pathogens, like chlamydia or gonorrhoea, that require direct sexual contact – be that penetrative or otherwise – for transmission,” he explained.

“Now, when we look at monkeypox we know that’s not the case. It’s typically skin-to-skin direct contact, but it can also be respiratory droplets or through contaminated fomites or objects in an infected person’s households.”

Dr de Gascun said referring to monkeypox as an STI “automatically causes some people to think they are not at risk because perhaps they’re not sexually active or they haven’t been in contact with somebody sexually in a period of time or they haven’t seen somebody with lesions”.

Referencing the way Covid was transmitted in various specific sectors or groups in society, de Gascun said “viruses just follow human behaviour”.

“They don’t pick and choose different groups within society. So when we talked about Covid, Covid didn’t pick on people that were going to pubs, Covid didn’t pick on people that were going to weddings, it’s just the virus will follow human behaviour,” he said.

De Gascun said the virus “doesn’t really care about your sexuality” and it should not be overlooked that household contacts of infected persons and healthcare workers are also at risk. 

“Certainly sexual contacts are at increased risk as well, but that’s not the only route of transmission,” he said. 

Balancing the need to ensure those at risk get information and protection with the risk of stigmatising a particular group in society is a challenge for public health officials, de Gascun said.

“We would have seen it historically in the 80s and 90s with something like HIV as well, so I think what public health and all of us as medical professionals have to do is communicate as effectively as we can, to educate the population at large, but also have our messages targeted at people where they’re likely to receive them,” he said.

We know that maybe younger people, for example, don’t watch traditional news as much so they might get their information from podcast or they might get their information on social media. So the likes of the HSE and the Health Protection Surveillance Centre have done huge work in trying to get the message across those platforms as well.

He said that while public health messaging needs to speak to the whole population, it is also important to be responsive to the data and explain to people where the cases are and why some of the messaging may be targeted.

“Again if we look at the likes of Covid, obviously we had a significant issue in residential care facilities so they might have had enhanced measures,” he said.

“So I think it’s important that we don’t get too caught up in the populations or the groups that are involved themselves, but if we explain why we’re directing certain messaging at particular groups and provide the context, then I think most people would be happy to take that on board and wouldn’t be I suppose, unduly offended by it. But it is a fine balance.”

The National Immunisation Advisory Committee (NIAC) has recommended that smallpox vaccine can be used to provide protection against monkeypox. The European Medicines Agency has also recently approved the use of this vaccine for the prevention of monkeypox disease.

The HSE has said it is continuing to work on a vaccination programme targeting those who are most at risk of infection, including gay, bisexual and other men who have sex with men. However the health service has said supplies of the vaccine in Ireland are currently low and limited. 

Health authorities have said Ireland, along with other EU countries, is actively exploring options to increase the medium to long-term supply of vaccines.

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