SINGAPORE — A global outbreak of monkeypox is being largely driven by men who have sex with men, based on a finding from the largest study of the disease.
The study published in the New England Journal of Medicine on July 21 found that of 528 confirmed infections diagnosed between April 27 and June 24 this year, 98 per cent were gay or bisexual men, and 95 per cent had caught the disease through sexual activity.
Last week, the World Health Organization (WHO) declared the disease a global health emergency.
As more is known of how the disease is spread, infectious disease experts here and overseas have warned against stigmatising monkeypox with the gay community because it will only serve to further its spread, alienating this group of patients and making them not want to get medical help or treatment.
Apart from that, the spread of monkeypox is not just limited to sexual activity among homosexuals. The disease also spreads through close contact, which means that it is possible for the virus to infect people who have sex with people of the opposite sex and through kissing, for example.
The number of monkeypox cases worldwide has ballooned past the 18,000 mark on July 25, the Centers for Disease Control and Prevention (CDC) in the United States reported.
Singapore has reported 10 cases as of Tuesday (July 26)
Medical experts around the world have thus emphasised the need to raise awareness of its spread.
TODAY takes a look at what the developments are and what is being done in Singapore to curb the spread of monkeypox.
WHO ARE AT RISK OF CONTRACTING MONKEYPOX?
The largest study of the disease led by scientists at Queen Mary University of London looked at 528 patients from 16 countries. All were men and 41 per cent had the human immunodeficiency virus (HIV).
The study’s findings are in line with previous studies of monkeypox. For example, a report from the British Health Security Agency found that 97 per cent of 699 monkeypox cases it studied were men who had sex with other men.
In the new study by Queen Mary University of London, the authors noted that 95 per cent of the patients had caught the disease through sexual contact, adding: “The strong likelihood of sexual transmission was supported by the findings of primary genital, anal and oral mucosal lesions, which may represent the inoculation site.”
An inoculation site is the location where something, such as bacteria or a virus, enters a human.
This is further supported by WHO, which said that monkeypox spreads through close contact, such as face-to-face, skin-to-skin, mouth-to-mouth and mouth-to-skin contact.
Monkeypox can cause symptoms such as fever, a rash, headaches, back pain, aching muscles and a general fatigue.
In an infographic put out on July 18, the international health organisation stated: “The virus can also spread from contaminated environments to humans, such as when a person with monkeypox touches clothing, bedding, towels, objects, electronics and surfaces.
“Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread through direct contact with the mouth, respiratory droplets and possibly through short-range aerosols.”
It is for these reasons that Dr Jay Varma, an infectious disease expert at Weill Cornell Medicine in the US, told news site NBC: “The finding that 95 per cent of cases may have been transmitted during sex provides reassurance that this outbreak is primarily caused by very close contact and may explain why it’s been largely limited, so far, to dense social networks of men who have sex with men.”
Associate Professor Gregg Gonsalves from the Yale School of Public Health, whose expertise is in epidemiology or the spread of diseases, told The New York Times last month that the spread is largely among men who have multiple sexual partners — thereby keeping it within this community.
This is why international awareness campaigns are largely targeted towards gay, bisexual and men who have sex with men — despite the disease’s potential to spread to those who do not fall in this category.
For example, WHO has put out targeted public health advice about monkeypox for this group of men, including an infographic that lay down tell-tale signs of the disease and how it spreads, among other information.
In response to queries, Singapore’s Ministry of Health (MOH) said: “In line with the WHO’s recommendations, efforts have also been taken to reach out to the at-risk population (for example persons engaging in high-risk sexual activities) through healthcare and community partners, to raise awareness of monkeypox virus transmission and the precautionary measures to reduce the risk of onward transmission.”
When asked what high-risk sexual activities may be, MOH referred to WHO’s website, which states that it involves activities “such as persons who have multiple sexual partners”.
WHY MONKEYPOX IS NOT A ‘GAY DISEASE’
The authors of the study from Queen Mary University of London wrote: “Although the current outbreak is disproportionately affecting gay or bisexual men and other men who have sex with men, monkeypox is no more a ‘gay disease’ than it is an ‘African disease’.
“It can affect anyone.”
For instance, nine of the monkeypox cases studied were heterosexual men.
There is a need for “vigilance when examining unusual acute rashes in any person, especially when rashes are combined with systemic symptoms, to avoid missing diagnoses in heterosexual persons,” they added.
Assoc Prof Gonsalves told The New York Times: “The potential for it to move into other populations within the LGBTQ (lesbian, gay, bisexual, transgender and queer) community or further afield is possible.”
This is linked to the way monkeypox is known to spread — close contact can be between anyone.
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