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WHO updates monkeypox advice to focus on sexually active gay men

World Health Organisation officials have updated their Monkeypox advice to target the sexually active gay community specifically.

The organisation released advice yesterday (July 26) defining those most at risk as ‘men who have sex with men and especially those with multiple sexual partners.’

There are 69 known cases of monkeypox in Ireland to date, according to the Health Surveillance Protection Centre (HSPC.)

All 69 cases are male, with an age range between 19 and 65 years. Sexual orientation is known for 58, all of whom are men who have sex with men.

Nine cases have been hospitalised, two for clinical care related to monkeypox infection and three for isolation purposes only. The HSPC said information on the reason for admission for the other four cases is still awaited.

The latest WHO monkeypox advice comes a week after the New York Times published a piece by journalist Benjamin Ryan calling on public health officials to issue accurate advice.

“Gay men deserve to hear the unvarnished truth about monkeypox so we can take action accordingly. We’re adults. Please be honest with us,” Ryan, who specialises in LGBTQ health issues, wrote.

He continued:

“An uncomfortable truth, one documented in peer-reviewed papers, is that sexual behaviours and networks specific to gay and bisexual men have long made them more likely to acquire various sexually transmitted infections compared with heterosexual people. This includes not only HIV, but also syphilis, gonorrhea, chlamydia, hepatitis B and sexually transmitted hepatitis C.” 

On July 23, WHO Director-General Tedros Adhanom Ghebreyesus redefined monkeypox as a Public Health Emergency of International Concern, which represents the highest alert level under international health regulations.

Two days later, the WHO issued a statement from Regional Director for Europe Dr Hans P Kluge calling on ‘at risk individuals to take action.’

Specifically, the statement asks gay men to ‘consider limiting your sexual partners and interactions at this time.’

“This may be a tough message but exercising caution can safeguard you and your wider community,” Dr Kluge said.

“If you have or think you have monkeypox, you are infectious so do everything you can to prevent spreading the disease. Isolate if you can, do not have sex while you are recovering, and do not attend parties or large gatherings where close contact will happen,” he said.

Dr Kluge urged cognisance of lessons learned from HIV/AIDS.

“Remove any judgement or stigma from the patient pathway; the lessons of HIV/AIDS must not be forgotten,” he said, addressing health providers directly.

He described Dr Tedros’ upgrading of monkeypox as ‘an approach based on no-regrets’.

“Monkeypox is, in general, a self-limiting, non-life-threatening disease in otherwise healthy persons,” Dr Kluge said.

Previously, in order to avert stigma, Mr Kluge said it is important to remember ‘the monkeypox virus is not in itself attached to any specific group.’

But the journalist Benjamin Ryan describes this as ‘misinformation.’

“This broad-strokes maxim — that everyone on Earth is susceptible to this troubling viral infection — might be factual on its surface. But it is so egregiously misleading it amounts to misinformation,” he said, urging public health officials not to priotise fighting stigma over their duty to inform the public.

“In particular, they are failing to properly convey the seriousness of this burgeoning crisis to gay and bisexual men,” Ryan wrote.

In Europe, there are cases of monkeypox recorded in 37 countries to date.

The WHO says it is aware of 12,000 ‘probable or confirmed cases’ reported between May and July. These reported cases exist mostly among men who have sex with men, with 8% hospitalised and no recorded deaths.

Cases among women and children remain minimal and close contact sexual transmission remains the key mode of spread. Many cases are not being detected or recorded, according to Dr Kluge.

His advice to ministries of health and public health authorities, including in countries that have not yet reported any cases, is to significantly boost monkeypox ‘surveillance, investigation, diagnostics and contact tracing to help identify and track every possible case.’

Previously, WHO advised that confirmed cases along with close contacts face 21 days of isolation.

There are two types of monkeypox: West African monkeypox and Congo Basin monkeypox.

“It is the milder, West African, type that is causing the current outbreak,” according to the HSPC. It is spread through close contact with the skin rash of someone with monkeypox.

“People who closely interact with someone who is infectious are at greater risk for infection: this includes household members, sexual partners and healthcare workers. The risk of spread within the community in general, is very low,” the HSPC said.

There is no medicine that can cure monkeypox and treatment offered is for pain relief and relief from itching.

The HSPC states that smallpox vaccinations are being offered to ‘high or intermediate risk’ close contacts:

“There is currently no licensed monkeypox vaccine available in Europe. Ireland’s National Immunisation Advisory Committee (NIAC) has recommended that smallpox vaccine can be used for monkeypox,” the HSPC states on its website.

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