“Monkeypox is here to stay but there is no need to be afraid” – Last minute

For almost twenty years there has been a specific clinic for tropical diseases in the Balearic Islands. Although cases are seen in private clinics, or in Primary Care, this Son Espases unit is the reference in this type of case. The internist doctor María Peñaranda is responsible for it and although with the pandemic her activity decreased, she is now recovering. In an increasingly globalized world, “we see a lot of infections that we didn’t have before,” she says. A good example of this is monkeypox. Is it a tropical disease?
—It came as such but now it has been established and is not considered. Before there were specific cases, imported from Africa, they were few and with some local contagion, but what has happened now is that it has been introduced and there is a significant transmission. We call tropical diseases those that are acquired in the tropics and are manifested or diagnosed here. Malaria, dengue, chaga, typical of other areas, traveler’s fever are typical… What is the difference between smallpox, as it is known, and monkeypox?
—They are produced by two different viruses even though they are from the same family and their symptoms are very similar. Smallpox had extensive and important skin manifestations. That of the monkey produces similar lesions and also a systemic clinic but the mortality is much lower, it is a different health situation. Is it true that the vaccine of the first protects in part, who takes it, from the second?
—Yes, it has between 50 and 75% protection. In fact, most cases are being seen in young patients. It circulates, above all, of men among men. The transmission is by fluids and requires a more intimate contact, it has spread in this context. With the first cases, the Spanish Society of Internists already assured that this virus would spread. Is it very contagious?
“It is, but not much. It has not happened like with COVID. There are cases and they are increasing, especially in men who have sex with other men. The forecast is that it will increase but not at the rate of contagion that has been seen with COVID. Has it come to stay?
Yes, but you don’t have to be scared at all. We must be vigilant, both doctors and the population, when skin lesions appear on the skin, sometimes also on the genitals, which have a central necrosis, and in this case go to the health system. It can be serious but it is very unlikely. The vast majority of cases are mild and have not required income. What do you think about what is being done to prevent it?
—I am very much in favor of vaccination in the population at risk, which right now are men who have sex with other men because that is where between 90 and 95% of all cases circulate, in all countries. How is society doing at the alarm level, more or less than normal?
—Being alarmed is never good, you have to be informed. People should not worry, only the population at risk should be more attentive and go to the CAITS, which is where they are being vaccinated. What is treated in your consultation?
—What we see most commonly in immigrants is Chaga disease, which greatly affects South America, especially Bolivia. It is transmitted by an insect that is in those countries. Among travelers, the most common is malaria, dengue or traveler’s diarrhea. We have not had indigenous cases, they are all imported, but it would be possible, for example with dengue, because we have the vector, the tiger mosquito. How do you know about the cases, are they diagnosed?
-It depends on the clinic, they come for abdominal pain, blood disorders, most of them due to fever… The symptoms are very diverse, each one responds to its pathology and, depending on the area where it has been, you have to think about one infection or another. Even so, it must be remembered that 80% of trips to tropical areas are safe, although precautions must be taken such as avoiding insect bites, drinking unbottled water, or unwashed fruit and vegetables. How many patients do you usually see? by season?
-We have a specific weekly consultation and we usually see 12. In September, October, November… is when, with the return of the trips, the demand usually increases more. It seems that this year we will recover the pre-pandemic figures. Why are tropical diseases said to be the diseases of poverty?
—Because in the poorest countries there are the vectors, which are the mosquitoes that transmit them, but the climate factor and poverty itself also have an influence, which makes their eradication difficult. In Europe there have been outbreaks of chikungunya, for example, but they have been limited thanks to living conditions and the health system. There is also less research, little is invested in diseases that affect poor areas. A vaccine against malaria was announced a long time ago, is it being applied?
-Yes. It prevents 30% of infections, which is not outrageous, but especially for serious ones. It is not supplied to travelers, it is for children and pregnant women from countries where malaria is endemic, such as in Mozambique. Travelers should always continue to take prophylaxis, for at least a month, and avoid bites by using repellent, mosquito nets, or appropriate clothing. Are we more exposed with globalization?
-Clearly. We travel, but also vectors, through vegetables and fruits. In addition, we are affected by population growth and the invasion of jungle areas and climate change, the increase in heat and humidity expands vectors. Would this be the new trend?
—Migrations and travel are not going to stop and if we move more, so will viruses, bacteria and parasites.