We read with interest the editorial by Chavda et al. [1]. Globally, monkeypox outbreaks are spreading like never before. Although the majority of monkeypox cases have been found in young men who have sex with men, the authors focused on the elderly and the immunosuppressed.
It is known that smallpox vaccination may give a cross-immunity of at least 85 % against monkeypox [2]. Since smallpox vaccination was ceased over 40 years ago, over 70 % of people worldwide became vulnerable to monkeypox [3]. Furthermore, a recent study has evaluated the molecular evolution of orthopoxviruses suggesting that it is an emerging topic that requires further investigations, given the potential threat of the spread of orthopoxvirus infections in the near future [4], [5].
As of June 29, 2022, reports of monkeypox in people aged over 60 years have been rare, representing only about 1.5 % of all cases. Overall, no deaths have yet been reported, although 10 % of these cases have required hospitalization [3], [6].
However, some important questions arise. First, it is unclear how long the cross-immunity to monkeypox conferred by the smallpox vaccine can last, particularly in the elderly. Secondly, the clinical manifestations related to monkeypox are extremely varied, and include systemic symptoms, different types of rash and asynchronous skin lesions that could be confused with other skin diseases thereby delaying the diagnosis.
Therefore, efforts must be intensified to promptly recognize cases and so reduce the spread of outbreaks even in patients whose immune system may not be fully effective, such as the elderly.
Funding
No funding from an external source supported the publication of this letter.
Declaration of competing interest
The authors declare that they have no competing interest in relation to this letter.
References
- 1.Chavda V.P., Apostolopoulos V. Rare monkeypox: Is it really a threat to the elderly? Maturitas. 2022 Jun 9;163:90–91. doi: 10.1016/j.maturitas.2022.05.014. S0378-5122(22)00118-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.WHO Clinical management and infection prevention and control for monkeypox: interim rapid response guidance. 10 June 2022. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022 Available from.
- 3.European Centre for Disease Prevention and Control (ECDC) ECDC; Stockholm: 29 June 2022. Monkeypox cases reported in UK and Portugal.https://monkeypoxreport.ecdc.europa.eu/ Available from. [Google Scholar]
- 4.Babkin I.V., Babkina I.N., Tikunova N.V. An update of orthopoxvirus molecular evolution. Viruses. 2022 Feb 14;14(2):388. doi: 10.3390/v14020388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Chen N., Bellone C.J., Schriewer J., et al. Poxvirus interleukin-4 expression overcomes inherent resistance and vaccine-induced immunity: pathogenesis, prophylaxis, and antiviral therapy. Virology. 2011;409:328–337. doi: 10.1016/j.virol.2010.10.021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.World Health Organization (WHO) WHO; Geneva: 27 June 2022. Disease Outbreak News; multi-country monkeypox outbreak in non-endemic countries.https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON396 Available from. [Google Scholar]