Here’s how to prevent monkeypox outside of sex

The current outbreak of monkeypox is most widespread during sexual intercourse, but transmission also occurs in other situations of close contact with an infected person. An example is the already reported cases of children who contracted the disease without any sexual contact.

“The risk of transmission exists regardless of sexual intercourse”, says Alberto Chebabo, infectious disease physician and president of SBI (Brazilian Society of Infectious Diseases).

The main form of transmission of monkeypox – the virus that causes monkeypox – is skin-to-skin contact with the vesicles that the patient has. As intimate contact is more recurrent in sex, transmission is easier to happen.

However, anyone can come into direct contact with the patients’ wounds without being in sexual activities and then become infected. “The Monkeypox Injury […] It has a very large amount of viruses. So, contact with these vesicles can lead to transmission,” says Chebabo.

Outside of sex, skin-to-skin touching directly on wounds may be more common in crowded environments, but varies depending on the level of exposure.

The CDC (US Centers for Disease Control) says that events where people are fully clothed and with little chance of direct skin contact are safe. Concerts and theaters, for example, can be considered a low-risk context.

Meanwhile, situations with a large number of individuals with few pieces of clothing and with a high probability of skin-to-skin contact present greater risks for disease transmission. Examples are parties, nightclubs and raves.

Direct contact with lesions can also occur on buses and subways when the crowding rate is high. “In public transport, the virus can spread from skin-to-skin contact or close to the person who is infected”, says Ana Brito, an epidemiologist at the Aggeu Magalhães Institute and an associate of Abrasco (Brazilian Association of Collective Health).

To avoid this type of transmission, one of the main recommendations is, if you see someone with monkeypox lesions, avoid close contact.

It is also recommended to maintain hand hygiene with 70% alcohol or soap and water. That’s because you can contaminate your hands and then touch your eye or mouth, making it easier for the virus to become infected.

In addition, prior assessment of the risks of direct contact with people at an event you intend to attend is indicated. It is also important that if you have the symptoms common to monkeypox, keep your distance from other people and seek medical attention for an accurate diagnosis.

Contact on infected objects

In addition to direct contact with wounds, transmission can occur when touching an object or surface infected with the virus. Cases are rare, but they can happen when a patient uses an object that is later accessed by an uninfected person.

Denise Garrett, epidemiologist and vice president of the Sabin Institute (USA), says that this risk of transmission by surfaces is smaller and variable. She cites two situations: the first in which an infected person has open lesions, expelling secretions and touching an object, in contrast to a second scenario in which the patient does not have many vesicles and does not eject as much secretion. In such cases, the first circumstance is when surface contamination will be much more likely to occur.

Garrett exemplifies with a case of a gym. She says that the risks of these environments increase if someone sick touches the equipment and doesn’t clean them afterwards.

“Sporting environments such as gyms are low risk unless someone has an open hand injury oozing, picks up a weight at the gym and someone else accesses the same weight right after.”

The risk is similar for other circumstances where an infected person touches an object. Therefore, a recommendation is to sanitize objects and surfaces with 70% alcohol or soap and water to prevent the spread of the disease. For example, in home environments where a person has monkeypox, it is recommended that the person’s objects are not shared with other residents and that they are always clean.

Clothes can also transmit the virus after being worn by someone who is sick.

Marcos Boulos, professor of infectology at the USP School of Medicine (University of São Paulo), says that, in tissues, the virus can survive for a longer period compared to other surfaces.

The fact that some clothes are in direct contact with the person’s skin is also an indication that they may be surfaces more likely to contain the virus. Therefore, the main guideline is not to share the pieces to keep the risk of transmission of the virus through surfaces low.

“Public settings where there is no intimate sharing of linens or towels have a very unlikely risk of transmission,” says Garrett.

In addition, it is recommended to sanitize clothes if they are used by someone who is sick. Cleaning should be done with soap and water.

airway

Respiratory secretions are another way in which transmission can occur. In the case of monkeypox, infection by this means is more difficult to occur. “It’s not contagious like Covid, but it’s transmissible by airways”, says Boulos.

Transmission by droplets requires very close and prolonged contact. “If you are on a plane sitting next to a sick person for six, seven or eight hours of flight, there is a chance of transmission”, exemplifies Chebabo.

“It’s not a transmission of ‘I passed through a person, so I’m going to get monkeypox'”, completes the infectologist.

Although rare, actions can be taken to prevent this type of transmission. One of them is the use of masks, especially in closed spaces, so that the infection of Covid-19 is also avoided.

“In any closed environment with a lot of people, the best thing is to wear a mask. Also because Covid is transmitted much more than monkeypox through this route, so it is necessary to use it”, says Boulos.

In addition to these care for people who have not yet become infected with the disease, one of the most important ways to stop the transmission cycle is testing suspected cases and isolation. By doing so, the chain of transmission of the virus will be interrupted.

“Diagnosis and isolation are the most important,” concludes Chebabo.