Symposium on Monkeypox Stigma Interrupted by Protesters

MONTREAL -- A symposium on the status of the monkeypox outbreak at the International AIDS Conference was briefly interrupted by protesters demanding that the U.S.'s stockpile of smallpox vaccines, which could be used to prevent monkeypox, be released to the world.

A group of about 50 activists mounted the stage with whistles, shouts, and signs, and gave brief, passionate, and often profanity-laced speeches, urging the Biden administration to use the cache of vaccines that are being stored for possible terrorist smallpox attacks to slow the spread of monkeypox.

Protests often occur at conferences, and the ones at this year's meeting have been generally peaceful -- a major difference from years past. During the monkeypox protest, the screens in the lecture hall cautioned protesters that they should limit the numbers of people on the stage for safety. After about 10 minutes, the screens suggested it was time for them to leave, and they filed out the back of the stage.

As they silently walked though the lecture hall, Demetre Daskalakis, MD, director of the CDC's Division of HIV/AIDS Prevention, explained how the agency is partnering with activist groups to get the message out to groups most affected by the monkeypox outbreak, such as men who have sex with men, noting that this requires a careful balance of being informative without being stigmatizing.

"By providing accurate and timely health information in a way that minimizes stigma and discrimination, we can empower individuals to make informed decisions for themselves and their communities," he said.

Earlier in the symposium, which was squeezed into the conference agenda in response to the late-breaking news about the monkeypox epidemic, Geneviève Bergeron, MD, medical officer for health emergencies and infectious diseases for Montreal public health, detailed the nature of the epidemic in the region -- one of the first epicenters of the monkeypox outbreak in the Western world.

On May 12, reports surfaced of five chancroid cases at a sexual health clinic in Montreal, and within a week, those and other cases were identified as monkeypox, she said. By May 18, emergency activation for a suspected monkeypox outbreak was initiated and outreach to the community began. As of August 1, the case count of people with monkeypox in Montreal was 317, mostly in men who reported having sex with other men, with a median age of 37.

David Hardy, MD, of the University of Southern California in Los Angeles, said that the extension of the definition of what might be monkeypox is important because initial cases of the disease were misdiagnosed.

He noted that the current outbreak of monkeypox differs from classical cases, in that anogenital lesions were observed among 93% of the patients. "That was rarely seen in other cases of monkeypox in endemic areas of Africa," he told MedPage Today.

He also said that the protesters were making a good point, since the smallpox vaccines could be both therapeutic and preventive for monkeypox

According to Bergeron, the monkeypox outbreak in Montreal has plateaued or is in decline, though she pointed out that because there is a long lag time of several weeks before cases can be confirmed, this hint of a decline should be viewed with caution.

Nicolò Girometti, MD, of the sexual health clinic 56 Dean Street in London, which is part of the Chelsea and Westminster Hospital NHS Foundation Trust, outlined the clinical manifestations of monkeypox in the 620 confirmed cases in the U.K.:

• 99% of cases involved men
• 31% of these men were living with HIV, with 90% having suppressed HIV virus
• About 94% reported having had a new sex partner within 12 weeks prior to being diagnosed

He noted that the mean incubation period for monkeypox lesions was about 8.5 days, with a prodromal period of mild illness of fever, asthenia, myalgia, headache, and sore throat preceding the appearance of lesions in the majority of cases (17% of patients in his study had no prodromal symptoms).

Of 101 patients tested from May 14 to June 1, 99% experienced at least one skin lesion, and 93% were anogenital lesions. Lesions appeared on the limbs of infected individuals in 49% of cases; on the trunk in 30%; on the face, neck, or scalp in 25%; and on the feet and hands in 20%. Patients often had lesions in more than one area.

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