Attaching a stigma to the LGBTQI+ community should be avoided during the monkeypox epidemic

Bragazzi, Nicola Luigi; Khamisy‐Farah, Rola; Tsigalou, Christina; Mahroum, Naim; Converti, Manlio

doi:10.1002/jmv.27913

Cited by 78 publications

(83 citation statements)

References 8 publications

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“…Contemporary public health and education should make clear that although there have been a high number of cases in men who have sex with men, and some cases of MPX with co-infection of HIV/AIDS 15 , MPX can also be spread via direct contact, clothing, and respiratory secretions, and that anyone can become infected. Nevertheless Bragazzi et al, 2022 39 point out the potential for exacerbation of stigma in already stigmatised communities.…”

Section: Discussionmentioning

confidence: 99%

Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis

Badenoch¹,

Conti

Rengasamy

et al. 2022

Preprint

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ObjectivesNeuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, Despite evidence of nervous system involvement associated with two related Orthopoxviruses, in the case of smallpox infection (with the variola virus) and smallpox vaccination (which contains live vaccinia virus). In this systematic review and meta-analysis, we aim to determine the prevalence and describe the spectrum of neurological and psychiatric presentations of MPX.DesignSystematic review and meta-analysisData sourcesMEDLINE, EMBASE, PsycINFO, AMED and pre-print server (MedRxiv) searched up to 31/05/2022Eligibility criteria for study selection and analysisAny study design of humans infected with MPX that reported neurological or psychiatric presentation. Studies which included more than ten individuals, and symptoms that were reported in a minimum of two separate studies were eligible for meta-analysisData synthesisResults were pooled with random-effects meta-analysis to calculate generalised linear mixed models and corresponding 95% confidence intervals for each prevalence outcome. Heterogeneity was measured with the I2 statistic. All included studies are summarised through a narrative synthesis. Risk of bias was assessed with the Newcastle Ottawa Scale and the Joanna Briggs Institute quality assessment tool.ResultsFrom 1,702 unique studies, we extracted data on 19 eligible studies (1,512 participants, 1,031 with confirmed infection using CDC criteria or PCR testing) most of which were cohort studies and case series with no controlled populations. Study quality was generally moderate. Six clinical features were eligible for meta-analysis, of which the most prevalent were myalgia in 55.5% [95%CI 12.1-91.9%], headache 53.8% [30.6-75.4%], fatigue 36.2% [2.0-94.0%], seizure 2.7% [0.6-10.2%], confusion 2.4% [1.1-5.2%] and encephalitis 2.0% [0.5-8.2%]. Heterogeneity significantly varied across clinical features (I2=0%-98.7%). Other reported presentations not eligible for meta-analysis included sensory-perceptual disturbance (altered vision, dizziness, and photophobia) and psychiatric symptoms (anxiety and depression).ConclusionsThere is preliminary evidence for a range of neurological and psychiatric presentations of MPX, ranging from commonly reported and nonspecific neurological symptoms (myalgia and headache) to rarer but more severe neurological complications, such as encephalitis and seizures. There is less evidence regarding the psychiatric sequelae of MPX, and although there are multiple reports of anxiety and depression the prevalence of these symptoms is unknown. MPX-related nervous system presentations may warrant surveillance within the current MPX outbreak, with prospective longitudinal studies evaluating the mid to long-term sequelae of the virus. Robust methods to evaluate the potential causality of MPX with these clinical features are required at an individual and epidemiological level.Systematic review registrationPROSPERO ID 336649SUMMARY BOXWhat is already known on this topicNeuropsychiatric symptoms can be highly disabling and have a detrimental effect on quality of life.Neuropsychiatric manifestations of monkeypox virus infection have not been well characterised, however, there is evidence of nervous system involvement with the related smallpox virus and vaccinia vaccine.What this study addsPreliminary evidence for a range of neurological and psychiatric presentations of monkeypox infection, ranging from commonly reported and nonspecific neurological symptoms (myalgia and headache) to rarer but more severe neurological complications, such as encephalitis and seizures.There is less evidence regarding the psychiatric sequelae of monkeypox infection, and although there are multiple reports of anxiety and depression the prevalence of these symptoms is unknown.This preliminary suspicion that there are monkeypox-related nervous system manifestations may warrant both surveillance within the current monkeypox outbreak and robust methods to evaluate the potential causality.

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Section: Discussionmentioning

confidence: 99%

Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis

Badenoch¹,

Conti

Rengasamy

et al. 2022

Preprint

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“…Human-to-human transmission emerged after the 1996-1997 Democratic Republic of Congo outbreak [6]. The transmission was reported caused by direct contact with rash, scabs, sores, scabs or contaminated objects or an infected person, and respiratory droplets [2].…”

Section: The Epidemiology Of Monkeypoxmentioning

confidence: 99%

Monkeypox and its Possible Sexual Transmission: Where are we now with its evidence?

Sah¹,

Abdelaal²,

Reda³

et al. 2022

Preprint

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Monkeypox is a rare disease which is rising nowadays in different countries since the first case in the UK was diagnosed on May 6, 2022, by the United Kingdom (UK) Health Security Agency. Then more than 12,500 cases were identified in over 68 countries up to July 18, 2022. In endemic areas, the monkeypox virus (MPXV) is commonly transmitted through zoonosis, while in non-endemic regions, it is spread through human-to-human transmission. Symptoms can include flu-like symptoms, rash, or sores in hands, feet, genitalia, or anus. In addition, people who did not take the smallpox vaccine were more liable to be affected than others. The exact pathogenesis and mechanisms are still unclear; however, most identified cases are reported in men who have sex with other men (MSM). According to the CDC, transmission can happen with any sexual or non-sexual contact with the infected person. However, a recent pooled meta-analysis reported that sexual contact is involved in more than 91% of the cases. Also, it is the first time that semen analysis for many patients has shown positive monkeypox virus DNA. Therefore, in this review, we will describe transmission methods for MPXV while focusing mainly on potential sexual transmission and associated sexually transmitted infections. We will also highlight the preventive measures that can limit the spread of the diseases in this regard.

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“…Minority groups have often been associated with and stigmatized for the spread of infectious diseases (Fischer et al, 2019;Hull et al, 2020), including COVID-19 (Kapiriri & Ross, 2020;Ransing et al, 2020;Wallach et al, 2020) and monkeypox (Bragazzi et al, 2022;Daskalakis et al, 2022). In South Korea, COVID-19 has become associated with unconventional, pseudo-religious groups (i.e., religious cult), sexual minorities, and with defying national interests (Yi & Lee, 2020).…”

Section: Layeredmentioning

confidence: 99%

LGBTQ+ individuals’ layered stigma experiences during COVID-19 outbreaks: The stigmatizing consequences of ineffective risk communication

Lim¹,

Jun²,

Ledford³

2022

Preprint

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Members of stigmatized groups, including lesbian, gay, bisexual, transgender, or queer-identifying (LGBTQ+) individuals, face greater vulnerability to infectious diseases, such as HIV/AIDS, coronavirus disease (COVID-19), and monkeypox, than non-stigmatized groups. Stigma can impact LGBTQ+ people’s access to health resources and can lead to discrimination. Risk communication messages for LGBTQ+ communities can also activate stereotypes and de-incentivize positive health behaviors. This vulnerability became clear for already heavily stigmatized LGBTQ+ people living in South Korea during the COVID-19 pandemic. As governments and media outlets communicated the sites of COVID-19 outbreaks, they shared details about transmission in LGBTQ+ spaces (e.g., gay nightclubs, bathhouses) that activated stereotypes about health, risk, and identity. LGBTQ+ individuals in South Korea subsequently experienced intersectional stigma related to gender, sexuality, and COVID-19. Since little research has examined intersectional stigma with COVID 19, the current study used in-depth interviews (N = 21) to examine the intersectional stigma and discrimination that LGBTQ+ communities experienced before and after the COVID-19 outbreak in Korea. Also, this study investigated risk communication that can help reduce and overcome stigmatization and thus encourage LGBTQ+ individuals to get tested, traced, and treated. Results revealed that reducing stigma is critical to encourage stigmatized groups to engage in infectious disease testing and treatment. Implications for public health are discussed. Highlights •LGBTQ+ people in South Korea experienced intersectional stigma with COVID-19•Anonymized testing procedures can reduce stigmatization and encourage testing•Health authorities can partner, consult, and collaborate with stigmatized groups•Health authorities can use trusted in-group messengers and messages with compassion•Governments should proactively develop anti-discrimination policies

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Attaching a stigma to the LGBTQI+ community should be avoided during the monkeypox epidemic

Cited by 78 publications

References 8 publications

Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis

Neurological and psychiatric presentations associated with human monkeypox virus infection: a systematic review and meta-analysis

Monkeypox and its Possible Sexual Transmission: Where are we now with its evidence?

LGBTQ+ individuals’ layered stigma experiences during COVID-19 outbreaks: The stigmatizing consequences of ineffective risk communication

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