Monkeypox in the elderly: Is an unwelcome surprise to be expected?

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.