Background and objective:
Monkeypox (MX) is a zoonotic emerging disease caused by the Monkeypox virus (MPXV). Cases of MPX have been reported in several states including Italy, mainly among men having sex with men (MSM). Lombardy Region has immediately introduced a surveillance program to describe the outbreak’s epidemiology and support control measures. This study aims to analyze what happened in order to manage the next season at best.

Methods:
The surveillance system comes into effect from physician reporting based on typical symptoms and suggestive history. This leads to a blood sample test managed by the two regional reference centers. In case of positivity, the quarantine of the patient and his close contacts is arranged. Depending on the clinical severity, the patient can be treated at home or hospitalized. Smallpox vaccine can be considered for the transgender and GBMSM population (gay, bisexual, and MSM).

Results:
As of 05/12/2022, the confirmed cases are 386: 381 males and 5 females, average age 38 years. 95 cases are caused by a foreign infection and 265 cases are reported by Milan’s local health authority. The symptom picture shows that: - 360 patients have rush; - 215 patients have hyperpyrexia; - 168 patients have lymphadenopathy. Time trend and epidemiological link highlight that peak periods correspond to two major event: Maspalomas and Milan’s 2022 gay pride.

Conclusion:
Data analysis shows that the disease is linked to some risky behavior. It will be necessary to take action by informing communities at risk (GBMSM and transgender) and by ensuring the regional healthcare system’s readiness. Lastly, an adequate vaccine campaign will have to be organized in advance for the concerned population.