Monkeypox is not expected to take on the same pandemic proportion seen with covid-19 due to its low transmissibility. The statement was made by the director-president of the Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Marcus Guerra.
In an interview with A CRITICISM, he, who is an infectious disease specialist, explained what we already know about the disease, the forms of contagion, prevention and treatment. He also commented on the emergence of zooanthroponeses (diseases transmitted from animals to humans) and the possibility that unknown viruses still exist in intact regions of forests, such as the Amazon.
What is the main information we already have on monkeypox?
Monkeypox has been diagnosed in humans for many years since the 1970s and has always been endemic in some African countries. The countries that are in what is known as West Africa, on the coast of the Pacific Ocean and in Central Africa. These are infections that occur frequently in animals and have also been observed in monkeys in laboratories in Europe. Then it was seen affecting human being. When it infects humans, monkeypox looks a lot like smallpox, already extinct in the 1980s, which was circumvented thanks to the vaccine. These are manifestations which appear in two pre-distinct periods; the first when the person has a fever, body aches, and in the second, with the appearance of classic lesions. There is swelling and then the manifestation of the disease appears by the skin lesions, which usually start with a reddened elevation of the skin and progress simultaneously.
What can explain this increase in cases now and this attention that has been given, when it is already endemic in parts of the African continent?
We have several countries in Europe registering cases, such as Spain, France, Portugal, Germany, Italy, Belgium, all registering cases. Remember that these countries had many colonies on the African continent and maintain relations with these regions to this day, whether in terms of inhabitants or economy. This epidemic has now caught the attention of the world.
Monkeypox, like covid-19, is part of a group of diseases called zooanthroponoses, meaning they are also transmitted from animals to humans. Do these diseases appear more often?
We saw Ebola in 2016, which originated in bats, the coronavirus with three outbreaks around the world, and now monkeypox. Probably man penetrates too much into the environment of animals or reduces this space in such a way that proximity has become an important and preponderant factor for the emergence of these zooanthroposes.
Do we have studies that attest to the growth in the emergence of these zooanthroposes? Is there research that shows, for example, the relationship between the increase in these diseases and the increasing invasion of man into the forest?
[Aqui na Fundação] we have a laboratory that can identify an infectious agent, but always from a clinical sample that can appear [que já seja conhecida]. In our region, what we have for research concerns endemic diseases, such as dengue fever and yellow fever. There is also research on the Zika virus. What we want now is to expand our laboratory to diagnose other diseases earlier.
And the relationship between deforestation and the emergence of new diseases?
Now about deforestation, it can increase the risk of a new pandemic by an unknown virus, yes. Some viruses were discovered by the Instituto Evandro Chagas, in Belém, from the 1970s. These viruses exist and circulate in the region [amazônica]and it is necessary to have a laboratory to report and study the measures to be taken in the event of a possible outbreak.
Currently, monkeypox is feared, as we are still emerging from a traumatic pandemic for everyone, so the question remains: can this disease now reach a global epidemic level similar to what we have seen with covid- 19?
I would say it is more difficult, firstly because of the transmissibility which is lower than that of the coronavirus. Additionally, monkeypox is easier to recognize, allowing for a faster procedure to isolate infected individuals. Also, I learned that there are currently three laboratories in Brazil working on the identification and study of the virus.
Still using the pandemic as a parameter. During the covid-19 peaks, we saw high demand in hospitals around the world, including in Amazonas. Although the state does not yet have any confirmed cases, do you think we are ready for an eventual increase in cases?
We already have a technical note prepared by the Health Surveillance Foundation last week. So we have an orientation so that the gateway [de possíveis infectados] either in base units. This document informs about all the procedures to follow, for example, if someone arrives from regions with confirmed cases, [como Europa e África].
This point you make reminds me of those sanitary barriers that were very common during the pandemic. Do you think that would be the case if the outbreak also happened in Amazonas?
Yes, all of this will be discussed, but currently the whole of Brazil has only confirmed three cases. Thus, the current measure is to guide the isolation of these patients.
What are the similarities and differences between the smallpox we know and monkeypox?
The clinical manifestation is similar, but the mortality is very different. The former caused more deaths and left scarring, especially in the phase, as it usually starts on the face and spreads to the body. So much so that in my day some people with these scars were called “bladder face” because there were a lot of holes bigger than acne lesions. And this one with the monkeys almost doesn’t do that.
The WHO pointed out at the start of this outbreak that cases had also been identified significantly among men who have sex with men. What explains this?
I couldn’t find it, but people said that this outbreak in Africa happened after two big events. Also, lesions have been observed on the genitals of men who have sex with men who have been diagnosed with the disease, but this is not something to consider in terms of susceptibility. Closer contact promotes a greater possibility of contracting the disease.
This question of placing a group at risk or “most affected” group is very delicate because it can lead the population to believe that the disease only affects certain people. Just to be clear, monkey pox can affect anyone, right?
This. This has nothing to do with. In this specific case of men who have sex with men, there is no relation of susceptibility simply because they have a certain sexual orientation. What we have is a higher risk of death in children and people with low immunity, who can develop more serious illnesses.
Taking advantage of this point of transmission, how does it happen?
The disease is transmitted through close contact with people. This can be by droplets, but especially by the product of the lesion, which is highly infectious. It also passes through the materials that the healthy person uses, such as the sheets and towels of an infected person. The disease has an incubation period of 5 to 21 days, but often the manifestation takes place in an intermediate period of these days, 8 to 14 days, and all people who acquire the disease will be possible infectors.
We have a monkeypox vaccine in production. What technology is used?
It is the same system as the covid-19 vaccine, so much so that it is not very easy to grow the smallpox virus, and it also carries a danger of manipulation. For example, the smallpox virus is always kept in very high security laboratories so that it is not released into the wild due to the mortality it can cause. But in addition to this, the known smallpox vaccine itself also confers some immunity against monkeys.
About the treatment of this new disease. How is it done and how long does it take?
The disease generally lasts three weeks and the treatment is for the moment all symptomatic, because there is still no antiviral, although it is being developed. We must also take into account that since it is an epidemic, not a long-term disease, the laboratories do not work very hard on a new drug because if there is a large stock, they do not won’t sell when cases go down.
Thinking of advice for the general population, how to prevent disease? Does the mask help?
Prevention is not the use of items intended for the personal use of a person with the disease. Also avoid close contact with people who appear to have physical injuries. Masks are already used for covid-19 and help with monkeypox as you can inhale virus particles and get infected.