10 questions and answers about monkeypox

considered as a global health emergency by the WHO (World Health Organization) since July 23, monkeypox already has about 1,200 confirmed cases in Brazil. The situation in the country, which confirmed the first death by illness on July 29, was described as disturbing by the entity.

The death was one of the few recorded outside the African continent, where monkeypox is endemic. The Brazilian Ministry of Health announced the purchase of vaccines against the disease, but there are no plans to massively vaccinate the population.

The disease has low lethality and more difficult transmission than the virus that causes covid-19, but it poses risks and requires different care, according to health authorities. In this text, the link answers ten questions about the situation of the disease in Brazil and in the world, symptoms, lethality and forms of prevention.

What is monkey pox?

A monkeypox is a viral zoonosis, i.e. a disease of animal origin. It earned the nickname because it was first identified in laboratory monkeys. It is considered endemic to parts of Africa. The first human case was recorded in the Democratic Republic of the Congo in 1970. Since then, it has become relatively common in central and western Africa.

The causative virus belongs to the same family (poxvirus) and the same subgroup (orthopoxvirus) as human smallpox – much more deadly and eradicated in 1980 thanks to vaccination. The diseases have similarities in symptoms and in the clinical course of the host in humans, but monkeypox is generally mild and usually does not cause major complications.

What is the health situation in the world?

The number of confirmed cases worldwide exceeds 20,000, in 78 countries, according to data from the WHO (World Health Organization) on Friday (29). As of Saturday (30), there have been three confirmed deaths outside the African continent and five in Africa in the current outbreak. Besides Brazil, Spain has confirmed two deaths linked to the disease.

WHO declared monkey pox a global health emergency July 23. The decision is an alert for countries to monitor the disease and implement actions to contain the circulation of the virus.

According to experts, as there are already many studies on monkeypox, this is a different situation than the appearance of covid-19, until then a new disease. The warning is that the success of the fight against the epidemic depends on the rapid action of public authorities.

What is the situation in Brazil?

More than 1,200 cases have been confirmed in Brazil as of Saturday (30), with most occurrences in the cities of São Paulo, Rio de Janeiro and Belo Horizonte. O first death in a patient with the disease was confirmed on Friday (29), in the capital of Minas Gerais.

The Ministry of Health is treating monkeypox as an epidemic and has created a monitoring committee of the disease. The epidemic is the first stage in the evolution of contagion, before the epidemic and the pandemic, as is the case with covid-19 today. It occurs when there is a sudden increase in the number of cases of a disease in a specific region. The first case of contamination in the country was confirmed in São Paulo less than two months ago, on June 8.

WHO’s technical lead for the disease, Rosamund Lewis, said July 26 that the situation in Brazil “is very concerning” and that cases may be underreported due to a lack of testing. the country has some laboratories authorized to take examinations.

What are the symptoms of monkeypox?

The first symptoms are fever, headache, muscle aches, fatigue and swollen lymph nodes (commonly called “ingua”). Usually, one to five days after the onset of fever, lesions appear on the skin, called exanthema or rash (red spots). Initially, they appear on the face and then spread to other parts of the body. The lesions are accompanied by itching.

According to the WHO, however, many cases in recently affected areas do not show this typical clinical picture, which requires special attention. Features that escape these symptoms include:

  • only some or even one single skin lesion
  • injuries in the genital or anal area which no longer spreads
  • wounds that appear in different steps of development
  • appearance of lesions before the onset of fevermalaise and other symptoms

According to the Ministry of Health, anyone with symptoms should go to a health unit, notify close contacts and self-isolate as soon as possible.

How is the transmission going?

The disease is transmitted by close contact with an infected person, especially if there is contact with broken skin, respiratory secretions, bodily fluids or objects, fabrics and surfaces used by the infected person.

Despite the recent increase in cases, monkeypox is generally not transmitted so easily. The United States Centers for Disease Control stresses that scientists are still conduct studies to understand whether the virus can be transmitted by asymptomatic people and how common respiratory transmission is.

Does the disease affect men more?

Currently, men who have had sex with men account for a large proportion of recorded cases and there is a transmission pattern associated with sexual activity, such as published study in the New England Journal of Medicine conducted in 16 countries. Therefore, thehealth authorities consider it important that gay and bisexual men stay alert at risk of infection.

But monkeypox is not limited to this audience, and we are concerned not to create stigmata that can amplify stigma and undermine disease control. Health Surveillance Secretary Arnaldo Medeiros confirmed on Friday (29) that anyone can contract the virus. “The main form of transmission is skin-to-skin contact,” he said.

Does monkeypox cause complications and deaths?

According to the WHO, in recent years, the death rate from monkeypox has been between 3% and 6% in endemic countries. In the current epidemic, the number of deaths recorded so far is less than 10 cases, among about 20,000 people infected. The entity estimates that 10% of patients had to be hospitalized because of disease in the world.

Some groups are the most vulnerable complications, according to health authorities: this is the case for newborns, children up to eight years old, pregnant women and immunosuppressed people (who have a weakened immune system). According to the WHO, possible complications include pneumonia, mental confusion, and skin and eye infections.

The first one death recorded in Brazil it was a 41-year-old man who, according to the Ministry of Health, had cancer, was hospitalized in Belo Horizonte and undergoing chemotherapy, in addition to suffering from a serious case of immunosuppression.

What is the situation with children?

Brazil currently has three confirmed cases of the disease in children, all in São Paulo – two six-year-old girls and a four-year-old boy. According to municipal health secretary Luiz Carlos Zamarco, patients are being monitored and showing mild symptoms. They had skin blisters (vesicles), swollen lymph nodes and fever.

To the Estado de Minas newspaper, the pediatrician, epidemiologist, master of tropical medicine and professor emeritus at the Faculty of Medical Sciences of Minas Gerais José Geraldo Leite Ribeiro declared that “the most serious forms of monkeypox occur in children, in pregnant women, including those at risk of harming the fetus, and in immunocompromised people”. He stressed that this knowledge is based on the endemic form of the disease in Africa, but that it is “likely” that this pattern will be repeated in other countries.

How to prevent the disease?

According to health authorities, the main form of protection is to avoid direct contact with infected people. The United States Centers for Disease Control lists three steps to protect yourself:

  • Avoid skin-to-skin contact with people with rash they look alike with those of monkeypox, and don’t touch wounds
  • Avoid contact with objects and materials used by someone with the disease, such as household items, clothing, and bedding
  • Wash your hands frequently or using hand sanitizer, especially before eating and touching your face, and after using the toilet

Given the concentration of cases among men who have sex with men, WHO Director-General Tedros Adhanom on July 23 advocated behavioral recommendations such as reducing the number of sexual partners until to contain the epidemic. “The best way to slow the rate of transmission is to reduce the risk of exposure. It means making safe choices for yourself and for others,” he said.

What treatments and vaccines are available?

Treatment for monkeypox relies on clinical support and medication to relieve pain and fever. Symptoms usually last between two and four weeks, and disappear on their own. An antiviral called tecovirimat, which blocks the spread of the virus, is already in use in some countries, but is not yet available in Brazil.

“Monkey pox causes a rash that can be uncomfortable, itchy and painful. So the most important thing when caring for someone with this condition is to take care of their skin and any symptoms someone might have.

Rosamund Lewis

WHO Technical Officer for Monkeypox

The Danish pharmaceutical company Bavarian Nordic has a specific vaccine against the disease, which has already started to be used in some countries but whose production is still limited.

The Brazilian Ministry of Health announced an agreement import 50,000 doses of vaccine. The forecast is that the first ones will arrive in September and will be applied to healthcare professionals who deal with the disease and to people who have been in contact with infected people. The acquisition will be made under an agreement with PAHO (Pan American Health Organization).

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