‘Monkey pox could reach Brazil in a short time’, says epidemiologist

The emergence of monkeypox outbreaks has raised concern among Brazilians about the possibility of cases of the disease being identified in the country.

To date, more than 100 cases have been confirmed in at least 16 countries outside Africa.

In South America, the first suspect was registered on Sunday (23) in Argentina. According to the local Ministry of Health, the patient is a resident of the province of Buenos Aires, who is in good condition, is in isolation and receiving treatment for his symptoms.

Brazil has no record of the disease yet, but the virus was identified in a 26-year-old Brazilian in Germany, coming from Portugal, after passing through Spain.

For epidemiologists heard by BBC News Brazil, cases can be identified here soon.

“Monkey smallpox could reach Brazil in a short time”, says epidemiologist Ethel Maciel, a professor at the Federal University of Espírito Santo (Ufes). “It is even possible that an infected person has already entered the country, coming from the places where there are cases.”

“We often say in infectious disease epidemiology that a disease transmitted by contact and respiratory droplets can take as long as a flight to spread,” he says.

“That is, if someone infected lands in Brazil, is not diagnosed and does not isolate in a timely manner, the disease can indeed begin to be transmitted.”

Epidemiologist Eliseu Waldman, from the School of Public Health at the University of São Paulo (FSP-USP), agrees with the diagnosis.

“Even if we have a lower level of exchange of people and travel after the Covid-19 pandemic, the possibility of this virus reaching Brazil is great”, he says.

For this reason, the specialist warns of the need to identify suspected cases as soon as possible.

“The population and health professionals need to be alerted to notify suspected cases. The most striking symptom are vesicular lesions, the type that occurs in chickenpox, but much more intense,” he says.

In addition to injuries, symptoms of monkeypox include fever, headache, back or muscle pain, swollen lymph nodes, chills and exhaustion.

And in this process, itching can appear, usually starting on the face and then spreading to other parts of the body, especially the hands and sole of the foot.

However, for epidemiologist Antônio Augusto Moura Silva, a professor at the Department of Public Health at the Federal University of Maranhão (UFMA), it is still too early to make predictions about the extent of the outbreak.

“It may be that Europe can block the transmission quickly, before it reaches Brazil”, he says.

“It would be much easier to do that with this disease than with Covid-19, for example, because it takes a much closer contact for transmission in the case of smallpox.”

In any case, the specialist also warns of the need for the country to be prepared.

“It is highly recommended to stay on maximum surveillance alert so that, if there is a case identification, the patient’s isolation can be done as soon as possible”, he says.

“That is, to do what Brazilian public health already knows how to do.”

The Ministry of Science, Technology and Innovations (MCTI) has already established an advisory commission to monitor cases of monkeypox.

So far, seven Brazilian specialists from the Federal University of Minas Gerais (UFMG) and from the Feevale University make up the group.

The researchers produced two technical reports on the disease, with the main forms of contagion and the information available on cases registered in other countries.

“We are on alert”

Unlike the new coronavirus or even smallpox, where the pathogen is highly transmissible, monkeypox is less contagious.

“As far as we know, monkeypox is not the type of disease that you get from someone infected in an elevator, for example. Unlike covid-19, this doesn’t happen so easily”, explains Silva.

There are two versions of monkeypox: one from West Africa and one from Central Africa. According to experts, the former is milder and appears to be the one causing the outbreak in Europe.

Medical officials note that there is still not much information about possible human-to-human transmission routes in current outbreaks.

As far as is known, the virus is transmitted primarily through close contacts and exchanges of bodily fluids. Many of the cases in Europe appear to be linked to sexual transmission.

But all possible routes are being studied, such as indirect transmission through contaminated objects and even aerosols.

“But the disease is not sexually transmitted. In sexual intercourse, there is close contact, but this is the only known risk factor so far”, explains Eliseu Waldman.

The epidemiologist draws attention, however, to the fact that the origin of the cases identified so far has not been formally clarified.

“Monkeypox is endemic in several countries in Africa, there have already been several epidemics, mainly in Congo, Nigeria and other West African countries. Outside of there, there have been some outbreaks in the United States and Europe, but the introduction of the virus took place through known means, such as travelers or laboratory animals from Africa”, he says.

“In this case, we still don’t know for sure who the introducer was or in which country”, he says. “But a new outbreak was an expected event, because this virus is causing epidemics in humans with increasing frequency.”

The virus was first identified in a captive monkey in the 1970s, and since then there have been sporadic outbreaks in Central and West African countries.

There was already an outbreak in the US in 2003 — the first time the virus was seen outside of Africa — with 81 cases reported but no deaths.

The biggest outbreak ever recorded was in 2017 in Nigeria: 172 suspected cases.

Epidemiologist Ethel Maciel says that although the fact that the virus has demonstrated rapid transmission (although less than that of its human version or the coronavirus) may indicate that it is adapting better to humans.

“In general, monkeypox is what we call a zoonosis, a disease that passes from animals to humans. But with the higher rates of human-to-human transmission, especially among people who have not been to areas where the disease is more common, it is possible that the virus has adapted”, he says.

“Whether there is a risk of a major epidemic or even a pandemic? We don’t know, but we are on alert.”

The WHO held an emergency meeting on Friday (20) to address the issue. In a statement, the organization said that the current situation is “atypical, because (the disease) is occurring in countries where it is not endemic”, and that it will help affected countries in monitoring cases.

Maria van Kerkhove, the WHO’s technical lead on emerging diseases and zoonoses, said the spread of monkeypox was “a situation that can be contained”, but warned that “we cannot take our eyes off the ball”.

Vaccination

Smallpox was the first disease eradicated in history more than 40 years ago, when the WHO certified its end in 1980 after a successful global vaccination campaign.

As the monkeypox virus is related to human smallpox, the immunizer against smallpox has a high efficacy of 85% against the second version.

In that case, people over 55 who were vaccinated against smallpox before its eradication may have considerable immunity against monkeypox.

Some countries still have large stockpiles of the vaccine, including the United States.

In the UK, Health Secretary Sajid Javid said the country is stockpiling vaccines. “I can confirm that we have acquired more doses,” he said.

But it is worth remembering that, in Brazil, only people born before 1979 were vaccinated.

“Although it has already been approved, the vaccine is not available on a large scale in Brazil and we do not know how long this may take. It is a difficulty and a concern”, says Ethel Maciel.