Opinion – Atila Iamarino: Monkeypox and the next pandemic

With the world sensitized by Covid-19, we see attention turning to monkeypox or “monkeypox”. Since the detection of the first case in the UK, 372 cases have been diagnosed in more than 20 countries outside the African continent, between Europe, the Middle East, the Americas —including our neighbor Argentina— and Australia. And more cases should follow, now that we know what to look for, as their symptoms and sores are quite evident.

Although it is caused by a virus in the same family as smallpox, this works in our favor for now. Because it is known, we already have a good idea of ​​its transmission, diagnosis and how to fight it. Its transmission happens mainly through direct or indirect contact with droplets of saliva and other body fluids, or even sheets, towels and other materials that have been in contact with someone with the wounds that the virus causes. Which is a more preventable form of contagion than through the air.

Also because it is a smallpox family virus, the smallpox vaccine we already have works well against it. This allows for strategies like the one the UK has been doing, immunizing close contacts of confirmed and suspected cases of monkeypox with the traditional smallpox vaccine. Despite the scare and concern, it is a disease that we have good conditions to deal with without going through something close to Covid. Chances are you and the people around you will not be affected by it.

The sudden outbreak of a disease that we have lived with for decades suggests a change in behavior or in the virus that generates this spread. And our behavior has a lot to explain. Molecular surveillance found very similar genomes between the European and US cases, with little to no change from a strain already found in Nigeria in an outbreak that has been happening there since 2017.

So far, we have found no indication that the virus would have changed or increased its transmission between humans. While the genital lesions found in many of the cases suggest that the contact that favors the transmission of the virus may be sexual. In that case, tracing contacts and isolating those infected can quickly contain cases.

The qualification “outside the African continent” for the cases symbolizes a lot about pandemics today. Monkeypox virus is so named because it was discovered in monkeys imported to Denmark in 1958. But its origin is on the African continent, where two strains of monkeypox circulate in rodents and regularly cause cases in monkeys and people they come into contact with. with the game meat of these animals.

Something similar to outbreaks of pulmonary mycosis linked to armadillo hunting here in Brazil. Its discovery is also reminiscent of the Marburg virus, a relative of Ebola, which originated in African bats but was discovered in monkeys in Germany in 1967. While its circulation outside Germany resembles Zika, a virus that was found in monkeys and caused some cases in humans since the 1940s in Africa, but which won the world for being transmitted by the dengue mosquito.

Coincidences with other viruses are no accident. There is no lack of cases of viruses that circulate in other animals, zoonoses, which can and will cause us problems. Every year we have sporadic cases of zoonoses in humans. The big problem happens when some of these viruses have the opportunity to improve their transmission between us. We are currently experiencing a pandemic caused by a respiratory virus from bats, Sars-CoV-2, which has already caused sporadic cases in humans in Asia. And with the environmental and climate changes we are causing, our coexistence with them, wild animals and their viruses, only increases.

Surveillance and combating infectious diseases are essential to minimize this risk. For example, with the end of smallpox in the 1970s, we stopped vaccinating it. Then, those born in the 1980s and those who had been vaccinated a long time ago were once again vulnerable to other smallpox viruses, such as monkeypox. So much so that its cases have been increasing on the African continent.

By the beginning of May, the World Health Organization had already registered more than 1,200 cases of monkeypox in endemic countries: Cameroon, Central African Republic, Democratic Republic of Congo and Nigeria. So many cases resulted in around 60 deaths. Scientists in Nigeria are seeking help to understand the outbreak that has been going on there since 2017, without receiving attention until now.

Smallpox vaccines could have helped end this much sooner. Surveillance and collaboration could have clarified the situation. Just as there is a lack of vaccines and surveillance in Covid, but variants remain. We still repeat the mistake of not treating a local outbreak as a global problem. And the sooner we act, the less chance we give viruses to evolve among us.