Clear your doubts about monkeypox

With symptoms such as fever, body aches and sores throughout the body, monkeypox worries doctors and scientists because of its rapid spread. According to the CDC (US Center for Disease Control), there are already more than 700 cases of the disease in the world.

One of the questions still open is how the virus spread so fast in different countries – outside of Africa, this is the biggest outbreak ever seen. The low production capacity of the vaccine to stop the transmission of the virus is another aspect that worries specialists.

Below, see the main issues involving the current scenario of the disease and what can be done to stop its transmission.

What causes monkeypox?

The disease is caused by monkeypox, a virus of the orthopoxvirus genus. Another pathogen that is also of this genus is the one that causes smallpox, a disease eradicated in 1980.

Although they have their similarities, there are differences between the two diseases. One of them is lethality: smallpox killed about 30% of those infected. Monkeypox, on the other hand, has a mortality rate between 3% and 6%, according to the WHO (World Health Organization).

So monkeypox doesn’t mean a risk for having less lethality?

Minor risks do not indicate that the disease is not serious. Children, pregnant women and immunosuppressed are people who can develop more serious conditions, for example.

“It is still worrying because every infectious disease is not to run wild. It is necessary to contain these outbreaks”, says Clarissa Damaso, a virologist at UFRJ (Federal University of Rio de Janeiro) and advisor to the WHO (World Health Organization) committee. for smallpox virus research.

She is one of the researchers who make up the working group to fight monkeypox organized at UFRJ. The initiative carries out tests on people suspected of having the disease —in Brazil, there are six cases investigated— and should also monitor patients to observe the evolution of the clinical picture and prevent the spread of the pathogen.

In addition to the UFRJ group, two other centers carry out tests to diagnose the disease in Brazil: the Adolf Lutz Institute, in São Paulo, and the Funed (Ezequiel Dias Foundation), in Minas Gerais.

Another way to diagnose the disease is a test from the company Roche. Carlos Martins, president of Roche Diagnostics in Brazil, says that the product is a PCR exam similar to tests for Covid.

According to him, the results of the exams are ready between 4 and 8 hours and the product should arrive in Brazil in a few weeks.

How to contain the spread of the virus?

Decreasing transmission mainly involves isolating suspected and confirmed cases, as well as immunizing people who have had close contact with someone infected. Higher risk groups, such as frontline healthcare workers, can also be immunized.

According to the WHO, the smallpox vaccine has an effectiveness rate of approximately 85% for the disease caused by monkeypox. However, it is not available to the general public. In 2019, another immunizer was developed and is effective in preventing monkeypox, but is produced on a small scale.

Currently, Brazil does not have vaccines. Marcelo Queiroga, Minister of Health, said that the ministry is in contact with PAHO (Pan American Health Organization) to evaluate purchases of doses, but it is still under evaluation.

What explains the new wave of cases?

Monkeypox was already known, but it was recorded mainly in African countries. What has the scientific community on alert was the rapid spread of the virus to other countries outside Africa.

Despite the reference to monkeys, the monkeypox’s natural hosts are likely rodents such as mice. From them, the virus can be transmitted to humans through contact with fluids or injuries from infected animals.

From person to person, transmission happens through close contact. Infection can be via the respiratory tract, but prolonged close face-to-face contact is required. In comparison, Sars-CoV-2, the virus that causes Covid-19, is also transmitted through the respiratory tract, but does not need such close or prolonged contact.

Another form of infection is through the blister-like sores that monkey pox causes on the skin. Cristina Bonorino, immunologist and professor at UFCSPA (Federal University of Health Sciences of Porto Alegre), explains that the liquid inside these bubbles contains the virus. Therefore, direct contact with these secretions also causes the spread of the pathogen.

Due to the fact that there is a transmission that needs very close contact, the new cases still lack explanations. “We are not understanding exactly how this transmission is happening”, says Damaso.

The most reported hypothesis is that a person may have been infected in Africa and transmitted to other individuals outside the African continent in agglomerations.

This may have happened mainly because the onset of the disease has common symptoms and can lead to confusion. “It can happen that the person is at the beginning of the symptomatology, feeling a little bad, but they confuse it with the flu, for example, and pass it on”, says Damaso.

Another hypothesis that can be investigated are asymptomatic cases, says Bonorino. “One question is, is there a way that doesn’t cause blisters and therefore spreads faster? We don’t know.”

A third assumption is mutations in the pathogen. DNA viruses like monkeypox have a much lower chance of being altered. Even so, this possibility should not be ruled out, says Raquel Stucchi, an infectious disease specialist and professor at Unicamp (University of Campinas).

“Really, the virus doesn’t usually change, but something happened to it to explain this huge explosion of cases.”

And how is the treatment?

Tecovirimat is a drug that can be used for treatment. Recently, a study published in The Lancet investigated the remedy in cases of monkeypox and saw a positive effect.

Another drug is brincidofovir, an antiviral drug that already has FDA approval for the treatment of smallpox.

However, none of the drugs is available in Brazil. “To date, Anvisa has not received a request for authorization for vaccine or drugs against smallpox or monkeypox”, the agency informs in a note.

Anvisa also states that it is the responsibility of the pharmaceutical companies to make the request and also indicates that it is “possible to authorize the […] in public health emergencies”.

What to do from now on?

Although the situation is atypical, the chances of monkeypox becoming a pandemic are small due to the low transmission capacity of the virus.

Still, measures need to be taken. They mainly involve testing suspected cases of the disease, isolation in the positive or even the results of the exam and application of vaccines in those who had contacts.

“It is important for the population not to panic. It is not a new disease. We know that it has existed for a long time and we have weapons to fight it”, says Damaso. She also explains that antivirals can be useful to treat more severe cases of the disease in the country.

In addition, experts say that the new outbreak only drew attention when the disease spread to richer regions of the world, such as the United States and Europe, but when it was endemic only in Africa it did not have as much appeal.

The fact opens an alert for the so-called neglected diseases, those without much investment in scientific research. “We never give importance to what happens in Africa until it reaches the whole world,” concludes Stucchi.