RJ and SP monitor flight passengers with monkeypox cases

Rio de Janeiro and São Paulo have been monitoring the health status of passengers who were on flights in which cases of monkeypox were identified. The procedure has been carried out by the Municipal Health Department of Rio de Janeiro and the São Paulo State Department of Health, according to the agencies’ press offices.

Brazil has already recorded seven cases of the disease. The last of them was confirmed by the Ministry of Health this Friday (17).

Of the seven confirmed cases in the country, four are from São Paulo, two from Rio Grande do Sul and one from Rio de Janeiro. Another nine cases are being investigated. The first case in Brazil was registered on June 8.

In the capital of Rio de Janeiro, the Municipal Health Department says it is starting a survey of passengers who were on the same flight as the patient with a confirmed case of monkeypox. Traveler data was provided by Anvisa (National Health Surveillance Agency).

The first case of monkeypox in Rio was confirmed on Tuesday (14). He is a 38-year-old man, resident of London, who arrived in Brazil on June 11 and sought care at Instituto Evandro Chagas the day after disembarking. The samples were analyzed by the Carlos Chagas Filho Institute, of the UFRJ (Federal University of Rio de Janeiro).

The municipal secretary also has the collaboration of the state health department of Rio de Janeiro to carry out the monitoring of people who had contact with the patient.

Currently, there are already five people being monitored by the health authorities in Rio for having had close contact with him. It is observed if they develop symptoms of the disease – if they do, diagnostic tests will be done. However, all five of these are not passengers on the plane, say the secretariats.

According to the municipal ministry, the monitoring procedures that must be followed for passengers have not yet been defined.

In São Paulo, the State Health Department says it has contacted all passengers on flights who had confirmed cases. As in Rio de Janeiro, passenger data was provided by Anvisa.

The health surveillance agency, in turn, explains that it is responsible for collecting information at ports and airports, both for monkeypox (the English name for monkeypox) and for other diseases. Anvisa says that it passes on passenger and crew information to the country’s health authorities, such as the local secretariats, and these define how to follow up on these people.

THE Sheet contacted the Ministry of Health to comment on this protocol in cases of flights with a diagnosis of monkeypox, but received no response until the publication of the report.

Chances of transmission

Monitoring passengers on flights with confirmed cases of monkeypox still raises some uncertainties. This is because the transmission of the virus occurs mainly through contact with the wounds of infected people. Another common way is through materials, such as clothing, that have had contact with these wounds.

However, the pathogen can also be transmitted through respiratory secretions, but requires close and prolonged contact. The CDC (US Centers for Disease Control), for example, states that passing someone with the disease in a supermarket should not cause transmission, for example.

Precisely because it has a lower chance of infection through the respiratory tract, the possibilities of transmission on planes are small. The CDC explains that “in cases where people with monkeypox have traveled by plane, no known cases of monkeypox have occurred in people sitting around them, even on long international flights.”

Even so, monitoring measures are important, especially in the initial moments of an outbreak like the one that is happening now, says Raquel Stucchi, infectious disease specialist and professor at Unicamp (State University of Campinas).

“This energy that is being spent on investigating passengers, at this moment when the first cases appear in the country, I think it is justified”, he says.

Stucchi says that, in these situations, one measure that can be taken is the adoption of a questionnaire or an app in which passengers indicate daily if they have developed any symptoms common to monkeypox, such as fever or blister-shaped lesions.

Based on measures to monitor these first flights, it is possible to determine whether this initiative should really be taken for other similar cases, continues the infectologist.

Clarissa Damaso, a virologist at UFRJ (Federal University of Rio de Janeiro) and one of the researchers who make up the working group to fight monkeypox organized at the university, says that an important aspect is to define monitoring protocols to be followed at all cases.

“Even if the probability [de transmissão] is low, does not mean it is impossible. That’s because you have a transmission by skin contact, that’s the main way, and there’s also a face-to-face transmission that inside the plane would be more complicated, unless the person knew very well the passenger next to him,” says Damaso.

The virologist exemplifies that it is possible to have contact on an airplane with the skin of an infected person, such as by shaking hands or touching the body, and then having a greater chance of infection.

However, if it is noticed that the person infected with monkeypox had not developed the lesions at the time of the flight, the chances of transmission drop. Therefore, Damaso says it is possible to have different monitoring mechanisms depending on the symptoms of the infected passenger.

In any case, an already known measure that can prevent the transmission of monkeypox through the respiratory tract is the use of masks. The CDC recommends that the infected person use the equipment in close contact with other people.

Similar guidance is given by Stucchi. “The use of masks prevents this respiratory transmission that can rarely happen”, concludes the infectologist.