How can I protect myself from monkey pox? See answers about disease prevention

Monkeypox has been a concern since May, when cases of the disease began to emerge in non-endemic regions, such as Europe and the United States. There are already more than 18,000 diagnoses worldwide, according to the Our World in Data portal. The situation made the WHO (World Health Organization) declare the disease as a public emergency of global concern.

In Brazil, there were 813 confirmed cases until this Tuesday (26), according to the Ministry of Health. The balance is more than triple verified on the 9th, when there were 218 diagnoses across the country.

“The number of cases in Brazil is growing rapidly,” says Marcia Castro, head of the Department of Global Health and Population at the Harvard School of Public Health and a columnist for Sheet.

The current outbreak has some quirks. Even though anyone can be infected, cases are concentrated in men who have sex with men. Tedros Adnahom, director-general of the WHO, said this Wednesday (27) that about 98% of diagnoses are in this population. In addition, research has already found that transmission occurs mainly through intimate contact during sexual intercourse.

The scenario raises questions, such as what measures to prevent infection and whether vaccines are available for prevention. Below are answers to some of these questions.

How is monkeypox transmitted?

The spread of the disease occurs mainly through direct contact with skin lesions that patients present. Ethel Maciel, epidemiologist and professor at Ufes (Federal University of Espírito Santo), explains that these wounds are similar to pimples with pus inside.

In the current outbreak, contact with the lesions during sex is identified as the main form of transmission. “In sexual intercourse, the contact is close so the possibility increases a lot”, explains Maciel.

But there are already confirmed cases of infection in children, which do not involve sexual activity.

“The monkeypox [nome em inglês pelo qual a doença também é conhecida] it is more related to sexual intercourse, but it can be transmitted in direct contact between the skin and the wound”, says Julio Croda, infectious disease physician and president of the Brazilian Society of Tropical Medicine.

In addition to direct contact with the lesions, sharing objects and clothing with an infected person can cause transmission. It is also possible to contract the disease through droplets, such as sneezing and coughing, through close and prolonged contact.

How to prevent the transmission of smallpox from monkeys during sex?

Unlike sexually transmitted infections (STIs) where the use of condoms is an important measure to prevent the spread of disease, monkeypox requires greater care.

Croda exemplifies a situation where the patient’s lesions are in the genital area, but not necessarily covered by the condom. “Then transmission can happen,” she says.

“This disease is very difficult from a prevention point of view, because if we have other STIs, the use of condoms alone is enough. reaffirming that condom use is still important.

Thus, one of the main ways to avoid transmission is to avoid sexual intercourse, as well as any other close contact, during the period when the lesion is active. According to Croda, the infection only stops occurring when all the wounds become crusts.

Maciel also recommends avoiding contact with strangers. “The more people you hang out with who don’t know if they’re sick, the greater your chance of getting monkeypox,” he says.

The epidemiologist’s recommendation is in line with research that shows that most cases occur in men who have sex with men with multiple sexual partners. The situation generates fear of prejudiced attitudes against this population. Croda says it is necessary to report the high number of cases in these men in order to alert them, but also “it is important to avoid stigma”.

Another point is that transmission is not restricted to this population, since anyone can have contact with someone infected. Croda says that a heterosexual with multiple partners may also be more exposed to infection.

“While one group is predominantly affected at the moment, it is important to understand that anyone can become infected,” WHO technical lead for monkeypox, Rosamund Lewis, told a news conference on Wednesday.

How can I protect myself from the disease?

The main guideline remains to avoid close contact with people who have the common lesions of monkeypox.

Currently, transmission of the disease without a sexual history is happening mainly in a household context in which one of the residents was infected.

In this case, it is recommended that the person isolates himself. The objects she uses should not be shared and clothes need to be washed. Constant hygiene with 70% alcohol is also necessary.

Other measures outside the residence can also be taken. Lewis recommends reducing attendance to crowded environments because they are more susceptible to physical contact with other people.

Should I be concerned about the transmission of the virus through respiratory droplets?

The chances of this type of transmission where there is no touching the lesions are much lower in the case of monkeypox. The CDC (US Centers for Disease Control), for example, states that passing someone with the disease in a supermarket should not cause transmission.

Protective masks, such as those used against Covid-19, prevent respiratory transmission. However, the equipment, in the case of monkeypox, should be restricted to very specific circumstances where you need to have close contact with someone who has the disease, such as indoors.

“[Uso de máscaras] It is not a measure that we should adopt for the general population”, says Croda, in specific reference to monkeypox.

What are the main symptoms of the disease?

In general, the patient has:

• fever
• headache
• malaise
• inflammation of the lymph nodes
• body injuries

But current cases show some particularities, such as more subtle or specific lesions in the genital and anal regions. According to experts, the scenario can make the diagnosis of monkeypox difficult.

What to do if you are sick or suspect of monkeypox?

If you suspect you have been infected, the first step is to look for the exact diagnosis. “If you’ve had contact with someone diagnosed with monkeypox, you should look for a health service to make an assessment of the need to collect a sample for examination”, says Maciel.

The epidemiologist also recommends that, while the diagnostic result is not available, it is already necessary to take some measures, such as washing hands and maintaining physical distance from other people. If the result is positive, isolation must continue.

Are there vaccines to prevent the disease?

Currently, the Jynneos vaccine, from the Danish pharmaceutical company Bavarian Nordic, is the only licensed immunizer in the world for monkeypox. Another possibility is the use of vaccines that have been developed to prevent common smallpox, such as Sanofi’s ACAM2000, which is used against monkeypox in the United States.

The measure is important, but immunizers take weeks to be effective, said Rosamund Lewis. Therefore, it is important to maintain other preventive measures.

Brazil still does not have vaccines. According to the Minister of Health, Marcelo Queiroga, negotiations are taking place to import drugs, but they should only be made available to health professionals who handle the virus.

In addition to higher risk groups, such as men who have sex with men, people who have had contact with someone who is sick may benefit from immunizations. “If the person receives the vaccine up to five days after contact, it prevents the disease”, summarizes Croda.

The lack of immunizations in Brazil is alarming, especially with the increase in cases, says Márcia Castro. “Without immediate action, the situation is worrying.”

I was vaccinated for common smallpox. Am I protected?

Evidence is lacking to confirm whether someone immunized for smallpox has protection for monkeypox. “We have a lot of uncertainties about that,” Andrea Vicari, head of PAHO’s (Pan American Health Organization) infectious threat management unit, said Wednesday.

He cites that cases have already been reported of people over 50 years old, who must have been vaccinated against common smallpox, with monkeypox. “It demonstrates that it is a risk in people who have been vaccinated […] against smallpox that could also be infected with monkeypox.”

The smallpox vaccine stopped being applied in Brazil in 1979 and, in May 1980, the World Health Assembly officially declared the eradication of the disease.