SP launches program to fight monkeypox

The Government of São Paulo announces, this Thursday (4), a series of measures to contain the rapid spread of monkeypox. According to data from this Wednesday (3) from the Health Department, the state has already recorded 1,298 cases of the disease. Two of these patients are hospitalized and ten children and adolescents have already been infected.

Among the measures is the creation of a statewide network of hospitals to care for the most serious patients and a network of public and private laboratories led by the Instituto Adolfo Lutz for epidemiological and genomic surveillance of the monkeypox virus.

“We have a significant increase in cases in Brazil in recent days. And there is a strange situation happening in Europe, in which [o surto] it came very fast and suddenly it stabilized. So there’s not much to predict what will happen on a day-to-day basis”, said David Uip, secretary of Science, Research and Development in Health of the São Paulo government, to Sheet.

The idea is that private laboratories, in addition to informing the cases they are testing, send samples to Adolfo Lutz for genomic surveillance.

A network for training and updating health professionals is also planned through state and municipal health surveillance. “They are the ones who manage to reach the tip. [o paciente da varíola dos macacos] is not an ICU patient.”

For patients who need hospitalization, Uip explains that the public and private hospital network needs to be prepared because they will need isolation. Jean Gorinchteyn, the state health secretary, said 93 health centers are available for more severe cases of monkeypox.

“We’re going to have to file everything. Are we going to keep the same entrance door to the emergency room or will there have to be two entrances? How do professionals have to attend? They have to wear gloves, masks, aprons and glasses. All this is a response and an investment” , said Uip.

According to him, the best strategy would be quick access to the vaccine, but at the moment, there will only be immunization available for 25,000 people in Brazil, two doses for each. For the state of São Paulo, 11,000 doses are planned for 5,500 people. The secretary informed that, in a conversation with the Minister of Health, Marcelo Queiroga, he was informed that the doses of vaccines should arrive in Brazil at the end of September.

“Then we’ll have to decide where we’re going to apply the vaccine. Which health professionals? From the laboratories? Those at the forefront? But that’s all the basic health units. It’s difficult.”

Uip says that the São Paulo government, through the Butantan Institute, is negotiating directly with the NIH (US National Health Institute) to acquire API (Active Pharmaceutical Ingredient), the input for vaccine production, but nothing is closed . “What we have in the medium term are 50,000 doses of vaccines [negociadas pelo Ministério da Saúde].”

According to the secretary, there will also be the creation of care protocols in the various specialties. “It’s a multidisciplinary and multiprofessional disease. Protoctologists, gynecologists, obstetricians, dermatologists, dentists, everyone has to be involved.”

He says that high turnover places, such as hotels and motels, will also have to be oriented towards proper care with bedding and bath linen.

Immunocompromised patients and vulnerable populations, such as those living on the street, are other sources of concern. “We have a case of a pregnant girl, living on the street positive [para monkeypox]HIV positive, C positive [hepatite]which disappeared [depois do diagnóstico].”

Uip also drew attention that São Paulo is the state with the highest number of cases in the country. According to him, most patients are asymptomatic or have mild symptoms. Even so, there are risk groups that can develop severe disease, such as immunosuppressed people. “There is no simple disease.”

The diagnoses in the state, as in the world, are concentrated in men. Of the total cases in São Paulo, 97% are in this population with an average age of 30 years. Uip, however, says that everyone can get the disease. “In a little while, everyone will be susceptible to infection.”

On July 23, the same day that the WHO (World Health Organization) declared monkeypox a public emergency of global concern, Uip stated that there is a fierce dispute over the monkeypox vaccine. The secretary also said that one possibility was the national production of the immunizer by the laboratories of Farmanguinhos (Fiocruz) and the Butantan Institute.

Last Friday (29), the Ministry of Health announced the order of 50,000 doses of the Jynneos vaccine, produced by the Danish pharmaceutical company Bavarian Nordic. The request was made via PAHO (Pan American Health Organization), which provides limited doses for 2022.

According to the ministry, the doses will be intended for health professionals who handle the virus and people who have had contact with infected people.

The announcement was on the same day that Brazil recorded the first death caused by monkeypox. The death was also the first reported outside the African continent.

Jynneos is the only licensed monkeypox vaccine. In addition, two other smallpox immunizations are considered for monkeypox, but evidence of their effectiveness is lacking, Tedros Adnahom, director-general of the WHO, said at a July 27 press conference.

In addition to vaccination, testing and contact tracing are identified as measures to stop the spread of the disease. In relation to these measures, Brazil is in a critical position, say a group of epidemiologists in a pre-print article published this Monday (1st) in the Brazilian Journal of Epidemiology.

The country has four laboratories for testing samples from suspected cases of monkeypox. The scenario of increasing cases in Brazil is already beginning to overwhelm these four centers and experts point to the need to increase the number of accredited laboratories.