Monkeypox cases drop in Brazil, but risks still exist

The monkeypox outbreak in Brazil shows signs of decline, repeating the downward trend observed in some European countries by the WHO (World Health Organization). However, experts, both here and abroad, view the retreat with caution and defend the maintenance of measures to control the outbreak of the disease.

“As with Covid-19, this is not the time to let your guard down,” said WHO Director-General Tedros Adhanom on the 14th.

In Brazil, according to the latest epidemiological bulletin on the disease made by the COE (Emergency Operations Center) linked to the Ministry of Health, the fall in the moving average of cases has been recorded since the first epidemiological week of August, between the 7th and 13th. of that month.

Even with the contraction, August accounted for the highest number of notifications of the disease: 3,699 cases. The sum is double that recorded in July.

The most substantial drop took place in the last epidemiological week recorded by the COE, between August 28 and September 3. The moving average of cases for this period was 35 new diagnoses. The week before, it was 107.

The bulletin also reports that only two states in Brazil still have no cases of monkeypox: Amapá and Rondônia.

São Paulo continues to be the Federation unit with the highest number of diagnoses: 57% of positive tests are in the state.

The scenario of decline should not necessarily be seen as a slowdown in the spread of the virus, says Ethel Maciel, epidemiologist and professor at Ufes (Federal University of Espírito Santo). She points out that there are few testing laboratories in Brazil — in total, there are only eight.

This causes a delay between sending the sample and the test result, which can result in a number of unaccounted for cases, says Maciel.

“In Brazil, we are not sure if this retraction is happening or if it is a diagnostic problem”, he summarizes.

Another factor mentioned by the epidemiologist is that the symptoms of the disease, such as vesicles throughout the body, can appear in a subtle way. For Maciel, this contributes to a possible number of cases that are not diagnosed. “Sometimes it’s one or two injuries and the person ends up not looking for a diagnosis.”

With these reservations, the epidemiologist recommends that preventive measures continue to be taken. Some of them are avoiding contact with suspects of the disease, isolation of those who show symptoms, such as the appearance of lesions, and vaccination.

In Europe

Some European countries have already seen a reduction in cases of infection. One of them is Portugal, which has been falling for more than a month. The country, which already had more than 60 diagnoses per week, recorded ten new infections in the last week.

The systematic reduction of cases in Portuguese territory was highlighted by the latest ECDC (European Center for Disease Control) report. In the document, which considers the results of 43 countries, Portugal appears with the third largest reduction, behind only Latvia and Slovakia.

Health authorities in the country, however, urge caution in the face of the epidemiological scenario. Responsible for the DGS (Directorate-General for Health) working group to deal with the virus in the country, infectious disease specialist Margarida Tavares recalls the scenarios of increases and drops experienced in the Covid-19 pandemic and highlights that viral infections often have dynamics contagion cycles.

“We may have the end of a wave but that, quickly, could be followed by another. Even the WHO (World Health Organization) has been very cautious with this reduction”, he ponders.

“But factually yes, it’s true, we have a decrease in cases. In fact, Portugal was one of the first countries to stabilize and now to have a decreasing trend”, adds the doctor.

According to the latest official bulletin, Portugal had 908 confirmed cases of monkeypox until last Wednesday (14).

In neighboring Spain, which was also on a downward trend in August, the number of new cases rose again in the last week. The 198 infections, however, still remain well below the 778 recorded in the first week of July.

Since August is the main summer vacation month in Europe, some experts also caution that there may have been a reduction in testing.

“The question is whether there was a real reduction or if it is an effect of the month of August, when there may have been diagnostic difficulties due to the holidays. Or if it is a combination of both,” ponders Spanish epidemiologist Joan Caylá, in an interview. to the newspaper El Independiente.

With 6,947 diagnoses of the virus since the beginning of the outbreak outside Africa, Spain remains the second country with the most confirmed infections in the world, behind only the US, which has more than 21,500 cases.

Portugal, which has already recorded more than 60 cases in a week, recorded 27 infections by the virus in the government’s latest weekly bulletin, released last Thursday (15).

Recently, WHO Director-General Tedros Adhanom Ghebreyesus said that the decline in new infections worldwide could be an indication that the outbreak is being contained.

In the European Union, countries are now moving to increase vaccination.

The decision by the European Medicines Agency to allow the technique of intradermal administration of the vaccine, announced in mid-August, is helping to expand the supply of the immunizer on the continent. The use of this method makes it possible to administer lower doses, multiplying the number of people immunized.

Stella Kyriakides, European Commissioner for Health, called the decision “extremely important” as it “allows five times as many people to be vaccinated” with the stock of vaccines available.

In Portugal, the Directorate-General for Health announced, last Thursday (15), that it will start preventive vaccination against the disease, using precisely this method.

Priority groups have not yet been defined, but should include people who are already on HIV pre-exposure prophylaxis (known as Prep) and healthcare professionals.

Until now, the country had adopted a policy of vaccinating people who had had close and prolonged contact with patients diagnosed with the virus. This policy will continue.

“In the beginning, all countries started by vaccinating the close contacts of the cases. However, this proved to be difficult and ineffective for many reasons”, says infectious disease specialist Margarida Tavares.