Scientists see ‘imminent risk’ of monkeypox coming to country

Brazilian scientists formed a commission to monitor the cases of smallpox in monkeys, which have spread around the world in recent days. The advance of the disease has scientists on alert, as it is the highest number of cases seen outside Africa – which suggests an atypical transmission chain.

The Temporary Technical Chamber is coordinated by RedeVírus do MCTI (Ministry of Science, Technology and Innovation) and the seven scientists will put together a plan to structure the health network for when the first cases appear in Brazil. “We are able to detect this virus. For now, we have no reason to panic”, says virologist Giliane Trindade, who is part of the group.

“We are seeing the profile of the spread of this virus in European countries, it has already reached the United States, Canada, Israel. So there is an imminent risk of its entry into Brazil”, says Trindade, who is a professor and researcher at the Instituto of Biological Sciences at UFMG (Federal University of Minas Gerais) and a specialist in poxvirus (a type of virus that causes skin rashes in vertebrates).

Until last night (20), according to a document shared by the countries, there were 143 cases reported, between suspected and confirmed – most of them in Portugal, Spain and the United Kingdom. However, Israel, Australia and the United States, outside the European continent, also have registered cases.

Also yesterday, Germany reported the first case of monkeypox — a Brazilian.

the type of virus

The Poxviridae (poxvirus) family comprises viruses that infect invertebrate and vertebrate animals. In this group, the most notorious member is the smallpox virus.

“Within the family of several genera, these viruses stand out for their ability to infect humans and other animals, assuming an importance for human and veterinary medicine”, says Andrade.

Monkeypox patient in Congo in file photo taken during an outbreak of the disease between 1996 and 1997 - Brian WJ Mahy/ via Reuters - Brian WJ Mahy/ via Reuters

Monkeypox patient in Congo in a file photo taken during an outbreak of the disease between 1996 and 1997

Image: Brian WJ Mahy/ via Reuters

The zoonotic virus (ie, it jumps from animal to human) has been circulating for at least 50 years in Africa, where it is considered endemic.

THE monkeypox is a disease that occurs mainly in tropical forest areas of Central and West Africa and is occasionally exported to other regions. Cases have already been diagnosed on other continents, but always imported.

As the WHO (World Health Organization) explained in a statement on Wednesday (18), three cases in the United Kingdom drew attention because they point out that the infection “appears to have been acquired locally in the United Kingdom”.

“The extent of local transmission is unclear at this stage and there is a possibility of identifying other cases,” the entity said.

The first reported cases of transmission in the current outbreak in Europe were through sexual intercourse between men who were infected. The sexual route is one of the hypotheses of transmission, which involves contact with secretions from infected people.

“In Africa, the biggest transmission trigger is contact with wild animals, mainly through hunting. The population goes to the wild zone to fish, hunt, and comes into contact with animals, and in these communities a chain of transmission begins”, says Trinity.

less virulent group

On Thursday (19), a first phylogenetic analysis of the virus genome was released, carried out with a sample from an infected patient in Portugal. The result points out that “the 2022 virus belongs to the West African clade and is most closely related to viruses associated with the export of monkeypox virus from Nigeria to various countries in 2018 and 2019.”

According to Trindade, the discovery was good news. “This virus that is in Europe belongs to this clade [grupo de monkeypox] which is considered less virulent. There are two clades, and the most virulent is the one in the Congo basin”, he points out.

For her, it is still too early to know if there was any mutation of the virus that explains a different behavior in the transmission to humans.

This virus has a much greater genetic stability than that of covid-19, dengue or the flu. Mutations can occur, but it’s still very preliminary. I say that because that kind of analysis hasn’t been done yet.”
Giliane Trindade, virologist

Even considering that the virus reaching the country should be a matter of time, she says there is no reason for the population to be scared. “This group [do MCTI] was organized to have a structured expert network. We are in a position to respond. We pay attention, that’s the main message”, he says.

According to virologist Fernando Spilki, from Feevale University (RS), the cases that are being reported in Europe are behaving like “something out of the loop” for monkeypox and, therefore, the situation requires attention.

“It’s still a little unclear what’s going on, because they are chains of transmission with an atypical behavior of these viruses, especially this monkeypox, which normally doesn’t have – over time – the spread that it’s having now”, he says, who also is on the commission.

Smallpox and symptoms

Smallpox was considered eradicated from the world on May 8, 1980, by the WHO (World Health Organization). The disease, for decades, was one of the biggest killers in the world. Only in the 80 years of the last century in which it circulated, there were 300 million deaths.

In the laboratory that produced the smallpox vaccine, in the 50s, technicians collected material from cattle - Fiocruz - Fiocruz

In the laboratory that produced the smallpox vaccine, in the 1950s, technicians collected material from cattle

Image: Fiocruz

However, monkeypox never went out of circulation.

Vera Magalhães, infectologist and professor of Tropical Diseases at UFPE (Federal University of Pernambuco), says that monkeypox is a virus from the same family as human smallpox and was discovered in the 1950s in animals, mainly non-human primates.

“But there is also monkeypox in other rodents and mammals, which can be reservoirs of this virus”, he says.

The first evidence of human transmission of this virus, he says, occurred in 1970, when smallpox was still circulating in the world. “It occurred in Africa and to this day causes human infection on the continent, mainly in people who have had contact with animals,” he reports.

It is not the first time that an outbreak has occurred outside of Africa. Vera says that in 2003, about 40 cases were recorded in people who had contact with dog breeds that were domesticated in the US. In turn, these animals had contact with small rodents imported from Africa.

In Africa, the literature says that the disease kills one in 10 people. In the US we have more optimistic data, but we do not have this statistic in relevant numbers. It is still difficult to predict exactly what will happen.”
Vera Magalhães, infectious disease specialist

Vera says that the transmission of this virus, unlike the coronavirus, for example, occurs by respiratory droplets, but not by aerosol. “That is, a more intimate contact is needed. It is common in veterinarians and animal caretakers who have contact with some secretion, or when they have been scratched or bitten.”

About symptoms, Vera Magalhães says that there is not much difference from smallpox. “The incubation period ranges from five to 21 days, and starts with fever, myalgia [dor muscular]headache [dor de cabeça] —like any infection. In one to three days, the macular rash begins [manchas na pele]then they will turn into papules [espinhas] and then the vesicles [que evoluem para virarem feridas] very characteristic of smallpox”, he reports.

The WHO pointed out that vaccines used during the smallpox eradication program provided protection against monkeypox. “An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox”, says the entity.

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