Brazil lives with monkeypox threat still without protocol and supplies to test suspected cases – News

The confirmed cases of monkey pox, or simian smallpox, now exceed two hundred in more than 20 countries, along with dozens of other suspects. The disease turned on the alert at the WHO (World Health Organization) because it had never appeared in this proportion outside Africa, where in many countries it is endemic (constantly registered).

Brazil, however, still does not have defined protocols for testing and isolating suspected cases that may arise here, nor the necessary inputs to provide tests, if necessary.

When cases occurred outside the continent, they occurred from contact with a wild animal, after traveling to places where the disease is present, or from wild animals taken from nature and brought into human contact.

In the outbreak this time, which started about a month ago in Europe, the transmission speed is different, and the emergence in distant places intrigues researchers.

“It’s a different behavior from what we saw in the past when this virus left Africa. We are seeing a rapid spread, both in terms of space and in the number of case records. This is really atypical, it draws our attention”, explains Giliane Trindade, virologist and professor at the Department of Microbiology at the Institute of Biological Sciences at UFMG (Federal University of Minas Gerais).

With that in mind, the Ministry of Health it’s the Ministry of Science, Technology and Innovations (MCTI) created working groups to develop protocols and procedures for the possible arrival of the disease in Brazil.

The virologist, who is also part of the Temporary Technical Chamber – CâmaraPox MCTI, is emphatic in stating that the country has human and technical resources to diagnose the disease, but the concern is with specific inputs to detect this virus specifically.

“Brazil is fully capable of attending and is prepared, as we have trained personnel and equipped laboratories. Now, we are really understanding what the laboratory protocols will be, so that we can order supplies. of that kind, specific molecular tools, we didn’t have. It’s not a diagnosis that is part of our routine. Nobody here comes to a laboratory and asks: I want to do a test for monkeypox [nome da doença em inglês]because it is not a virus that circulates naturally in Brazil”, says Giliane.

Infectologist José Ângelo Lindoso, coordinator of the Neglected Diseases Group at the Emílio Ribas Institute of Infectious Diseases, in São Paulo, has the same concern.

“The diagnosis is made through the recognition of viral DNA, through the PCR test, or through another sequencing technique. But this is not available for the whole of Brazil. [Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo]Emílio Ribas and at the Institute of Tropical Medicine at USP [centros de referência]. These places are more likely to make a quick diagnosis”, laments the doctor.

In addition to collecting via swab (sterile swab) from the lesions, which are rich in viral materials, the disease can be diagnosed by blood tests performed at the beginning of symptoms, when the virus circulates through the bloodstream.


Guidance for healthcare professionals

After the availability of supplies, the guidance of health professionals should be among the priorities of health authorities.

“It’s an extremely unknown disease for 90% of health professionals around the world. The first thing we have to do is raise awareness of all health professionals,” says Lindoso.

The Ministry of Health sent a Risk Communiqué to all states with guidelines for health professionals and information available so far about the disease.

“It is essential to warn of the occurrence and what should be done immediately. As we are in a pandemic, we end up attending with hospital clothes, with a mask. and then discard”, alerts the infectologist.

For now, in South America, only Argentina investigates a person suspected of having the disease. But there are already records of infected in Europe, North America, Oceania and Asia. The WHO (World Health Organization) considers it the worst outbreak of the virus outside Africa.

From the appearance of a suspicious case, the indication is that professionals put the person in isolation.

“It is a disease that has no specific treatment. So, the patient arrives with some suspicion, it is already necessary to leave the patient isolated and try to make the diagnosis, as early as possible, and try to guide the patient in relation to what he must be careful in relation to contact with other people to avoid transmission”, points out Lindoso.

Giliane Trindade adds: “If you have a suspected case, it has to be notified to the Ministry of Health and the material from the suspect will be collected by doctors or nurses properly dressed and this material will be sent to the Lacen (Central Laboratories) of each state to be able to make the diagnosis. There, they will redirect them to the laboratories that will be able to attend during this period of diagnoses.”


What is the isolation period?

From the suspicion and positive diagnosis, the orientation is to stay in isolation for three to four weeks or while the patient has lesions on the body.

“The ideal thing is that the person stays in isolation until the wounds dry and preferably the healing scabs fall off. These crusts have viruses, even if the person [saudável] do not have contact with that individual’s crust or skin [doente]but where he sits, leans, he is leaving viral particles and will transmit the disease”, highlights Giliane.


Vaccine production in Brazil

The Butantan Institute, one of the main vaccine producers in Brazil, also created a working group to assess the spread of the monkeypox virus on the world stage and a possible confirmation of cases in the national territory.

The group is in the phase of studying the disease and evaluating the immunizations available on the market, which are few and produced on a small scale.

The manufactured vaccine against traditional smallpox, which was declared eradicated from the world in 1980, has considerable efficacy (about 85%) against monkeypox. However, the immunizer is no longer produced and “used a technology that, perhaps, no longer fits with the current technological context”, said the Butantan in a statement.

If necessary, the institute has committed to producing a new vaccine. It is worth noting that the WHO said last Monday that it does not see the need for mass immunization of the population.

In addition to providing protection before exposure, the immunizing agent can also be used in people already infected.


Is anyone more likely to have monkeypox?

It is worth mentioning that there is no proven group or age group that has a greater chance of being infected. The concern is only for people with problems in the immune system, as with any infectious disease.

“There is no risk group. There is no age group that is more possible to be infected. The only people we consider at great risk are immunosuppressed. With these we have to be very careful. All immunosuppressed people are at risk for any infectious disease “, concludes virologist Giliane Trindade.


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