The Ministry’s Surveillance Secretary, Arnaldo Medeiros, explained this Friday that the vaccine that will be acquired is made from a non-replicating virus. “The WHO (World Health Organization) does not recommend mass vaccination. We are not talking about a vaccination campaign like we did with covid-19. They are absolutely different diseases”, said Medeiros.
According to him, the vaccine’s target audience will be health workers who handle the samples collected from the lesions and people who have had direct contact with infected people.
Known internationally as monkeypox, the disease, which is endemic to regions of Africa, has already affected 20,637 people in 77 countries this year. More than 70% come from Europe and 25% from the Americas. Worldwide, 5 deaths from the disease had already been reported to the WHO as of Wednesday (27).
- Sao Paulo – 744
- Rio de Janeiro – 117
- Minas Gerais – 44
- Paraná – 19
- Federal District – 15
- Goiás – 13
- Bahia – 5
- Ceará – 4
- Santa Catarina – 4
- Rio Grande do Sul – 3
- Pernambuco – 3
- Rio Grande do Norte – 2
- Holy Spirit – 2
- Tocantins – 1
- Mato Grosso do Sul – 1
- acre – 1
Understand transmission, symptoms and vaccine
Considering the importance of information to combat the advance of the outbreak, the Federal University of Rio de Janeiro (UFRJ) held a meeting this Thursday (28) where experts presented what is already known about the disease and also answered questions from in-person participants. and online.
“We know this virus and we know how to deal with it. We have all the elements to eradicate it”, said physician Amilcar Tanuri, coordinator of the Molecular Virology Laboratory at UFRJ and a consultant for the Ministry of Health.
According to him, as there are already many studies on the monkeypox, is a different situation from covid-19, which emerged as a new disease. However, the researcher warns that success in combating the outbreak will depend on the commitment of the public authorities.
THE monkeypox is caused by a poxvirus of the subgroup orthopoxvirusas with other diseases such as vacciniaa cowpox and smallpox, eradicated in 1980 with the help of vaccination. The endemic picture on the African continent is due to two distinct strains.
One of them, considered more dangerous because it has a fatality rate of up to 10%, is present in the Congo Basin region. The other, with a case fatality rate of 1% to 3%, is found in West Africa and is the one that gave rise to the current outbreak.
However, according to the doctor, the virus in circulation suffered a gene rearrangement that contributed to its ability to transmit around the world. “He had a disruptive evolution. He underwent a drastic mutation,” he said. The researcher stated that serious cases are not recurrent. The biggest concern covers risk groups that include immunosuppressed, children over 13 kg and pregnant women.
“The fatality rate is related to the local health system. In the current outbreak, so far we have not had any deaths outside endemic areas. monkeypox is of low lethality”, emphasized virologist Clarissa Damaso, head of the UFRJ’s Laboratory of Molecular Biology of Viruses and advisor to the WHO.
Transmission and symptoms
Monkeypox was first described in humans in 1958. At the time, monkeys were also being affected, and they died. Hence the name of the disease. However, in the transmission cycle, they are victims like humans. In nature, wild rodents represent the animal reservoir of the virus.
“There are no reservoirs described in places outside Africa. One of the biggest concerns in the current outbreak is to prevent the virus from finding a reservoir in other countries. If this happens, it is much more difficult to contain”, guaranteed Clarissa.
Without an animal reservoir, transmission in the world has occurred from person to person. The infection arises from the wounds, body fluids and droplets of the patient. This can occur through close and prolonged contact without respiratory protection, contact with contaminated objects or skin contact, including sexual contact.
The incubation time of the virus varies from 5 to 21 days. The most characteristic symptom is the formation of painful rashes and nodules on the skin. Fever, chills, headache, muscle aches, and weakness may also occur.
“The lesions are deep, well defined at the edge and there is a progression: it starts as a red spot that we call a macula, it rises to become a papule, it becomes a blister or vesicle and, finally, it breaks up to form a crust”, explained infectious disease specialist Rafael Galliez, a professor at the UFRJ School of Medicine.
According to the WHO protocol, cases in which the patient has at least one skin lesion on any part of the body and meets one of these requirements in the last 21 days must be considered suspicious: travel history to a country with confirmed cases, contact with travelers who have been to that country or intimate contact with strangers.
diagnosis and treatment
The Molecular Laboratory of Virology at UFRJ has established itself as one of the national centers for diagnosing the disease. The first case in the state of Rio de Janeiro was detected on June 14, five days after the first case in the country was confirmed in São Paulo. Since then, there have been 117 positive results in the state of Rio. Other states have also sent samples for analysis at UFRJ.
These analyzes are performed on fluids collected directly from the skin lesions, using a swab [cotonete estéril] dry. There is an expectation that the population will soon have access to rapid antigen detection tests, similar to those made for covid-19.
Even in the most characteristic cases, the exam is important to confirm clinical analysis. A challenge for the detection of the disease is the similarity of its lesions with those caused by chickenpox, a disease popularly known as chickenpox and caused by a virus from another group. The change in the profile of symptoms has also raised an alert from experts. In monkeypox the eruptions tended to appear more or less together and progressed at the same rate.
“We started to see cases with single lesions, sometimes in the genital or anal region, sometimes on the lip, sometimes on the hand. And we also see lesions that appear at different times, more similar to chickenpox. This pattern is different from that was studied about monkeypox“, said infectious disease specialist Rafael.
Once the disease is detected, treatment is based on clinical support and medication to relieve pain and fever. An antiviral called tecovirimat, which blocks the spread of the virus, is already used in some countries, but is not yet available in Brazil.
According to the doctor, 10% of patients have been hospitalized for pain control, usually when there are lesions in the anus, genitals or oral mucosa, making swallowing difficult.
Prevention and vaccines
Surveillance for the rapid identification of new cases and isolation of the infected are essential to prevent the spread of the disease. It may take up to 40 days to resume social activities. Even if the patient feels better, he should continue as long as he still has a rash. “In chickenpox, the lesion with a crust no longer transmits the virus. In monkeypox, this lesion transmits”, emphasized Rafael.
The infectologist warned of the importance of avoiding contact with people who are part of risk groups. According to him, although there are few case studies involving pregnant women, the results are not good. “There is a high pediatric lethality. There is what we call vertical transmission, that is, the involvement of the fetus with serious damage: loss of placental structures and spontaneous abortions. With the little that is known, it is considered a serious obstetric disease . Suspected of being contaminated should be instructed to avoid contact with anyone who may be pregnant”, he warned.
UFRJ experts also noted that condom use does not prevent infection, as the intense contact and exchange of body fluids during sexual intercourse offers several opportunities for the transmission of the virus. On the other hand, there are indications that people vaccinated against smallpox have protection against monkeypox.
It is also known that the immune system develops cross-protection against the different orthopoxvirus. This means that anyone who has already been infected with smallpox or vaccinia, for example, and possibly has immunity to monkeypox. It was based on this knowledge that the smallpox vaccine was created. Although aimed at combating smallpox that affected exclusively humans and had a high lethality rate between 30% and 40%, the immunizer was developed from the virus of vacciniaa disease that usually infects dairy cattle and milkers.
With the eradication of smallpox, vaccination was suspended around the world around 1980. In Brazil, more robust campaigns took place until 1975, but until 1979 the immunizing agent was applied at health posts. The evidence points out that those who were born before that date and were vaccinated are protected against the monkeypox. The average age of those infected is below 38 years.
While vaccines already exist to help combat the monkeypox outbreak, there is no provision for a mass immunization campaign.
The WHO guides the protection of health professionals and laboratory researchers. For other population groups, immunization should be after exposure. According to virologist Clarissa, it is about using the ring vaccination strategy: people who are living and who have had contact with a positive patient are vaccinated in an attempt to block the spread of the virus. “This vaccine works very well up to four days post-infection,” she noted.
Clarissa adds that there is currently no vaccine for everyone and world production will take time. “Manufacturers had no production forecast for a disease that would affect the whole world. Production was exclusively for strategic stock in countries that have biodefense programs. Brazil, like many other nations, does not have that,” he explained. According to Rafael, studies have already shown the effectiveness of the ring vaccination strategy in certain outbreak scenarios.
Profile of the infected
Men under the age of 40 represent the vast majority of those infected. Studies in the UK have found that many victims declare themselves to be homosexual or bisexual. Experts, however, warn that monkeypox can affect anyone, not just sexually active males. Women and adolescents have already been diagnosed with the disease by the Molecular Laboratory of Virology at UFRJ.
WHO Director Tedros Adhanom Ghebreyesus this week advised men who have sex with men to reduce their number of sexual partners at this time. At the same time, he warned that “stigma and discrimination can be as dangerous as any virus and could fuel the outbreak.”
According to doctor Amilcar Tanuri, misinformation can leave society unprepared to deal with the outbreak. “This goes back to the history of AIDS and HIV. In the beginning, there was a stigma that only got in the way of preventing the disease. This is because when the virus enters an initial group it takes a while to spread to other groups. With HIV It started like this. Then it was realized that hemophiliacs had HIV, that children were born with HIV. There is no biological evidence that the monkeypox virus is sex-specific. In fact, I don’t know which virus has this specificity”, finished.
Butantan Institute is a partner of the Ministry of Health. If you have the agility to produce the vaccine as soon as possible, we will make the negotiations as soon as possible.