In the last week the world followed one rapid increase in the number of cases of apepox, or monkeypox, mainly in European countries. However, the virus has already spread across the continents of North America and Oceania. The number of confirmed diagnoses and suspected cases exceeds a hundred.
According to virologist Camila Malta, researcher at the Medical Investigation Laboratory at the Hospital das Clínicas of the FMUSP (Faculty of Medicine of the University of São Paulo) and at the Institute of Tropical Medicine, no country is free of cases.
“There’s no way to predict anything, but there’s no reason why she won’t arrive in Brazil. It is not possible to know which country in South America it will enter through, but we do know that it has excellent connections via São Paulo, Brasília and Rio de Janeiro. It is possible that it comes from countries with cases this way. But it’s just a guess.”
She adds: “The WHO [Organização Mundial da Saúde] call an urgent meeting to define whether the situation is an emergency. Given this, we cannot believe that Brazil is safe, no country is safe.”
What is curious among health officials is that at other times when cases of monkeypox have occurred outside of African countries where the disease is endemic (it usually occurs), the outbreaks have been localized. Now the transmission is faster and there are already cases of community spread.
“It’s a disease that shouldn’t be easily transmitted because its natural host isn’t human, it’s probably a rodent. Even though it’s the monkey disease, rodents are believed to be the most natural host,” says Camila.
One of the possibilities being studied is that the virus has undergone a mutation that facilitates transmission between people.
“The first genomes were sequenced in Portugal, it is still being analyzed, so we cannot say anything. Could it have undergone a mutation that facilitates humantohuman transmission, and that’s how we’re seeing this outbreak now? It is not known yet, but it is a hypothesis,” he points out.
In the first report on the genome analysis carried out in Portugal, the researchers stated:
“A first rapid phylogenetic analysis of the genome sketch indicates that the 2022 virus belongs to the clade [ramo] from West Africa and is most closely related to the virus that has been linked to the export of monkeypox virus from Nigeria in 2018 and 2019 to several countries, namely the United Kingdom, Israel and Singapore. These preliminary data and analyzes will be updated shortly with the release of new genomic data that will be important in elucidating the origin and international spread of the currently circulating virus.”
Unlike SarsCoV2, which causes Covid19, the smallpox virus does not undergo rapid mutations because it is DNA the coronavirus is RNA.
Fabian Leendertz from the Robert Koch Institute described the outbreak as an epidemic.
“However, it is very unlikely that this epidemic will last long. Contact tracing is a good way to isolate cases, and there are effective drugs and vaccines that can be used when needed,” he said in an interview with Reuters.
stream
Apepox is transmitted by prolonged contact or by sharing clothing, bedding, and towels between a healthy person and an infected person.
“When we talk about clothes, that’s a fact. Smallpox has these pustules, so all materials and clothing that the person comes into contact with become contaminated. It’s just an airborne virus, not small droplets like Covid19. In the case of smallpox viruses [família desse tipo de patógeno]it takes more, a big droplet, it has to be a kiss or long very close talks to increase the likelihood of this transmission,” emphasizes Camila Malta.
The incubation period of the disease can be from 5 to 21 days, but the virologist explains that transmission occurs through the first symptoms of the disease, which are not the sores on the skin, the main feature of smallpox.
“This disease does not always show pustules, so it can be completely benign and the person only has a febrile condition. Now we have a hard autumn in Brazil, for example; a person appears with a headache, fever, rash [erupções na pele], muscle pain, you will think of dengue, covid. By the time she has the dermatological manifestation, she has already transmitted the virus,” he warns.
For humantohuman transmission to occur, “the virus has to replicate and the person has to show a symptom, even if it’s mild,” he says.
“She must be sick, but not necessarily with a pustular appearance. One person can have a severe headache, another can have dermatological manifestations, and another person doesn’t feel anything, and all three transmit it.”
One of the reassuring news for health organizations is that the disease tends to be mild and has a much lower mortality rate than common smallpox, which has been eradicated worldwide with vaccines. According to the WHO, these immunizers are about 85% effective against monkeypox.
There is also an antiviral drug approved in the US to treat the disease, Tpoxx (tecovirimate). However, what you generally do is control the symptoms and wait for the flareups to resolve.
Despite all of this, the researcher believes that this outbreak is tending to be controlled more quickly.
“The hope is that this doesn’t turn into an emergency like that of Covid19, but I don’t think it’s such an optimistic scenario given every day a new country is detecting this virus. However, we have the technology to build vaccine vectors, vaccine skeletons, much faster than we thought we would be able to. While it is worrying, it is better than 20 years ago to control this new outbreak,” he concludes.
In Europe, there is concern that the summer holidays could amplify the outbreak if transmission cannot be brought under control in the coming weeks.
“As we enter the summer season of mass gatherings, festivals and parties in the European region, I am concerned that transmission may accelerate as currently recognized cases are among those engaged in sexual activity and the symptoms are unknown to many” , said the head of the European department of the WHO, Hans Kluge, in a statement.
UKHSA (UK Health Safety Agency) Chief Medical Adviser Susan Hopkins said the number of new diagnoses is expected to increase.
“We expect more cases to be discovered through our active case finding across NHS services. [Serviço Nacional de Saúde do Reino Unido] and greater vigilance among health professionals. We believe this increase will continue in the coming days and that more cases will be identified in the community at large. In addition, we are receiving reports of other cases identified in other countries around the world.”