Clear your doubts about monkey cups

SÃO PAULO, SP (FOLHAPRESS) – With symptoms such as fever, body aches and sores throughout the body, monkey poop worries doctors and scientists because of its rapid spread. According to the CDC (US Center for Disease Control), there are already more than 700 cases of the disease in the world.

One of the still open questions is how the virus spread so fast in different countries – outside Africa, this is the biggest outbreak ever. The vaccine’s low production capacity to stop the transmission of the virus is another aspect that worries specialists.

Below you can see the main issues involving the current scenario of the disease and what can be done to stop its transmission.

What causes monkey pox?

The disease is caused by monkey pox, a virus of the genus Orthopoxvirus. Another pathogen that is also of this genus is that which causes smallpox, a disease that was eradicated in 1980.

Although they have their similarities, there are differences between the two diseases. One of them is mortality: smallpox killed about 30% of those infected. Monkey poop, on the other hand, has a mortality rate of between 3% and 6% according to the WHO (World Health Organization).

So monkey cups do not mean a risk of having less mortality?

Minor risks do not indicate that the disease is not serious. Children, pregnant women and the immunosuppressed are people who can develop more serious disorders e.g.

“It is still worrying because any communicable disease should not run amok. It is necessary to limit these outbreaks,” said Clarissa Damaso, virologist at the UFRJ (Federal University of Rio de Janeiro) and adviser to the WHO (World Health Organization) committee for smallpox virus research.

She is one of the researchers who make up the working group for the control of monkey pox organized by the UFRJ. The initiative carries out tests on people suspected of having the disease – six cases have been investigated in Brazil – and should also monitor patients to observe the development of the clinical picture and prevent the spread of the pathogen.

In addition to the UFRJ group, two other centers are conducting tests to diagnose the disease in Brazil: the Adolf Lutz Institute in São Paulo and the Funed (Ezequiel Dias Foundation) in Minas Gerais.

Another way to diagnose the disease is a test from the company Roche. Carlos Martins, president of Roche Diagnostics in Brazil, says the product is a PCR test similar to tests for Covid.

According to him, the results of the exam are ready between 4 and 8 hours and the product should arrive in Brazil in a few weeks.

How to limit the spread of the virus?

Decreased transmission mainly involves isolating suspected and confirmed cases as well as immunizing people who have had close contact with an infected person. Higher risk groups, such as frontline healthcare professionals, may also be vaccinated.

According to the WHO, the smallpox vaccine has an efficacy of approximately 85% for the disease caused by monkey pox. However, it is not available to the public. In 2019, another immunizer was developed that is effective in preventing monkey pox but is produced on a small scale.

Currently, Brazil does not have vaccines. Health Minister Marcelo Queiroga said the ministry is in contact with the PAHO (Pan American Health Organization) to evaluate the purchase of doses, but it is still under evaluation.

What explains the new wave of cases?

Monkey pox was already known, but it was mainly recorded in African countries. What has the scientific community on alert was the rapid spread of the virus to other countries outside Africa.

Despite the reference to monkeys, the natural hosts of monkey cups are likely rodents such as mice. From them, the virus can be transmitted to humans through contact with liquids or damage from infected animals.

From person to person, the transfer takes place through close contact. Infection can occur through the respiratory tract, but prolonged close face-to-face contact is required. In comparison, Sars-CoV-2, the virus that causes Covid-19, is also transmitted through the respiratory tract but does not require close or prolonged contact.

Another form of infection is through the blister-like wounds that monkey cups cause on the skin. Cristina Bonorino, an immunologist and professor at the UFCSPA (Federal University of Health Sciences in Porto Alegre), explains that the fluid inside these bubbles contains the virus. Therefore, direct contact with these secretions also causes the spread of the pathogen.

Due to the fact that there is a transfer that needs very close contact, the new cases still lack explanations. “We do not understand exactly how this transmission happens,” Damaso says.

The most reported hypothesis is that a person may have been infected in Africa and transmitted to other individuals outside the African continent in urban areas.

This may have happened primarily because the onset of the disease has common symptoms and can lead to confusion. “It may happen that the person is at the beginning of the symptomatology and is feeling a little bad, but they confuse it with, for example, the flu and pass it on,” says Damaso.

Another hypothesis that can be investigated is asymptomatic cases, Bonorino says. “One question is, is there a way that does not cause blisters and therefore spreads faster? We do not know.”

A third assumption is mutations in the pathogen. DNA viruses such as monkey pox have a much lower chance of being altered. Still, this possibility should not be ruled out, says Raquel Stucchi, a specialist in infectious diseases and a professor at Unicamp (University of Campinas).

“Really, the virus does not usually change, but something happened to it to explain this huge explosion of cases.”

And how is the treatment?

Tecovirimate is a medicine that can be used for treatment. Recently, a study published in The Lancet examined the remedy in the case of monkey pox and saw a positive effect.

Another drug is brincidofovir, an antiviral drug that already has FDA approval for the treatment of smallpox.

However, none of the drugs are available in Brazil. “So far, Anvisa has not received a request for permission for a vaccine or medicine against smallpox or monkey pox,” the agency said in a note.

Anvisa also states that it is the responsibility of the pharmaceutical companies to make the request and also states that it is “possible to approve […] in public health emergencies “.

What to do from now on?

Although the situation is atypical, the chances of monkey pox becoming a pandemic are small due to the low transmission capacity of the virus.

Nevertheless, measures must be taken. They mainly involve testing of suspected cases of the disease, isolation in the positive or even the results of the study and use of vaccines in those who had contacts.

“It’s important for the population not to panic. It’s not a new disease. We know it’s been around for a long time and we have weapons to fight it,” Damaso said. She also explains that antiviral drugs can be helpful in treating more severe cases of the disease in the country.

In addition, experts say the new outbreak first attracted attention as the disease spread to richer regions of the world, such as the United States and Europe, but since it was only endemic in Africa, it did not have much appeal.

The fact opens an alarm for the so-called neglected diseases, those without major investment in scientific research. “We never pay attention to what is happening in Africa until it reaches the whole world,” Stucchi concludes.

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