Experts warn that Mpox is still a public health problem

The Evandro Chagas National Institute of Infectious Diseases (INI) of the Oswaldo Cruz Foundation ( Fiocruz
) and The Lancet Regional Health Americas scientific journal today (25) launched a special edition of the insert Mpox
multinational corporation in the Americas: lessons from Brazil and Mexico, with articles on monkeypox or “monkeypox,” as it is popularly known.

Mpox is a viral disease and transmission between humans occurs mainly through contact with skin lesions of infected people. The editor-in-chief of the magazine, Taissa Vila, highlighted that although moving towards a resolution in some countries, Mpox is still a problem of public health
in various parts of the world, such as the Americas.

For the infectious disease specialist Beatriz Grinsztejn, head of the HIV/AIDS Clinical Research Laboratory (LapClin Aids) and president-elect of the International Aids Society (IAS), it is important to remember that Mpox “is a neglected disease in terms of research and resources and effective treatments”, which could be made available, avoiding a high number of cases and deaths in poor African countries. Beatriz recalled that it was only when she arrived in Europe in the middle of last year that the disease gained worldwide attention, and it is embarrassing to see how many people have been dealing with the disease in Africa for decades.

According to the infectologist, the characteristic of genital lesions had already been described in the epidemic in Nigeria, where the diversity of people’s sexual options is not accepted. Beatriz Grinsztejn said Mpox is in line with sexually transmitted infections (STIs), which leads to the possibility of worsening the disease in these people. And she has always defended the fight against stigma and discrimination.

Mpox is most commonly seen among gay and bisexual men. For the head professor of the Department of Social Psychology of the University of São Paulo (USP), Vera Paiva, five areas cannot be ignored in the covid-19 pandemic and the pandemics to come, without ignoring Mpox either. The first is that they are associated with people from more vulnerable segments.

It is also necessary to differentiate the structures of the health system; fight misleading and inaccurate messages, such as fake news; reduce dependence on foreign vaccines and treatments and solve the governance crisis in which the fight against epidemics takes place.

“It became clear that since AIDS and covid-19 these are not just viral events,” Vera noted.

According to the USP professor, among the lessons that cannot be forgotten from covid-19 and other epidemics is that the number of deaths and diseases depends on the politics of confrontation, that deaths and diseases occur more in impoverished peripheral territories , who have race, colour, gender, who grow more where governments are negligent in protecting human rights or violate the right to life and integral health.

The growth of epidemics confirms markers of inequality and human rights violations, he said. As Vera Paiva reiterated, it will be essential, in the face of any epidemic, to first fight the stigma, associated with the infection and with people belonging to the most vulnerable groups; fight the infodemic (a large flow of information spreading on the internet about a specific topic) that is inaccurate and misleading, not only in relation to Mpox, but other epidemics; need for funding for the Unified Health System (SUS); revival of the idea of ​​breaking patents and producing vaccines, ending the dependence on foreign vaccines and treatments.

Prevention must be an integral part of all epidemics, keeping in mind the principles of human rights. “That’s the big challenge,” she said.

Cases

INI infectious disease specialist Mayara Secco reported that up to 24 January 2023, 10,711 cases of Mpox had been confirmed in Brazil, with 11 deaths. The most affected states were São Paulo and Rio de Janeiro. In 2022, INI assisted 416 confirmed cases in Rio de Janeiro and 402 discarded cases.

This January, 32 cases were treated, of which 22 were confirmed, 5 discarded and 5 under investigation. For the specialist, the health emergency still represents a challenge for the health sector and the 22 cases confirmed in January 2023 mean a high positivity rate.

The analysis of cases confirmed by the appearance of the first patient reveals that cis men constitute the largest share of those affected, with 87%, against 5.5% of cis women. Most of those affected are in the age group between 30 and 39 years.

Of those confirmed, 97% had intercourse 30 days before the first symptoms of Mpox appeared. Of the patients who confirmed Mpox in the INI/Fiocruz, 51% were living with HIV and 30% had only one body region affected.

Nomenclature

The nomenclature change from monkeypox to Mpox was announced by the World Health Organization (WHO) on November 28, 2022, following complaints of discrimination and racism and reports of monkey killings in Brazil.

The deadline for worldwide adoption of the new nomenclature is one year. The head of the Molecular Biology Laboratory of the Federal University of Rio de Janeiro (UFRJ), Clarissa Damaso, clarified that monkeypox is not a disease of monkeys , nor is it of a new disease or a new virus, having been described in 1958. “The monkey is as much a victim as humans.”

Clarissa defended that the name change to Mpox must be gradual, “because there is a history of research behind it”, of ongoing clinical trials, including, and of approved treatments and vaccines.

For the UFRJ virologist, what needs to be debated and fought against is human behavior and not the name of the disease itself, because she believes that it will not be possible to change the issue of societal prejudice just by changing the name of the disease. You mentioned, on the other hand, successful name changes, including Down syndrome, or Mongolism, due to trisomy 21, and leprosy due to leprosy.