Mpox is still a public health problem, say Fiocruz specialists

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The Evandro Chagas National Institute of Infectious Diseases (INI) of the Oswaldo Cruz Foundation (/Fiocruz) and the scientific journal The Lancet Regional Health Americas launched today (25) a special edition of the Mpox booklet multinational in the Americas: Lessons from Brazil and Mexico, with articles on monkeypox or “monkey pox”, 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 it is moving towards a resolution in some countries, Mpox is still a public health problem in several places in the world, such as the Americas. In the opinion of infectologist Beatriz Grinsztejn, head of the Clinical Research Laboratory on HIV/AIDS (LapClin Aids) and president-elect of the International Aids Society (IAS), it is important to refer to the fact that Mpox “is a neglected disease in terms of research and effective resources and treatments”, which could be made available, avoiding high occurrence and deaths in poor countries in Africa. Beatriz recalled that it was only when she arrived in Europe, in the middle of last year, that the disease caught the world‘s attention, and it is embarrassing to see how many people have been dealing with this disease in Africa for decades.

According to the infectologist, the characteristic of genital lesions was already described in the epidemic in Nigeria, where the diversity of people’s sexual options is not accepted. Beatriz Grinsztejn stated that Mpox is in line with sexually transmitted infections (STIs), which leads to the possibility of worsening the disease in these people. And she has championed fighting stigma and discrimination at all times. Mpox is most commonly seen among gay and bisexual men.

Highlight areas

For the head professor of the Department of Social Psychology at the University of São Paulo (USP), Vera Paiva, five areas cannot be ignored in the covid-19 pandemic and in 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; combat misleading and inaccurate messages, such as fake news (fake news); reduce dependency on foreign vaccines and treatments and resolve the governance crisis in which the fight against epidemics unfolds. “It has become clear that since AIDS and covid-19 that these are not just viral events,” noted Vera.

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 illnesses depends on the policy of confrontation, that deaths and illnesses occur more in impoverished peripheral territories, which have race , color, gender, which 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, she said.

As Vera Paiva reiterated, it will be essential, in the face of any epidemic, to combat stigma in the first instance, associated with the infection and people from the most vulnerable segments; combating infodemics (a large flow of information that spreads over the internet on a specific subject) that is inaccurate and misleading, not only in relation to Mpox, but to other epidemics; need for funding for the Unified Health System (SUS); resumption of the idea of ​​breaking patents and producing vaccines, ending dependence on foreign vaccines and treatments. Prevention must be integral to all epidemics, bearing in mind the principles of human rights. “That’s the big challenge,” she said.

Cases

The INI infectologist, Mayara Secco, reported that by January 24, 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. In this month of January, 32 cases were treated, of which 22 were confirmed, 5 discarded and 5 are under investigation.

For the specialist, the health emergency still represents a challenge for the health sector and the 22 confirmed cases in January 2023 mean a high positivity rate. The analysis of confirmed cases since the appearance of the first patient reveals that cis men make up the largest portion of those affected, with 87%, against 5.5% of cis women. The largest portion of those affected is in the age group of 30 to 39 years. Of those confirmed, 97% had sexual intercourse 30 days before the appearance of the first symptoms of Mpox. Among the patients who confirmed Mpox in the INI/Fiocruz, 51% lived with HIV and 30% had only one region of the body affected.

Nomenclature

The change of nomenclature from monkeypox to Mpox was announced by the World Health Organization (WHO) on November 28, 2022, following complaints of discrimination and racism and news of the murder of monkeys in Brazil. The deadline for the world to adopt the new nomenclature is one year.

The head of the Molecular Biology Laboratory at the Federal University of Rio de Janeiro (UFRJ), Clarissa Damaso, clarified that the monkeypox it is not a disease of monkeys, nor is it a new disease or a new virus, having been described in 1958. “Monkeys are as much a victim as humans”.

Clarissa defended that the change of name to Mpox has to be gradual, “because there is a history of research behind it”, of clinical trials in progress, including, and of approved treatments and vaccines. For the UFRJ virologist, what needs to be debated and fought 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 society’s prejudice just by changing the name of the disease.

She cited, on the other hand, successful name changes, including the Downor mongolism, by Trisomy 21, and leprosy by leprosy.

Translated to english by RJ983

From Brazil, by EBC News

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