Cristina Azevedo (Fiocruz News Agency), with information from Max Gomes and Maíra Menezes (IOC/Fiocruz)
The need to detect and to promote a quick response to the possible emergence of monkeypox cases has led the Pan-American Health Organization (PAHO/WHO), the Ministry of Health and Fiocruz to promote, last Thursday and Friday (June 9 and 10), the first training for the laboratory diagnosis of the virus. The initiative, ministered by the Enterovirus Laboratory of the Oswaldo Cruz Institute (IOC/Fiocruz), had the participation of technicians from national health institutions of Bolivia, Ecuador, Colombia, Peru, Paraguay, Uruguay and Venezuela.
Latin American technicians participate in an immersion in all the details of the protocol that must be adopted in the reference laboratories designated for the diagnosis of the monkeypox virus (photo: Gutemberg Btito - IOC/Fiocruz)
Endemic in Africa, the disease is now having the largest outbreak ever recorded outside the continent. 1,186 cases were confirmed between May 13 and June 8, mostly in Europe, but two cases have already been reported in Argentina and one in Mexico. This raised an alarm for the PAHO, which, together with the Ministry of Health and with Fiocruz, assembled, in less than a week, a training workshop for molecular diagnosis based on the identification of viral genetic material, using real-time PCR (the standard protocol adopted by the WHO). Participants will also be given the necessary inputs to implement the methodology in their countries. These were produced by the Molecular Biology Institute of Paraná (IBMP, an association between Fiocruz and the government of the state of Paraná) and delivered to the PAHO.
“Fiocruz and the world have been challenged to an increasingly integrated work. We are only able to address these emergencies because we have previous knowledge of old pathogens that are circulating again, now in a different way, as well as of new ones”, said Fiocruz president, Nísia Trindade Lima, at the auditorium of the Joaquim Venâncio Polytechnical School (EPSJV/Fiocruz) last Thursday. “We need to move forward towards more integrated work in the Americas. We will only be able to provide a response at the necessary speed if we maintain this permanent preparation action”, Lima added at the opening of the workshop.
Speed and quality
PAHO/WHO representative in Brazil, Socorro Gross Galiano, mentioned the similar training on COVID-19 provided in cooperation with Fiocruz in 2020 to countries of the region. She highlighted that the workshop goes beyond monkeypox, as it represents an opportunity for nations to share their knowledge and to expand their genomic surveillance network. “Our region has a very special characteristic: we can organize our forces very quickly. And we have to do more”, she added. “We have the ability to state that the inputs we will be using are from our region, the training takes place in our region, and with our personnel. We are stronger together”.
IOC director, Tânia Araujo-Jorge, said the entire institute was mobilized to prepare the training and the laboratories in time. “We were told about it last Friday. Today is already Thursday. In less than a week we managed to get everything ready to do our job, which is a reference in the region and offers technical guidance when necessary”. Arnaldo Correia, secretary of Health Surveillance and acting Minister of Health, quoted the director-general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, who usually says “nobody is safe until everyone is safe". "We are going through another historical moment in this pandemic. I believe more and more in the importance of surveillance and in the fact that it is crucial to give quality of life to the population. From this perspective, it is crucial to look at our own region”, Correia said.
A participant in the 2020 training, Jairo Mendes, technical leader for Infectious Diseases for the PAHO/WHO, went back to the Foundation for the new workshop. He was in charge of presenting the goals of the training, the current status of the disease, and biosafety processes. Mendes emphasized that the prompt articulation made it possible to carry out the work with the necessary speed and quality, despite the emergency situation. “The training will last just two days, but the impact it has in each of our countries is huge”. He highlighted that if it were necessary to send samples to the American reference laboratory in Atlanta, for instance, the diagnostic process could take two weeks. “This is why I insist: we must be able to test in our own countries. This is why we have organized this workshop”, he said.
Mendes said that there are two variants of monkeypox in Africa, one more aggressive and a milder one. The latter is the one that has been observed in this outbreak in Europe and now Americas. Cases had been identified in other countries in the last few years, but usually involving people who had been to Africa and nowhere near this outbreak in terms of intensity. “This is enough to raise concern, but not panic”.
The technical leader also mentioned that transmission takes place through close contact and that there is no evidence of sexual transmission. Jairo Mendes also highlighted the need for healthcare workers to keep an eye out for symptoms and to differentiate them from other infirmities, from measles to allergies. “It is important to trace contacts even before the diagnosis, and to instruct people regarding precaution
measures”, he said. “We don’t know yet whether we will have imported cases, we don’t know the level of transmission, we don’t know whether the disease will expand rapidly. This is why we are getting ready now”.
On Thursday afternoon and also on Friday, Latin-American technicians participated in an intense immersion in all the details of the protocol that must be adopted by the reference laboratories designated to diagnose the monkeypox virus.
A member of the Orthopoxvirus genus, which also includes the pathogens responsible for human smallpox and bovine pox, the MPXV was discovered in 1958, when researchers were investigating an infectious outbreak among monkeys coming from Africa that were being studied in Denmark. The pathogen, unknown at the time, received the name of monkeypox because it was found in samples from these primates. Scientists later learned that monkeys did not participate in the dynamic of the infection as reservoir animals for the virus. They were also affected by it, as well as other mammals. To this day the reservoir species for the MPXV are still unknown. We also do not know how its circulation is sustained in nature.
The first case of human monkeypox was reported in 1970, in the Democratic Republic of the Congo. Since then, infections in humans have been reported mainly in countries of Central and Western Africa, where it is endemic. Disease symptoms may include swollen lymph nodes, skin lesions, fever, and weakness, in addition to intense headaches and pains all over the body. Lethality is estimated to range from 1 to 10%, with more serious disease affecting children and people with low immunity.
Transmission of the virus from animals to people may occur through bites or scratches by an infected animal, through the handling of wild game, or through the use of products made from infected animals. Transmission of the virus between people takes place mainly through direct contact, for example, through kissing or hugging, or via infectious wounds, scabs or body fluids. It can also be transmitted through respiratory secretions during prolonged personal contact.