Most of the cases of the so-called monkeypox are concentrated in the United States (23,336 confirmed infections); Brazil (6,809); Peru (2,091); Canada (1,363); Colombia (1,260) and Mexico (1,051), according to the epidemiological bulletins of the World Health Organization until September 19. Venezuela has five patients.
Caracas. As of September 19, the majority of monkeypox (SV) patients, mainly among men who have sex with other men, are concentrated in the United States (23,336 confirmed cases); Brazil (6,809); Peru (2,091); Canada (1,363); Colombia (1,260) and Mexico (1,051). In Venezuela the figure remains at five cases.
The World Health Organization (WHO) defines the virus as monkeypox or monkeypox as an orthopoxvirus that causes a disease with symptoms similar to smallpox, but less severe.
Although this disease eradicated in 1980, still occurs in countries of central and western Africa. According to the WHO, the region of the Americas has become the epicenter global epidemic. In this continent more than 37,444 cases, 1,667 probable and four deaths.
What do we know about its incidence in Venezuela?
Dr. Patricia Valenzuela, vice president of the Venezuelan Society of Infectious Diseases (SVI) and deputy of the Infectious Diseases Section of the Institute of Tropical Medicine of the Central University of Venezuela (UCV), referred to the lack of information on the cases, during a conversation organized by the non-governmental organization Citizen Action Against AIDS (ACCSI).
Of the first three patients, reported by the government of Nicolás Maduro, all are men. Of the last two, he indicated, one came from Brazil and the other from Peru. “It is known that of the three, one lives with HIVbut it is not known if he was already undergoing treatment or if it was a recent diagnosis, in order to know his evolution”.
He stressed that Venezuela has the diagnostic ability at the Rafael Rangel National Institute of Hygiene (Inhrr) and pointed out that the research should be done through real-time polymerase chain reaction.
Dr. Valenzuela recommended that if the person has a vesicle, pustule or scab, they should have a swab of each one and take the samples to the Inhrr, separately, in triple packaging and refrigerated.
He also warned about:
- In Venezuela there are no vaccines against smallpox, neither antiviral treatments.
- People who arrive from some of the countries of South America, the US or Europe and who are known to have been in contact with someone with a diagnosis or suspicion of SV, should contact their treating doctor or quarantine.
- Those areas of isolation that they no longer have, because the cases regarding the COVID-19 pandemic have decreased, they should be reactivated to support people with suspicions or confirmed with smallpox.
- The campaigns of prevention have been null in this sense.
- The latest epidemiological data from the Pan American Health Organization (PAHO) recorded that the number of cases of monkeypox in women and children has risen.
It will increase
On the panel of the Accsi conversation was the Argentine infectologist Omar Sued, technical advisor for HIV and the monkeypox incidence management team of the Pan American Health Organization (PAHO), who emphasized that “now the situation is not good”.
What else did he say about smallpox?
- They are men who have sex with men, most of the cases between 30 and 40 years of age. “And, probably, they are represented because, in addition, they have HIV”.
- A large number of these situations occurred within the framework of sexual encountersat parties or in the context of celebrations for the beginning of pride month LGBTIQ+ in Europe.
- Of all the reports in the Americas region, 11% require hospitalization. This does not mean that it is a very severe or very serious disease, but because of the discomfort, such as difficulties swallowing, anal pain or urinary retention.
- East outbreak has had the characteristic that began among men who have sex with men. And it is not because they are homosexual, but because there are some subgroups of this population, with multiple changes of partners, in a short period of time.
- The most common symptoms are fever, headache, sore throat, cough, lymphadenopathy, swollen glands and skin lesions.
- These skin lesions follow a very typical course, a vesicle that later becomes an umbilical pustule, turns from a small pustule to a larger one, becoming an ulcerated lesion. Subsequently, the scab falls off, and that is when it heals and no longer transmits.
- The period of incubation it is short, in some cases up to five days.
- 30% of these cases may be associated with Sexually Transmitted Infections (STIs).
- It also can transmit to dogs. One case was confirmed in France and another in Brazil, so you also have to isolate yourself from pets.
- The broadcast it is not avoided with condoms.
Edgar Carrasco, Venezuelan, lawyer graduated from the Central University of Venezuela (UCV), expert in human rights, gender and HIV, founder and member of the board of directors of Accsi, spoke of the ethical implications and the health measures associated with the approach to the disease.
“We are in a country where there is a permanent public health crisis, which is determined by the scarcity and deterioration of public health services that threaten not to achieve all the protection, prophylaxis and prevention efforts”.
Now, he said, respecting human rights, preserving professional secrecy and ethical diagnosis, the necessary mandatory notification and contact tracing must be done.
“LThe ministries must take this notification in preventive terms for prophylaxis and comprehensive care, so that this information does not go off the rails and reach the hands of people or organizations that can misuse it. Let us remember what happened with the COVID pandemic, when people were discriminated against and publicly singled out”.
And he pointed out:
- We live in a scenario where there are still no HIV prevention campaigns, nor is the vulnerable population targeted.
- We are facing a constitutional obligation, such as the State’s health policies, which have been fulfilled in an erratic and inequitable manner.
- Isolation or quarantine has been recommended for 21 days and can be done at home.
- Regarding vaccines, in the protocol of the Ministry of Health, which is published on the website, there is no mention of men who have sex with men.
- There is additional concern about a lack of universal access to antiretroviral treatments.
- The ethical balance of human rights and health measures requires effective leadership that uses adequate resources, recognizes the ethics of prevention and fosters cooperation.
- Efficient and equitable services must be provided and the confidence of citizens in public health must be fostered.
- To health workers and unions, it is important that they observe medical ethics, continue providing knowledge and strengthen research.
- Communities must ensure compliance with international recommendations in the provision of services and prevention. They are also obliged to promote the dignity of people and respect for human rights.
Prevention instead of combat
Dr. José Esparza, surgeon, doctor of Medical Sciences and Honoris Causa from the University of Zulia; adjunct professor at the Institute of Human Virology at the University of Maryland School of Medicine; member of the National Academy of Medicine of Venezuela and of the Latin American Academy of Medicine, focused on the recommendations to cut the chain of transmission of the virus, avoid pain and deaths.
He called for prioritizing health actions for epidemiology, prevention, treatments and vaccines in vulnerable individuals, such as men who have sex with men, with multiple sexual partners.
“The monkeypox (VS) is not a question of whether or not it reaches Venezuela, since we already have it, but what its intensity will be. How many cases do you have to have to start stopping? The problem is that health is not to combat epidemics, it is to prevent them. Having to fight an epidemic would represent a public health failure”.
He referred to the recommendations of the National Academy of Medicine (published in mid-August):
- Declare a health alarm that allows mobilizing resources and undertaking the necessary actions in collaboration with civil society and with strict adherence to respect for human rights.
- Ensure transparency in the handling of information, with due respect for privacy.
- Strengthen the capacity for molecular diagnosis and genetic monitoring of the virus.
- Develop active epidemiological surveillance programs, including in sexually transmitted infection clinics.
- Begin efforts to ensure future access to antivirals and monkeypox vaccines.
“I hear, very frequently, that the vaccines do not reach Venezuela, but if we do not organize ourselves and if we do not make the appropriate requests, we will not have them. There are initiatives that have been taken to provide Latin America with 100,000 immunizations against smallpox. It’s not much, but if used wisely, there must be some benefit to it.”.
What do you suggest?
- Actions must be prioritized. Currently, most cases of the international monkeypox outbreak have been reported in men who have sex with men and many sexual partners.
- Sanitary actions must be guided and based on epidemiology. “We cannot continue with this immoral idea and make the most vulnerable invisible”.
- To protect yourself from smallpox you must have access to education and information, preventive measures and vaccinations against the disease.
- To mitigate any possible negative consequences of smallpox in people living with HIV, it is necessary to ensure access to antiretroviral treatment.