Monkeypox: SES-DF infection expert advocates for habits review to contain cases - Eixo Capital

Monkeypox: SES-DF infection expert advocates for habits review to contain cases – Eixo Capital

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Interview with Livia Vanessa Ribeiro, infectious disease physician at De Pace Hospital and District Technical Reference in Infection at the Federal District Department of Health (SES-DF)

Written by Jessica Eufrasio for column Eixo Capital

How can we assess the situation in DF today, where there are 102 confirmed cases of monkeypox? Are we seeing an outbreak?
It’s an outbreak, because an outbreak is an unusual increase in cases. We didn’t have any records, and that resurgence, with cases increasing, is an outbreak. We have to analyze all this context, both in the country and around the world, to check what the label is. The World Health Organization (WHO) has not declared it a pandemic, but it remains a public health emergency, because cases are on the rise.

What is the Ministry of Health doing to prevent the spread of the disease?
Since we began noticing the increase in cases outside the country, especially after the detection in São Paulo, where the first was recorded, we, along with other technical areas of the Directorate of Epidemiological Surveillance, have begun to prepare a technical note to guide specialists in relation to possible cases. We describe the virus, its mode of transmission, the incubation period and the possible clinical presentations of the disease known to date, as well as some issues related to the clinical management and guidance of the individual – the flow of care in the network (public health) and home isolation. After this period, we have prepared a contingency plan, which is on the Ministry of Health website, with slightly broader guidelines. With the emergence of new cases, in Brazil and in the world, we are also advancing in the description and in (studies) data from the literature, such as the clinical presentation forms. This is in favor of our management guidelines. We, with Ascom (the communications section of the volume), have provided general recommendations to the population regarding the clinical picture, when to suspect, and when to seek health service. And also about prevention, for those who are sick, infected and those who transmit the disease, advise on the appropriate period of isolation. For people who have not had the disease, (advise) about possible means of transmission.

Is monkeypox virus more transmissible than COVID-19?
It is less portable. Although it also has respiratory transmission, (monkeypox) is not transmitted by aerosols. It can be transmitted by droplets, but we have noted that there is a much lower Rt (relative to transmission rate), in all places with recorded cases, than Sars-CoV-2 (the virus that causes covid-19).

What is the difference between droplets and aerosols?
Drops are particles of saliva that are discarded when speaking, talking and coughing. It can reach 1.5m or 2m max. An aerosol is a smaller particle, which can be emitted, essentially, when a person has a cough or performs some action that we call a “mist” (which results in the emission of an aerosol). It is a less heavy and smaller particle; Therefore, the virus remains in the surrounding air for a longer time.

What are the recommendations regarding when to isolate the patient?
The recommended isolation time is for as long as the person has skin lesions. This closely follows the progression of the disease. In general, symptoms begin with a febrile phase, a classic picture. The person has a fever that lasts for a maximum of five days, and this may be accompanied by non-specific symptoms such as headache, back, muscle aches, and swollen lymph nodes. Three days later, as the fever persists, the second stage begins, the rash: lesions that increase transmissibility (of disease). As long as there is some type of infection, the individual must be isolated. When there is little, it can disappear between 10 and 14 days. However, in cases of patients with more than one patient, it is necessary to take a leave of three or four weeks, depending on the development of skin lesions. They begin as imperfections, as if they were imperfections; Then they saw a papule, a small lump; then a vesicle, as if a blister; They can turn into a pimple, when they become infected; And when it bursts, it generates a wound that ends in a crust. Until complete recovery and the disappearance of this crust, a person must be isolated. Although it is a disease that does not produce many serious cases – we have far fewer hospitalizations and deaths than those of covid-19 – monkeypox does generate significant social and economic impact and stigma, due to its emergence and the need to remove the individual from activities.

What part of the struggle against the advancement of cases belongs to the public authority and what part belongs to the population?
Public authorities are primarily responsible for the issue of revealing the means of transmission, the clinical picture and the impact that this disease can have on each individual. It is interesting that the population is familiar with the modes of transmission: by respiratory droplets, direct contact with skin lesions, mucous membranes and body fluids, which includes transmission by kissing and sexual contact. We have records of studies that report the detection of monkeypox virus in semen. Therefore, people need to understand that since it is a disease transmitted through these ways, the moment does not require agglomerations, especially in closed environments. It is important to be aware of the use of face masks in closed and crowded environments; Try to keep these places well ventilated; Sanitize hands and surfaces that many people touch… And when we talk about crowded places, we don’t just think of events, but public transportation, classrooms and workplaces. All this in terms of educating and preparing services and training health workers is the responsibility of the government. An important thing was the progress in terms of diagnosis. When the Lacen (Federal District’s Central Laboratory of Public Health) begins to process these tests locally, the result (which is detected faster) helps a lot in detecting disease, for knowing when the individual will be isolated, and (in determining de) which others occur at the same time. Or even diseases that have a similar clinical picture. With regard to individuals, it is essential (information) appropriate (information about) all such transmissions, clinical presentations, and knowledge that in the event of a suspicious or suspected skin lesion, one should seek a sanitary unit, in addition to wearing a mask and (wear) Clothes covering wounds. If you have a suspected or confirmed disease, you should remain isolated to protect people. This sense of community has to be touched upon well. We saw it failed in covid-19 (pandemic) moments on the part of some people. But you have to think that although (monkeypox) is a disease that does not have a high mortality rate or high rates of hospitalization, it does have complications. Mainly for immunosuppressed people, children or those who have difficulties accessing health services.

What attitudes in the COVID-19 pandemic should be maintained at this time?
With respect to COVID-19, monkeypox, and other viruses of respiratory transmission and microorganisms, what we call individual risk management is very important. Although we have many issues that depend on public authority, it is interesting that residents are well aware of what they can do and how to prevent them. Although masks are no longer mandatory, it is interesting to assess risk management. If you intend to ride public transportation with gatherings, it is recommended to wear a mask and sanitize your hands and surfaces with 70% alcohol or other suitable product. Try, when possible, to keep a minimum distance between people, in schools, offices and businesses. Try to avoid crowded events. The important issue is the conscience of the individual. (Monkeypox) a disease that has visible damage. If I had one, even if it wasn’t visible, I should be aware that I need to isolate myself, despite all the damage it can cause, to prevent the virus from spreading and reaching vulnerable populations, who could potentially contract dangerous forms (disease). ). Although the mortality of monkeypox is very low, it (the chance of death) exists. Although hospitalizations are few, they do exist. There must be this collective consciousness. Many habits are (now) similar (to those at the start of the COVID-19 pandemic): wearing masks in enclosed or crowded spaces, cleaning surfaces, washing hands frequently, and social distancing, if possible. And (it is important) to assess the issue of sexual exposure, especially for those who do not have an established partnership: try to reduce the number of partners and be aware, for the moment, of the possibility of restricted contacts. We know that this kind of request is very difficult, because everyone has their independence, but we understand that, at least for a period of time, it is interesting to protect yourself, because it is a disease that can also be transmitted through sexual activity, whether through skin-to-skin contact or by fluid.

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