Monkeypox: 2,900 cases investigated in 8 SUS centers;  Understand how the test is conducted in the country

Monkeypox: 2,900 cases investigated in 8 SUS centers; Understand how the test is conducted in the country

Testing for monkeypox cases has not yet been conducted on a large scale in Brazil, which is a reflection of the disease’s progress and how the public and private health sectors are moving against the monkeypox virus, according to experts consulted by the expert panel. g 1.

Although available in the SUS, there are testing bottlenecks ranging from the time required to develop specific tests to be commercialized to the difficulty in obtaining reagents that would enable more test centers to train.

“Diagnosis today is a big bottleneck — having so few places that do this, it takes time between material collection and the diagnosis response to the health professional, from the health professional to the patient, and that’s bad,” assesses epidemiologist Ethel Maciel. Professor at the Federal University of Espiritu Santo (Uves).

Data collected by the federal government as of Tuesday (9) shows that Brazil has 2,415 confirmed cases of monkeypox (monkeypox) and 2,963 suspected cases still awaiting a diagnostic test result, according to the latest available balance.

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In all, since the beginning of the current outbreak, 6,986 diagnostic tests for the disease have been processed in the country’s public laboratories. The government does not have a consolidated account of tests conducted in the private sector, but representatives estimate that they are responsible for 60% of the tests already conducted in the country.

To confirm disease, SUS has eight reference laboratories that analyze samples collected across the country. The test is restricted and the result may take days to arrive. Virologist Clarissa Damaso, of UFRJ, points out that the expansion of reference centers should be gradual in the country to avoid wasting material used in the analyses.

“In my view, it should be dynamic: since there are regions with an increased number of cases, this region can be reinforced with more laboratories doing the analysis,” comments the virologist. She cited a recent example of a change in sending samples collected in the Midwest to Brasilia, before they went to Rio. Damaso explained that the change came due to increased demand and ease of logistics.

The virologist explains that in the current scenario of scarce resources in the pharmaceutical industry, it is wise to expand centers without wasting materials. The virologist explains: “We have difficulty dealing with reagents. The companies that supply these reagents require 20-30 working days to deliver them. This is a very long time. Without reagents, we also do nothing.”

The current scenario of testing against monkeypox in the country is also characterized by significant participation from the private network, whose companies have developed their own methods to meet demand: the sector estimates that it was responsible for more than half of the tests already performed in Brazil, even without health plans obligated to pay fees Tests that may cost R$450.

As the government reference network grows, driven by rising demand, there is an expectation that in the coming weeks Anvisa will launch the marketing of monkeypox tests developed by private companies, facilitating access and eventually causing prices to fall.

According to the Ministry of Health, monkeypox is diagnosed exclusively by PCR testing. The test evaluates genetic material collected from lesion samples using molecular biology technology, with a sensitivity level greater than 95%.

“A rapid test (as opposed to PCR, which requires lab processing) would help a lot. If the same countries had it, they would no longer send as many cases (to referral centers) that end up negative. There is no rapid test for smallpox. apes,” Damaso analyzes.

SUS . Reference Laboratories

As of August 6, according to information available on the website of the Ministry of Health, eight laboratories were responsible for processing samples and diagnosing monkeypox in Brazil:

  1. Enterovirus Fiocruz-RJ Laboratory;
  2. Central Public Health Laboratory of Minas Gerais / Fundação Ezequiel Dias;
  3. Central Laboratory of Public Health in São Paulo / Adolfo Lutz Institute;
  4. A consortium between the Laboratory of Molecular Virology of the Carlos Chagas Filho Institute of Biophysics and the Laboratory of Molecular Virology of the Institute of Biology of the Federal University of Rio de Janeiro (UFRJ)
  5. Central Laboratory of Public Health of the Federal District (Lacen / DF);
  6. Central Laboratory of Public Health in Rio Grande do Sul (Lacen/RS);
  7. Regional Reference Laboratory for Enteroviruses at the Evandro Chagas Institute in Pará;
  8. Instituto Leonidas and Maria Dean, associated with Fuecruz de Amazonas.

a g 1 Reference laboratories contacted:

  • The Carlos Chagas Filho Institute for Biophysics, of UFRJ, reports that the consortium has received 300 to 500 samples per week. The tests take about 24 hours to be analyzed.
  • The Fiocruz Enterovirus Laboratory in Rio de Janeiro reports that it has the capacity, on average, from 400 to 500 analyzes per week, and that the report containing the result takes an average of 24 hours to be issued.
  • The Central Laboratory of Public Health in Minas Gerais reports that it has the capacity to analyze 500 samples per day. Since the beginning of the diagnostic tests, on June 6, more than 2,000 samples from 582 patients have already been processed (More than one sample is sent to each patient). About 30% of the tests analyzed were positive for monkeypox. Results are published, on average, 24 hours after sample receipt.
  • Lacen in Rio Grande do Sul reports that it receives, on average, 100 to 150 samples per week, takes 24 to 72 hours to release a test result and has the capacity to perform about 500 tests per week.
  • Fiocruz do Amazonas reported receiving, on average, 5 samples per week, only from Amazonas; The laboratory is also responsible for analyzing Acre and Raima, but has not yet received samples from these two states. The current analysis capacity is 100 samples per week, reaching 500 as more inputs arrive. The results took less than 24 hours to be ready.

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Anvisa analyzes commercial tests

There is still no commercial record of the National Health Watch Agency (Anvisa) tests for monkeypox. Until the 11th, the agency was evaluating six applications to register commercial tests for diagnosing monkeypox, two of which were made by Vuecruz.

The tests used in the private network are developed by the labs themselves – so-called “in-house” development – and cannot be commercialized.

Carlos Eduardo Gouvêa, of the Brazilian Chamber of Laboratory Diagnostics (CBDL), believes this approval from Anvisa is important, because the tests will be cheaper and, therefore, more accessible.

“The diagnostic market is very competitive. With scale and competitiveness, you can get better and better products at lower prices. So, the trend is that this value, which is limited to a few laboratories and heavy technology, is high. Little by little the price will go down. “.

There is no insurance coverage

health plans It is not required to cover the exams of monkeypox, according to the National Supplementary Health Agency (ANS).

According to the agency, the offer of tests in the private network is still “preliminary” and depends on test groups that need Anvisa’s approval.

“It is important to stress that the ANS is concerned with the health scenario involving monkeypox (monkeypox) and, in due course, will adopt measures in line with national health policies,” the ANS highlighted in a note.

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