The World Health Organization warned, on Thursday (15), of the possibility of new cases of smallpox emerging in Europe after a case was discovered in Sweden, which raised doubts about whether the transmission of the infection could spread and cause similar effects to Covid around the world.
According to the WHO European Regional Office, “there are likely to be more imported cases in the European region in the coming days and weeks.” This statement came after the first new version was recorded outside Africa.
A person seeking treatment in Stockholm, Sweden, was diagnosed with Mpox on Thursday, due to clade 1 subtype.
A clade is a group of viruses with large genetic mutations, but coming from the same common ancestor. In the case of a lineage, the differences are much smaller.
There are two main strains of the virus that transmit the disease worldwide: strain 1, endemic in Central Africa, and strain 1b, a new version involved in the current outbreak.
In 2022, a milder strain of smallpox, belonging to category 2, caused a global outbreak that was controlled by vaccination of vulnerable groups.
Experts consulted Binder He said the disease has a high potential to spread globally, but should not reach the same severity or lethality as Covid.
“We live in a small global village of 8 billion people who are completely interconnected. It is a matter of time before the disease spreads to other countries. It will happen, we can be sure of that. And we hope that it will be of low volume and intensity,” said Alexandre Naemi, an infectious disease specialist and scientific coordinator of the Brazilian Society of Immunology.
Pediatrician Izabella Balalay, director of the Brazilian Society for Immunization, agrees with this opinion and highlights that, unlike Covid, which surprised the world and spread rapidly, smallpox had an early global warning, which allowed countries to prepare for its spread.
The World Health Organization declared on Wednesday (14) that smallpox represents a public health emergency of international concern.
“The risk of an epidemic spreading is if this alert does not work,” explains Balalay. “Each country must adopt its own preventive measures and inform professionals to be alert for patients with symptoms.”
In Brazil, in 2024 alone, 709 cases and 16 deaths from smallpox have already been recorded. Despite the increase and spread of a more dangerous type of the virus, the Ministry of Health estimates that the risk for the country is low.
Health Minister Nicia Trindade said the situation was “not a cause for concern but a warning.”
Trinidad announced on Thursday (15) the purchase of 25,000 doses of smallpox vaccine with the Pan American Health Organization (PAHO).
The Ministry also opened the Health Emergency Operations Center to coordinate smallpox response actions (COE-Mpox), located at the headquarters of the Secretariat for Health and Environmental Surveillance (SVSA), in Brasilia.
Despite the doses, mass vaccination should not be carried out. “Only very exceptional cases and very vulnerable groups,” the minister said. The decision follows the World Health Organization’s recommendation against vaccinating entire population groups.
Mass vaccination in Brazil is not the best decision, because the risk-benefit ratio is still low, says José Serbino, an infectious disease specialist and researcher at the Golden Institute and the National Institute of Infectious Diseases in Fiocruz.
“Mass vaccination involves production and distribution costs, as well as exposing people to the risk of getting sick,” he says.
Serbino believes that efforts must now focus on containing the disease on the African continent. Local control must prevent the disease from spreading outside the region.
A global outbreak of the disease occurred in 2022. More than 100 countries reported cases, including Brazil and parts of Europe and Asia. At the time, the World Health Organization also considered smallpox a pandemic of international concern, but raised the alert level a year later.
“It was a mistake,” says Tulio de Oliveira, director of the Centre for Epidemic Response and Innovation at Stellenbosch University in South Africa.
Oliveira is part of a working group that has been tracking Mpox for five years. According to him, the WHO suspension has caused cases to increase again on the African continent this year.
Since the beginning of the year, the Africa Centers for Disease Control and Prevention (CDC) has recorded a significant increase in cases. By the end of July, more than 14,500 cases and more than 450 deaths from smallpox had been detected.
About 96% of cases occurred in the Democratic Republic of the Congo. The rest spread to four neighbouring countries – Burundi, Kenya, Rwanda and Uganda.
“Unfortunately, these epidemic conditions are neglected in poor countries,” says Barbosa. “Because of this lack of attention and coordination, diseases spread.”
According to the infectious disease specialist, transmission in Africa occurs differently due to the mixed urban and rural environment. Culturally, children have frequent contact with animals, which are often used as food, which facilitates transmission of the disease.
Although a global spread is expected, as already observed in the first European case, the spread will not be the same as in the African continent. Each country will present its own mutations and characteristics.
In the Brazilian case, experts are calling for increased surveillance and monitoring of cases, especially among people who have traveled to affected countries in the last 30 days or who have symptoms consistent with the disease.
“We have the structure and expertise to control this disease,” says Serbino.
