Monkeypox in Peru: these are the reasons that would explain the considerable increase in infections

On August 26, it will be two months since the first monkeypox patient was detected in Peru, and to date, the figure has exceeded a thousand cases, including one fatality. Unlike other countries in the region, infections are growing steadily for multiple reasons.

As of Friday, August 19, 1,022 people infected with the monkeypox virus have been detected in fifteen regions of the country, according to data from the Ministry of Health (Minsa). Metropolitan Lima continues to have the largest number of positive cases, adding a total of 841 citizens with this disease.

In this note we will detail the possible reasons that would favor the increase in infections:

Difficulty tracking patients

The infectious disease doctor Juan Carlos Celis indicated that the cases of monkey pox They are reported in several countries around the world, so it is not exclusive to Peru. He explained that all of them reflect that the work of tracking and isolating patients with this disease has failed because cases continue to rise.

“The monitoring and isolation has not worked and it can be said now that this control of the epidemic has failed because the countries with better epidemiological surveillance than us, such as the countries of Europe and the United States, with good control, with good monitoring and diagnosis, have not been able to control it,” Celis, current head of the Department of Infectious Diseases and Tropical of the Regional Hospital of Loreto.

For its part, César Munayco, executive director of Public Health Surveillance of the National Center for Epidemiology, Disease Prevention and Control of the Ministry of Health (CDC) of the Ministry of Health (Minsa)stated that the strategy of immediate identification of cases, isolation and follow-up of these will continue as part of epidemiological surveillance in Peru.

“The key is to quickly identify the infected person to cut the chain of transmission and, obviously, isolate yourself, but it is not so much that you avoid close contact with other people or avoid sexual contact. Above all, also do the contact study to identify them and that this person does not continue to infect”, the Minsa representative told this newspaper.

Stigma

On July 24, the World Health Organization (WHO) declared the outbreak of monkey pox as a public health emergency of international scope, its highest alert level. He reported that the current outbreak mainly affects men who have sex with men (MSM).

Juan Carlos Celis considered that the monkey pox It has a stigma and that makes the issue of diagnosis more complicated. This in reference to the LGTBIQ+ community and men who have sex with men (MSM). He recalled that sex is one of the ways the virus spreads, but it is not the only one.

In this regard, the medical epidemiologist Antonio Quispe agreed that there is a topic “very serious of stigmatization”. “The very people who have symptoms of monkey pox They are afraid of losing their jobs, of entering an isolation that does not allow them to go out to look for daily bread and, above all, understand that the two populations at risk are minorities that have been neglected for a long time. Patients living with HIV during the pandemic have had serious problems accessing this treatment and many have gone from having controlled HIV to having uncontrolled HIV,” she said.

For its part, Cesar Munaycodirector of the CDC of the Minsa, affirmed that it cannot be said at this time that community transmission of monkeypox has gotten out of control. “We are in scenario 2, it means that there is only one group that is being affected [comunidad LGTB o en este caso los HSH] all over the world. Those mainly affected are this community, but they are not all because in different places there are different patterns of sexual behavior, that is what is driving the epidemic, ”he explained.

Diagnostics and statistical underreporting

Juan Carlos Celis He also said that the lack of a corroborated diagnosis and being classified as “suspicious” affects the real statistics of the progress of the disease. monkey pox.

“I attended a suspected patient of the monkey pox with characteristic lesions and he tells me ‘the couple with whom I have been in Lima has informed me that it came out positive’. So, I’ve taken care of it. It is a picture that can be managed at home so far, but he does not want to take the diagnostic test because it says that why do it if you have already had contact with the infected person. He has been offered confidentiality, taken to a more private office and said ‘no, what for if I already know what I have’”.

“So, I have to report that case as a probable case, but not confirmed. So the statistic varies. Another doctor has said that the patient does not want to give any data. The patient has every right to refuse any test. These are the situations for which this epidemic has no controlL,” he added.

Regarding this, the epidemiologist Antonio Quispe He stated that “there are many barriers to access the diagnosis in Peru, which increases the issue of underreporting.”

Lack of a registration

Antonio Quispea former adviser to the Minsa, added that the population at risk such as gays, bisexuals and other men who have sex with men do not appear in any registry of the Ministry of Health (Minsa).

This situation causes, according to what he said, that the representatives of the Minsa do not have quick access to them and, above all, reach the leaders of these communities, who are the ones who should be participating in the dissemination of strategies to prevent this disease.

Communication

For him infectologist Juan Carlos Celis Another transmission factor is lack of clearer, more focused and non-discriminatory information that should have been provided since the first case was reported in Peru regarding monkeypox and above all that it be directed to the vulnerable population group.

In addition, he pointed out that the Health sector must be “more aggressive in communication and communicate directly and honestly.” “You don’t have to discriminate,” she said. “We should all know that this epidemic in 99% of cases is due to close intimate sexual contact, skin to skin, kisses and intense hugs. Nothing of ‘tocaditas‘”

“I have casual sex and if I report a fever for three to five days, it could be casual or I could be at risk. And the person should know that she needs to be diagnosed. Risks need to be communicated. We can all catch monkeypox, but we need to know that it could be, for the most part, through mechanisms of intimate sexual contact. we should all know that”, he remarked as an example.

Celis and the epidemiologist Antonio Quispe agreed that the Ministry of Health (Minsa) should concentrate its efforts on the most affected population through campaigns in the centers where this vulnerable group is cared for.

“The strategy we are using is completely wrong. If one reads the Minsa advertisements, nowhere do they mention that the two main risk groups are gays, bisexuals and men who have sex with men and people living with HIV. They recommend mass use measures such as hand washing, distancing, wearing a mask, which are irrelevant because monkeypox is hyper-concentrated in these risk groups.“, said.

In this regard, the head of the Minsa CDC, Cesar Munaycoexplained that the Health sector is working with specific groups and specialized personnel, in which information is provided on the monkey pox to try to reduce the exposure of people who are currently being affected.

“We have been working strategies with the community under meetings with UNAIDS and other groups. This community in our country has always suffered from stigma, not like other countries where they are much more open, but that also makes it difficult for us to reach that population”held.

“That is why we now work with peer educators to be able to reach out directly because these groups generally open up much more to their peers”he remarked.

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