ABSTRACT

Objective

To describe the profile of cases of mpox in the city of Rio de Janeiro between June and November 2022.

Methods

This was a descriptive study of secondary data obtained from mpox notification forms. Socioeconomic, clinical and spatial data were analyzed.

Results

Of the 928 cases, 93.7% were male, 85.0% cisgender male, 65.6% homosexual, 41.8% between 30 and 39 years old, and 41.0% were of White race/skin color. A total of 34.5% had immunosuppression due to illness, and 41.9% reported their HIV status as being positive. The most prevalent signs and symptoms were: skin lesions (96.6%), especially with multiple manifestations (67.8%) in the genital region (46.1%), in addition to fever (58.3%), adenomegaly (43.3%) and headache (38.7%). Most notifications occurred in public services (81.3%) and in hospital care (51.3%).

Conclusion

The study revealed high incidence of mpox, especially among young, cisgender and homosexual men. Most cases were mild, with genital lesions, progressing to cure without hospitalization. Person-to-person transmission was predominant.

Palabras clave
Monkeypox; Brotes; Epidemiología; Vigilancia en Salud Pública; Salud Pública

Study contributions

Main results

The notified cases of mpox in the city of Rio de Janeiro were mainly concentrated in men aged 30 to 39 years. The majority presented a mild condition that progressed to cure without hospitalization.

Implications for services

The profile obtained can contribute to the targeting of local health care policies, targeting prevention and health promotion actions.

Perspectives

Additional investigations can contribute to expanding knowledge of the disease. Investment in health surveillance is necessary to respond to public health emergencies.

Palabras clave
Monkeypox; Brotes; Epidemiología; Vigilancia en Salud Pública; Salud Pública

RESUMEN

Objetivo

Describir el perfil de los casos de mpox en la ciudad de Río de Janeiro entre junio y noviembre de 2022.

Métodos

Estudio descriptivo de datos secundarios de los formularios de notificación de mpox. Se analizaron datos socioeconómicos, clínicos y espaciales.

Resultados

De los 928 casos, 93,7% eran hombres, 65,6% homosexuales, 41% blanca, y 41,8% de 30 a 39 años. Estaban inmunocomprometidos debido a una enfermedad 34,5%, y 41,9% reportaron serología positiva para virus de inmunodeficiencia humana. Signos y síntomas más prevalentes fueron: lesiones cutáneas (96,6%), con manifestaciones múltiples (67,8%) y en la región genital (46,1%), además de fiebre (58,3%), adenomegalia (43,3%) y cefalea (38,7%). Mayoría de las notificaciones ocurrieron en la red pública (81,3%) y atención hospitalaria (51,3%).

Conclusión

El estudio reveló alta incidencia de mpox, especialmente entre hombres jóvenes, cisgénero y homosexuales. Mayoría de los casos tuvieron una presentación leve, progresando hasta la curación sin hospitalización.

Palabras clave
Monkeypox; Brotes; Epidemiología; Vigilancia en Salud Pública; Salud Pública

INTRODUCTION

Mpox is a zoonotic viral disease with an average incubation period of 6 to 16 days, the reservoir of which is unknown.¹1 Quiner CA, Moses C, Monroe BP, Nakazawa Y, Doty JB, Hughes CM, et al. Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the Congo. Yang Y, organizador. PLoS ONE. 2017;12(2):e0168664. doi:10.1371/journal.pone.0168664. The first cases were associated with hunting and eating infected wild animals,²2 Khodakevich L, Jezek Z, Messinger D. Monkeypox virus: ecology and public health significance. Bull World Health Organ. 1988;66(6):747-52. although its transmission also occurs between people or through contact with infected material.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791.,⁴4 WHO. Monkeypox. 2022. Disponível em: https://www.who.int/news-room/questions-and-answers/item/monkeypox.
https://www.who.int/news-room/questions-... The most common signs and symptoms of the disease are skin lesions, headache, fever, myalgia, fatigue and lymph node enlargement,⁵5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map. and transmission ends once the lesions have disappeared. Most cases have mild clinical manifestations and have good prognosis, however, in immunosuppressed individuals, the condition may worsen and require hospitalization.⁴4 WHO. Monkeypox. 2022. Disponível em: https://www.who.int/news-room/questions-and-answers/item/monkeypox.
https://www.who.int/news-room/questions-...

Mpox is an abbreviation for monkeypox, as it was identified in a non-human primate in 1958.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791. In 1970, the first case in humans was identified in the Democratic Republic of the Congo,²2 Khodakevich L, Jezek Z, Messinger D. Monkeypox virus: ecology and public health significance. Bull World Health Organ. 1988;66(6):747-52. with outbreaks occurring in the 1970s and 1980s in that republic and in other countries in the West and Central Africa.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791. In recent years, there has been an increase in the incidence rate from 0.72 cases per 100,000 inhabitants, in 1980, to 14.4 cases/100,000 inhab. in 2000, on the African continent.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791. In 2003, the United States had its first outbreak of mpoxs⁶6 Sejvar JJ, Chowdary Y, Schomogyi M, Stevens J, Patel J, Karem K, et al. Human monkeypox infection: a family cluster in the midwestern United States. J Infect Dis. 2004;190(10):1833-40. doi:10.1086/425039. and, in 2017 and 2018, there were outbreaks in Nigeria and Cameroon, where there had been no recorded cases for two decades.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791. From May to July 2022, more than 16,000 cases of mpox were reported in 75 countries,⁷7 Brockmeyer NH. As monkeypox goes sexual: a public health perspective. J Eur Acad Dermatol Venereol. 2022;36(8):1164-1166. doi:10.1111/jdv.18301. with the World Health Organization (WHO) declaring a Public Health Emergency of International Concern in relation to the mpox outbreak.⁸8 OPAS. Diretor-geral da OMS declara que surto de monkeypox constitui uma emergência de saúde pública de importância internacional. 2022. In Brazil, 10,904 confirmed mpox notifications had been registered by Epidemiological Week (EW) 16 of 2023,⁹9 Brasil. Card Situação Epidemiológica de Monkeypox no Brasil nº 172. 2023. of which 1,039 (9.5%) notifications related to confirmed cases in the city of Rio de Janeiro.¹⁰10 EpiRio. EpiRio - Observatório Epidemiológico da Cidade do Rio de Janeiro. 2023.

The scientific literature on mpox is still scarce.¹¹11 Foster SO, Hutchins DL, Pifer JM, Lourie B, Moser CR, Cummings EC, et al. Human monkeypox. Bull World Health Organ. 1972;46(5):569-76. In the same way as other endemic diseases on the African and South American continents, this health problem has been neglected, gaining repercussion and research funding only after the occurrence of cases in the Northern Hemisphere, revealing the colonial perspective in scientific practice.¹²12 Oliveira RG de. Sentidos das Doenças Negligenciadas na agenda da Saúde Global: o lugar de populações e territórios. Ciência Saúde Coletiva. 2018;23(7):2291-302. doi:10.1590/1413-81232018237.09042018. The importance of understanding the manifestation of the disease in the population is highlighted, so as to contribute to building health actions. As such, the objective of this article was to describe the sociodemographic and clinical characteristics of reported mpox cases among residents of the city of Rio de Janeiro.

METHODS

Design and data source

This was a descriptive study of mpox data reported to the Ministry of Health. The Research Electronic Data Capture (REDCap) tool was used to manage the database, which was structured, validated and managed by the Rio de Janeiro Municipal Health Department.

Study participants

The study included confirmed mpox cases among people resident in the city of Rio de Janeiro, Brazil, registered on the aforementioned platform from June 15, 2022 – date of the first mpox case notified in the city of Rio de Janeiro – until November 7, 2022, the closing date for notifications input to REDCap.

Context

This study used case definitions according to risk communications about mpox issued by the Rio de Janeiro Strategic Health Surveillance Information Coordination Service (Coordenação de Informação Estratégica em Vigilância em Saúde) in the city of Rio de Janeiro, adapted from Ministry of Health definitions (Supplementary Box 1). A suspect case is considered to be an individual of any age who, with effect from March 15 2022, has sudden onset of acute skin rash suggestive of mpox, either single or multiple, on any part of their body (including the genital region), whether or not associated with adenomegaly or report of fever. A confirmed mpox case is an individual who meets the suspect case definition and has a “positive/detectable” mpox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing).

Variables

The variables analyzed were sex (“male”, “female”); age in years and age group (“0-9”, “10-19”, “20-29”, “30-39”, “40-49”, “50-59”, “60+”); gender identity (“cisgender man”, “cisgender woman”, “transgender man”, “transgender woman”, “non-binary” and “not informed”); sexual orientation (“homosexual”, “heterosexual”, “bisexual”, “pansexual”, “other” and “not informed”); race/skin color (“White”, “mixed race”, “Black”, “Asian”, “Indigenous” and “not informed”); schooling (“illiterate”, “incomplete elementary education”, “complete elementary education”, “complete high school education”, “complete higher education”, “not applicable” and “not informed”); nationality (open field); immunosuppression (“due to illness”, “due to medication”, “cause unknown”, “not immunosuppressed” and “not informed”); HIV positive (“yes”, “no” and “not informed”); active sexually transmitted infection (“yes”, “no” and “not informed”); type of active sexually transmitted infection (“chlamydia”, “gonorrhea”, “genital herpes”, “lymphogranuloma venereum”, “mycoplasma genitalium” “syphilis”, “trichomoniasis”, “genital warts”, “chancroid” “human papillomavirus”, “pelvic inflammatory disease”, “donovanosis”, “human T-lymphotropic virus infection”, “other”); signs and symptoms (open field); site of lesion (“face”, “torso”, “lower limbs”, “upper limbs”, “genital”, “anal”, “oral”, “palm of the hand”, “sole of the feet”, “other places”); probable form of transmission (“from animal to man”, “associated with health care”, “transmitted in a laboratory”, “due to exposure at work”, “contact with contaminated material”, “person-to-person”, “transmission via use of intravenous drugs and blood transfusion”, “vertical transmission”, “sexual transmission”, “other transmission”, “unknown”, “not informed”); hospitalization (“yes ‒ due to clinical needs”, “yes ‒ for isolation”, “no”, “not informed”); progression (“unknown”, “cure”, “death from mpox”, “death from other cause”); place of residence in the city of Rio de Janeiro (open field); notifying service (open field); notifying health system (“public”, “private”, “military”); date of symptom onset (dd/mm/yyyy).

Programmatic areas were taken as the unit of analysis regarding place of residence. The city of Rio de Janeiro is divided into ten health programmatic areas, which are organized according to the city’s administrative regions, which, in turn, are comprised of neighborhoods. The ten programmatic areas are distributed in the Central region (programmatic area 1.0), South Zone (programmatic area 2.1), North Zone (programmatic areas 3.1, 3.2 and 3.3) and West Zone (programmatic areas 4.0, 5.1, 5.2 and 5.3) of the city (Figure 1).

The estimated population of the city of Rio de Janeiro was obtained from the population projection for the year 2022 made available by the Instituto Pereira Passos.¹³13 IPP. População residente estimada e projetada, por sexo e grupos etários do Brasil, Estado do RJ e Município do Rio de Janeiro entre 1980/1991/2000-2065 [Internet]. 2022. The populations of the administrative regions were grouped into the ten programmatic areas of the city of Rio de Janeiro, and were then used as a denominator to calculate the mpox incidence rates for each territory. After calculation, these data were plotted in order to visualize the spatial distribution of mpox rates in the city of Rio de Janeiro in the period analyzed.

Data analysis

Descriptive statistical analyses of the demographic, socioeconomic and clinical data of confirmed cases of mpox were performed out using R software version 4.2.1, and measures of central tendency and dispersion of continuous variables and frequencies of categorical variables were calculated.

QGIS software version 3.18.1 “Zürich” was used to describe the spatial distribution of incidence rates, whereby analyses were performed according to the programmatic areas, through shapefiles made available by the Instituto Brasileiro de Geografia e Estatística¹⁴14 GE. Geociências [Internet]. 2018. and by the Instituto Pereira Passos.¹⁵15 IPP. Áreas Programáticas da Saúde [Internet]. 2022.

Data quality control

Database records underwent quality control to eliminate any duplicate records or to modify records with inconsistent data.

Ethical aspects

This study was approved by the Rio de Janeiro Municipal Health Department Research Ethics Committee, as per Opinion No. 5.739.997 on 04/11/2022, Certificate of Submission for Ethical Appraisal (Certificado de Apresentação de Apreciação Ética) No. 64021122.6.0000.5279.

RESULTS

All 928 confirmed cases of mpox resident in the city of Rio de Janeiro notified during the study period were included. The onset of symptoms of the first case occurred in EW 24 of 2022, and the peak in cases can be seen in EW 30 of 2022 (Figure 2).

The cases were predominantly of the male sex (93.7%), between 20 and 49 years old (91.3%) ‒ with a median age of 34 years (range: 0-93 years), cisgender (91.1%), homosexual (65.6%), of White race/skin color (41.0%) and had complete high school education (44.2%) (Table 1).

There were no pregnant women in the sample and the majority of cases (98.8%) were of Brazilian nationality. Of the 11 foreigners, 5 were Argentinian, 2 were Colombian, 2 were French, 1 was from Bolivia and 1 was from Peru.

Among the notified cases, 34.5% had immunosuppression due to diseases, 41.9% reported being HIV positive, 13.2% reported having some other active sexually transmitted infection at the time of care, and of these, 85.2% had active syphilis at the time of mpox notification (laboratory confirmed) (Table 2). The most common mpox signs and symptoms were: lesion in genital/perianal/oral skin tissue/mucous membrane (96.6%), fever (58.3%), adenomegaly (43.3%), headache (38.7%). Lesions predominated in multiple sites on the body (67.8%), the most common being in the genital region (46.1%). The main form of transmission, assumed based on the information contained in the notification, was person-to-person (33.0%), followed by sexual transmission (19.2%). No hospitalization occurred in the majority of cases (94.7%) and the majority of individuals recovered (89.3%) (Table 2). Other signs and symptoms were reported less frequently, which characterized atypical conditions of the disease (Supplementary Table 1).

Regarding the location of case notification, 51.3% occurred in hospitals, 39.9% in Primary Health Care Centers, whereby 81.3% of total care was provided in public health system services (Table 3). Regarding place of residence, all ten programmatic areas in the city of Rio de Janeiro had resident cases registered, with the highest concentration of cases in programmatic area 2.1 (25.8%), followed by programmatic area 4.0 (17.2) and programmatic area 1.0 (14.0%) (Table 3).

Regarding the incidence rate, the highest rate was found in programmatic area 1.0, with 43 cases per 100,000 inhab., followed by programmatic area 2.1 and programmatic area 2.2, with 39 and 21 cases per 100,000 inhab., respectively (Figure 1).

DISCUSSION

This study described the profile of confirmed cases of mpox living in the city of Rio de Janeiro, which occurred, for the most part, among young male adults, with a cisgender identity and homosexual sexual orientation, in addition to people who reported being of White race/skin color and having completed high school education.

This study has some limitations. During this analysis period, the notification form was updated three times, resulting in changes and updates to variables, including new mandatory fields. This generated gaps in the initial forms. Furthermore the difficulty of migrating and integrating data, together with changes to the notification form, led to some information being incomplete.

The epidemiological profile was similar to that described in European countries, which also showed higher incidence of cases in the population of young male adults, with homosexual and bisexual sexual orientation and among men who have sex with men.¹⁷17 Tarín-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suñer C, Antón A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. The Lancet. 2022;400(10353):661-9. doi:10.1016/S0140-6736(22)01436-2.

18 Patel A, Bilinska J, Tam JCH, Fontoura DS, Mason CY, Daunt A, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022; e072410. doi:10.1136/bmj-2022-072410.

19 Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE, et al. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Eurosurveillance. 2022;27(22). doi:10.2807/1560-7917.ES.2022.27.22.2200421.-²⁰20 Sánchez Doncell Javier, et al. Viruela símica: vigilancia epidemiológica en la Unidad de Monitoreo Ambulatorio Muñiz, Buenos Aires. Medicina (B. Aires) [Internet]. 2022; 82(6): 816-821. It is essential to highlight that the disease is not exclusive to a certain gender or sexual orientation, and this reflection must be emphasized to combat any stigma that may be associated with the population most at risk. When comparing the results of this research with data for Brazil as a whole,²¹21 Pascom ARP, et al. Características epidemiológicas e clínicas dos casos de monkeypox no Brasil em 2022: estudo transversal. Epidemiol. Serv. Saúde. 2022;31(3):[1-15]. doi:10.1590/S2237-96222022000300036. it is possible to corroborate the trends found, with a peak in cases between EWs 30-31, followed by a drop in the occurrence of the disease. The epidemiological and clinical profile observed in the city of Rio de Janeiro was also similar to the national one, with higher incidence in cisgender men, of White race/skin color, in the 30 years age group, presenting mild symptoms and with good case progression.²¹21 Pascom ARP, et al. Características epidemiológicas e clínicas dos casos de monkeypox no Brasil em 2022: estudo transversal. Epidemiol. Serv. Saúde. 2022;31(3):[1-15]. doi:10.1590/S2237-96222022000300036.

Several findings of this study are in line with the clinical characteristics described by the WHO.²2 Khodakevich L, Jezek Z, Messinger D. Monkeypox virus: ecology and public health significance. Bull World Health Organ. 1988;66(6):747-52.

3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791.

4 WHO. Monkeypox. 2022. Disponível em: https://www.who.int/news-room/questions-and-answers/item/monkeypox.
https://www.who.int/news-room/questions-...

5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map.

6 Sejvar JJ, Chowdary Y, Schomogyi M, Stevens J, Patel J, Karem K, et al. Human monkeypox infection: a family cluster in the midwestern United States. J Infect Dis. 2004;190(10):1833-40. doi:10.1086/425039.

7 Brockmeyer NH. As monkeypox goes sexual: a public health perspective. J Eur Acad Dermatol Venereol. 2022;36(8):1164-1166. doi:10.1111/jdv.18301.

8 OPAS. Diretor-geral da OMS declara que surto de monkeypox constitui uma emergência de saúde pública de importância internacional. 2022.

9 Brasil. Card Situação Epidemiológica de Monkeypox no Brasil nº 172. 2023.

10 EpiRio. EpiRio - Observatório Epidemiológico da Cidade do Rio de Janeiro. 2023.

11 Foster SO, Hutchins DL, Pifer JM, Lourie B, Moser CR, Cummings EC, et al. Human monkeypox. Bull World Health Organ. 1972;46(5):569-76.

12 Oliveira RG de. Sentidos das Doenças Negligenciadas na agenda da Saúde Global: o lugar de populações e territórios. Ciência Saúde Coletiva. 2018;23(7):2291-302. doi:10.1590/1413-81232018237.09042018.

13 IPP. População residente estimada e projetada, por sexo e grupos etários do Brasil, Estado do RJ e Município do Rio de Janeiro entre 1980/1991/2000-2065 [Internet]. 2022.

14 GE. Geociências [Internet]. 2018.

15 IPP. Áreas Programáticas da Saúde [Internet]. 2022.

16 SES-RJ. Looker Studio. 2023. MONKEYPOX SES-RJ.

17 Tarín-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suñer C, Antón A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. The Lancet. 2022;400(10353):661-9. doi:10.1016/S0140-6736(22)01436-2.

18 Patel A, Bilinska J, Tam JCH, Fontoura DS, Mason CY, Daunt A, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022; e072410. doi:10.1136/bmj-2022-072410.

19 Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE, et al. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Eurosurveillance. 2022;27(22). doi:10.2807/1560-7917.ES.2022.27.22.2200421.

20 Sánchez Doncell Javier, et al. Viruela símica: vigilancia epidemiológica en la Unidad de Monitoreo Ambulatorio Muñiz, Buenos Aires. Medicina (B. Aires) [Internet]. 2022; 82(6): 816-821.

21 Pascom ARP, et al. Características epidemiológicas e clínicas dos casos de monkeypox no Brasil em 2022: estudo transversal. Epidemiol. Serv. Saúde. 2022;31(3):[1-15]. doi:10.1590/S2237-96222022000300036.

22 Macedo LR, Maciel ELN. Monkeypox: contexto, implicações e desafios para serviços de saúde e vigilância. Epidemiol Serv Saúde [Internet]. 2023;32(1):e2022723. doi:10.1590/S2237-96222023000100018.-²³23 WHO. 2022. Mpox Outbreak: Global Trends. 2022. It is important to highlight that although the occurrence of multiple lesions is the most frequent clinical characteristic,¹⁷17 Tarín-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suñer C, Antón A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. The Lancet. 2022;400(10353):661-9. doi:10.1016/S0140-6736(22)01436-2. many people infected by the virus may be asymptomatic.²⁴24 Satapathy P, Mohanty P, Manna S, Shamim MA, Rao PP, Aggarwal AK, et al. Potentially Asymptomatic Infection of Monkeypox Virus: A Systematic Review and Meta-Analysis. Vaccines. 2022;10(12):2083. doi:10.3390/vaccines10122083. Although the cases were predominantly mild, it is important to highlight the high prevalence of risk factors for severity.

We found a high percentage of people with positive HIV serology, and mpox and HIV co-infection could explain a possible greater severity of clinical manifestations, although this was not found in our sample.²⁵25 de Sousa D, Patrocínio J, Frade J, Correia C, Borges-Costa J, Filipe P, et al. Human monkeypox coinfection with acute HIV: an exuberant presentation. Int J STD AIDS. Setembro de 2022;33(10):936-8. doi:10.1177/09564624221114998. It is possible that the severity of the cases was low due to the timeliness of case diagnosis and treatment.

We found higher incidence of cases in central areas with greater purchasing power in the city of Rio de Janeiro (programmatic areas 1.0 and 2.1). These areas are characterized by the presence of leisure facilities and concert halls, in addition to being the territories most visited by tourists who come to the city of Rio de Janeiro.²⁶26 Prefeitura da Cidade do Rio de Janeiro. Plano Estratégico para a Retomada e o Futuro do Rio. Plano Estratégico 2021-2024. 2023. Plano Estratégico Rio 2021-2024. These factors may provide more opportunities for prolonged contact between individuals, as well as increasing the likelihood of interaction with people from other countries or regions where the virus is circulating.

Public hospitals and health centers made most case notifications and, more than a reflection of the severity or socioeconomic profile of the cases, this distribution may be linked to the referral strategy adopted by the public health authorities in the city of Rio de Janeiro. As the mpox outbreak was a Public Health Emergency of International Concern, the city ​​concentrated attention on the first cases at a reference unit for infectious disease clinical research, teaching, referral services and care, this being a fact that facilitated the care and surveillance services to achieve timely epidemiological investigation and case monitoring.

Around 1% of mpox cases in the world were residents of the city of Rio de Janeiro,⁵5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map. which accounted for 74% of cases in the state of Rio de Janeiro¹⁶16 SES-RJ. Looker Studio. 2023. MONKEYPOX SES-RJ. and 9% of cases in Brazil.⁹9 Brasil. Card Situação Epidemiológica de Monkeypox no Brasil nº 172. 2023. Although there were no deaths among residents of the city of Rio de Janeiro, Brazil was the country with the second highest absolute number of deaths⁵5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map. and the state of Rio de Janeiro had the highest number of deaths in Brazil.⁹9 Brasil. Card Situação Epidemiológica de Monkeypox no Brasil nº 172. 2023.

Considering the epidemiological panorama of mpox infection in Brazil,⁹9 Brasil. Card Situação Epidemiológica de Monkeypox no Brasil nº 172. 2023. despite the decreasing trend in the world,⁵5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map. the United States Centers for Disease Control and Prevention stressed the importance of monitoring and preventive interventions among people living with HIV due to the serious manifestations in this population group. This guidance was given in view of the frequency of deaths and the greater occurrence of morbidity and mortality among people living with HIV, specifically those with CD4+ T lymphocyte counts < 200 cells.²⁷27 Ministério da Saúde. Informe Técnico Operacional de Vacinação Contra a MPOX. 2023. As such, in March 2023, the Ministry of Health began its pre-exposure vaccination campaign in Brazil against mpox aimed at this population using the immunizing agent MVA-BN Jynneos mpox.³3 Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, organizador. PLoS Negl Trop Dis. 2019;13(10):e0007791. doi:10.1371/journal.pntd.0007791.,⁵5 CDC. Centers for Disease Control and Prevention. 2023. 2022 Mpox Outbreak Global Map. At an individual level, vaccination should not replace other known protective measures.²⁷27 Ministério da Saúde. Informe Técnico Operacional de Vacinação Contra a MPOX. 2023.

This study is the first to analyze the profile of mpox cases in the city of Rio de Janeiro, contributing to a better understanding of this problem in the population and providing support for effective health actions. Case management also reflects the central and fundamental role of Health Surveillance in the city of Rio de Janeiro, with emphasis on the Rapid Response Unit teams of the Strategic Health Surveillance Information Coordination Service, which allowed detection and timely notification of cases, enabling the implementation of control actions, such as contact tracing, isolation and monitoring of individuals until the cases were closed. This study also helps to highlight the importance of investing in Health Surveillance as an essential tool for responding to public health emergencies, fundamental in advancing the field of public health, as well as highlighting the need for additional investigations and studies to continue tackling this health problem.

In conclusion, this study offered a comprehensive analysis of the profile of mpox cases in the city of Rio de Janeiro, in 2022. The disease predominantly affected young male adults, self-declared homosexuals and of White race/skin color. In most cases, transmission occurred directly, presenting mild symptoms and progressing to cure without hospitalization.

REFERENCES

Supplementary Table 1

Supplementary Box 1

Publication Dates

History