Casos notificados de mpox en la ciudad de Río de Janeiro, Brasil: estudio descriptivo, 2022

Ribeiro, Caio Luiz Pereira; D’Oliveira, Camila Arantes Ferreira Brecht; Campos, Élida de Albuquerque; Carvalho, Luciana Freire de; Pinto, Luciana de Almeida; Duffrayer, Karoline Moreira; Magalhães, Poliana Hilário; Proença, Raquel; Cerbino Neto, José; Aguilar, Gislani Mateus Oliveira; Garcia, Márcio Henrique de Oliveira

doi:10.1590/S2237-96222024v33e2023899.en

Caio Luiz Pereira Ribeiro

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Coordenação de Informações Estratégicas de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-3886-5769

Camila Arantes Ferreira Brecht D’Oliveira

designed the study

analyzed and interpreted the data

drafted the first version of the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Ministério da Saúde, Departamento de Análise Epidemiológica e Vigilância de Doenças Não Transmissíveis, Brasília, DF, Brazil

https://orcid.org/0000-0002-7456-885X

Élida de Albuquerque Campos

designed the study

analyzed and interpreted the data

drafted the first version of the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Coordenação de Informações Estratégicas de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0003-1604-8845

Luciana Freire de Carvalho

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0002-7372-3133

Luciana de Almeida Pinto

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Coordenação de Informações Estratégicas de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-8032-5478

Karoline Moreira Duffrayer

designed the study

analyzed and interpreted the data

drafted the first version of the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Coordenação de Informações Estratégicas de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-6012-963X

Poliana Hilário Magalhães

designed the study

analyzed and interpreted the data

drafted the first version of the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Coordenação de Informações Estratégicas de Vigilância em Saúde, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-9269-8474

Raquel Proença

designed the study

analyzed and interpreted the data

drafted the first version of the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Ministério da Saúde, Departamento de Emergências em Saúde Pública, Brasília, DF, Brazil

https://orcid.org/0000-0002-3380-5089

José Cerbino Neto

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-9254-917X

Gislani Mateus Oliveira Aguilar

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Secretaria de Vigilância em Saúde do Rio de Janeiro, Superintendência de Vigilância em Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

https://orcid.org/0000-0001-9103-9864

Márcio Henrique de Oliveira Garcia

analyzed and interpreted the data

critically reviewed the manuscript

All the authors have approved the final version for publication and are responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Ministério da Saúde, Departamento de Emergências em Saúde Pública, Brasília, DF, Brazil

https://orcid.org/0000-0002-9001-278X

Correspondence: Raquel Proença | raquelproencaufrj@gmail.com

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

Associate editor:

Taís Freire Galvão http://orcid.org/0000-0003-0098-1681

Characteristics	N	%
Sex
Male	870	93.7
Female	58	6.3
Age group (years)
0-9	7	0.8
10-19	20	2.2
20-29	261	28.1
30-39	388	41.8
40-49	199	21.4
50-59	45	4.8
60+	8	0.9
Gender identity
Cisgender man	789	85.0
Cisgender woman	57	6.1
Transgender woman	12	1.3
Non-binary	7	0.8
Transgender man	2	0.2
Not informed	61	6.6
Sexual orientation
Homosexual	609	65.6
Heterosexual	144	15.5
Bisexual	99	10.7
Pansexual	20	2.1
Other	7	0.8
Not informed	49	5.3
Race/skin color
White	380	41.0
Mixed race	333	35.9
Black	161	17.3
Asian	24	2.6
Indigenous	2	0.2
Not informed	28	3.0
Schooling
Illiterate	1	0.1
Incomplete elementary education	32	3.5
Complete elementary education	54	5.8
Complete high school education	410	44.2
Complete higher education	337	36.3
Not applicable	5	0.5
Not informed	89	9.6

Characteristics	N	%
Immunosuppression
Comorbidity	320	34.5
Due to medication	6	0.7
Cause unknown	2	0.2
Not immunosuppressed	505	54.4
Not informed	95	10.2
HIV positive
Yes	389	41.9
No	486	52.4
Not informed	53	5.7
Active sexually transmitted infection
Yes	122	13.2
No	645	69.5
Not informed	161	17.3
Types of active sexually transmitted infection
Syphilis	104	85.3
Gonorrhea	5	4.1
Chlamydia	2	1.6
Genital herpes	2	1.6
Other	9	7.4
Signs and symptoms ^a
Skin/mucous membrane/perianal/oral lesion	896	96.6
Fever	541	58.3
Adenomegaly	403	43.4
Headache	359	38.7
Asthenia/weakness	286	30.8
Muscle pain	268	28.9
Sore throat	222	23.9
Sweating/shivering	207	22.3
Backache	120	12.9
Other	799	86.0
Characteristic of the lesion
Single	72	7.8
Multiple	629	67.8
Not informed	227	24.4
Site of the lesion
Genital	428	46.1
Upper limbs and palms	334	36.0
Face	294	31.7
Torso	289	31.1
Lower limbs and soles of feet	227	24.5
Anal	82	8.8
Oral	58	6.3
Other sites	20	2.2
Not informed	225	24.2
Probable form of transmission
Person-to-person^b	306	33.0
Sexual transmission	178	19.2
Associated with health care	3	0.3
Contact with contaminated material	2	0.2
Unknown	191	20.6
Not informed	248	26.7
Hospitalization
Due to clinical needs	42	4.6
For isolation	4	0.4
Not hospitalized	879	94.7
Not informed	3	0.3
Case progression
Cure	829	89.3
Death from other cause	1	0.1
Not informed	98	10.6

Characteristics	N	%
Programmatic area of residence
1.0	130	14.0
2.1	239	25.8
2.2	84	9.0
3.1	86	9.3
3.2	60	6.5
3.3	72	7.8
4.0	160	17.2
5.1	46	5.0
5.2	27	2.9
5.3	24	2.5
Notifying service
Hospital	476	51.3
Primary care	370	39.9
Emergency Care Unit or Regional Emergency Coordination	41	4.4
Others	41	4.4
Notifying health system
Public	754	81.3
Private	162	17.4
Military	12	1.3

Signs and Symptoms^a	N	%
Nausea/vomiting	79	8.5
Arthralgia	65	7.0
Localized lymphadenopathy	64	6.9
Pruritus	56	6.1
Pain in other places	55	6.0
Cough	54	5.8
Difficulty swallowing/odynophagia	48	5.2
Diarrhea	43	4.6
Other flu-like symptoms (hoarseness, sneezing, runny nose, congested nose)	41	4.4
Photosensitivity	36	3.9
Fatigue/tiredness/exhaustion	31	3.3
Proctitis	30	3.2
Edema (penis/anus)	29	3.1
Urinary incontinence	22	2.4
Signs of hemorrhaging	21	2.3
Dysuria/burning when urinating/urinary retention	17	1.8
Anal/rectal/vaginal secretion and/or discharge	17	1.8
Hyperemia/exudation	15	1.6
Conjunctivitis	14	1.5
Generalized lymphadenopathy	11	1.2
Malaise	5	0.5
Dyspnea/chest pain/tight ribs	4	0.4
Exanthema	4	0.4
Anal bleeding	4	0.4
Confusion	3	0.3
Hematuria	3	0.3
Irritability	3	0.3
Ulcer	3	0.3
Anal fissure	3	0.3
Eye burning	3	0.3
Lack of appetite/hyporexia	3	0.3
Dizziness	2	0.2
Anorexia	1	0.1
Ageusia	1	0.1
Gastrointestinal alterations	1	0.1
Balanitis	1	0.1
Dry mouth	1	0.1
Shivering	1	0.1
Lumbosacralgia	1	0.1
Paraphimosis	1	0.1
Blushing	1	0.1
Night sweats	1	0.1
Tachypnea	1	0.1

Version 01 Issued on 07/06/2022	Suspect case definition: Individual of any age who, with effect from March 15 2022, has sudden onset of fever, adenomegaly and acute skin rash of the papulovesicular type and progressing uniformly. Probable case definition: Individual who meets the suspect case definition AND one OR more of the following criteria: Have an epidemiological link (close and prolonged exposure without respiratory protection; direct physical contact, including sexual contact; or contact with contaminated materials, such as clothes and bedclothes) with a probable or confirmed monkeypox case, since March 15 2022, in the 21 days prior to the onset of signs and symptoms OR History of traveling to a country that is endemic or had confirmed monkeypox cases in the 21 days prior to the onset of symptoms AND without laboratory confirmation. Confirmed case definition: Individual who meets the suspect case or probable case definition with laboratory confirmation of having the monkeypox virus obtained by means of molecular testing (qPCR and/or sequencing). Discarded case definition: Suspected case that does not meet the monkeypox confirmation criterion or who had another disease confirmed by means of clinical or laboratory diagnosis.
Version 02 Issued on 17/06/2022	Suspect case definition: Individual of any age who, with effect from March 15 2022, has sudden onset of acute skin rash suggestive of monkeypox, either single or multiple, on any part of their body (including the genital region), whether or not associated with adenomegaly or report of fever AND History of traveling to a country that is endemic or had confirmed monkeypox cases in the 21 days prior to the onset of symptoms OR Have an epidemiological link with people with a history of traveling to a country that is endemic or had confirmed monkeypox cases, since March 15 2022, in the 21 days prior to the onset of signs and symptoms OR Have an epidemiological link with suspected, probable or confirmed monkeypox cases, since March 15 2022, in the 21 days prior to the onset of signs and symptoms OR History of intimate contact with strangers and/or casual partners, in the 21 days prior to the onset of signs and symptoms. Probable case definition: Suspect case, submitted to clinical and epidemiological investigation, AND who developed a clinical condition compatible with monkeypox, but without possibility of laboratory confirmation by means of qPCR and/or sequencing. Confirmed case definition: Individual who meets the suspect case definition and has a “positive/detectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing). Discarded case definition: Individual who meets the suspect case definition but has a “negative/undetectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing).
Version 03 Issued on 29/06/2022	Suspect case definition: Individual of any age who, with effect from March 15 2022, has sudden onset of acute skin rash suggestive of monkeypox, either single or multiple, on any part of the body (including the genital region), whether or not associated with adenomegaly or report of fever AND History of intimate contact with strangers and/or casual partners, in the 21 days prior to the onset of signs and symptoms OR Have an epidemiological link with confirmed monkeypox cases, since March 15 2022, in the 21 days prior to the onset of signs and symptoms OR History of traveling to a country that is endemic or had confirmed monkeypox cases in the 21 days prior to the onset of symptoms OR Have an epidemiological link with people with a history of traveling to a country that is endemic or had confirmed monkeypox cases, since March 15 2022, in the 21 days prior to the onset of signs and symptoms. Probable case definition: Suspect case, submitted to clinical and epidemiological investigation, AND who developed a clinical condition compatible with monkeypox, but without possibility of laboratory confirmation by means of qPCR and/or sequencing. Confirmed case definition: Individual who meets the suspect case definition and has a “positive/detectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing). Discarded case definition: Individual who meets the suspect case definition but has a “negative/undetectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing), OR Suspect case who during clinical, epidemiological and laboratory investigation was diagnosed as having another disease compatible with the clinical condition the patient presented, except STI.
Version 04 Issued on 27/07/2022	Suspect case definition: Individual of any age who, with effect from March 15 2022, has sudden onset of acute skin rash suggestive of monkeypox, either single or multiple, on any part of their body (including the genital region), whether or not associated with adenomegaly or report of fever. Confirmed case definition: Individual who meets the suspect case definition and has a “positive/detectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing). Probable case definition: Suspect case, submitted to clinical and epidemiological investigation, AND who developed a clinical condition compatible with monkeypox, but without possibility of laboratory confirmation by means of qPCR and/or sequencing. Discarded case definition: Individual who meets the suspect case definition but has a “negative/undetectable” monkeypox laboratory test result/report obtained by means of molecular diagnosis (real-time PCR and/or sequencing), OR Suspect case who during clinical, epidemiological and laboratory investigation was diagnosed as having another disease compatible with the clinical condition the patient presented, except STI.

[tfnea1] a) An individual could report more than one sign/symptom occurring in the 21 days prior to the medical consultation.

Casos notificados de mpox en la ciudad de Río de Janeiro, Brasil: estudio descriptivo, 2022

RESUMEN