What can you teach the monkey to eradicate the smallpox? health

Just over four decades ago, something unprecedented in human history happened: an infectious human disease stopped circulating in the world. In 1980, the smallpox was considered extinct.

It was one of the most devastating diseases of all time. One in three people infected with smallpox was killed. In the twentieth century alone, it killed 300 million people worldwide, or 4 million a year.

Now, this path between destruction and extinction brings lessons to the time when a virus from the same family, the monkey, is advancing unusually across countries on all continents, in a process that scientists still understand.

And in Brazil, which was one of the last countries in the world to eradicate smallpox in the 1970s, the fight against the disease formed the basis of the national vaccination program we know today, explains Tania Maria Fernandes, a graduate professor of history. Health Sciences at Casa de Oswaldo Cruz / Fiocruz.

Monkey pox: see 5 points about the disease

Brand on the arm until 1971

Here, the last cases of smallpox were recorded in 1971, in the northern region of the city of Rio de Janeiro.

At the time, there were already isolated cases of the disease, as the country had been promoting massive vaccination campaigns since the previous decade.

  • Does the vaccine mark on the arm indicate protection against the monkey?

According to Tania Fernandes, the vaccine was initially given to children from the age of six to adults. Children under one year of age were also vaccinated.

Those born up to 1971 – the last year of vaccination in the country – may have a vaccination certificate from that time or a small mark on their left arm or leg. This is important because this demographic group may still have some kind of immunity against the monkey. (more details about the disease below).

At the time, big popular parties were held in city squares across the country to attract the public and immunize anyone who showed up, Fernandes says. There were also vaccinations to immunize children in health posts and schools.

“Everyone, from one hundred to zero years ago, was vaccinated,” said the historian.

Baztanga vaccine lays the groundwork for Brazil’s National Immunization Program in 1970 – Photo: ACERVO COC / FIOCRUZ

In 1962, Brazil set up a federal public agency specifically dedicated to smallpox control, named after four years of the smallpox eradication campaign (CEV), which is responsible for centralizing and monitoring the progress of the disease as part of a global initiative. World Health Organization (WHO) against smallpox.

“From 1966 to 1971, CEV coordinated the organization and implementation of mass vaccination campaigns in all Brazilian municipalities and collaborated with state health departments in structuring epidemiological surveillance units,” according to Fiocruz’s historical collection.

He had this care reported and investigated smallpox cases across the country and traced possible chains of contamination. From there, a technique called blockade vaccination was performed: people close to the infected patient were immunized to interrupt the transmission chain.

Vaccine credentials are now also required when enrolling children in school, Fernandes explained.

“These logics made it possible to create a National Immunization Program (NIP),” which is now followed by the Brazilian Integrated Health System, Fernandes says.

“The same model was then applied against measles, and a national epidemiological surveillance program was created, which centralizes the reporting of communicable diseases – diseases are reported and cataloged, so we can access the number of cases, vaccinations and deaths of various diseases.” Brazil, he added.

This set of factors led to zero cases of smallpox in Brazil back in 1971. Two years later, the WHO confirmed that Brazil was free of disease.

Once that was done, details Tania Fernandes, Brazil ended up exporting professionals who participated in the Brazilian vaccination campaign to Asia and Africa to countries still struggling with smallpox, such as Bangladesh, Ethiopia and Somalia, to implement similar programs.

The last known case of smallpox in the world was recorded in Somalia in 1977. Three years later, the WHO declared the disease extinct, the only case in world history to date.

Remembers the eradication of the 1980 WHO poster – a unique case in the history of public health around the world – Photo: WHO

“Human eradication is the first and only human disease in the world, thanks to the cooperation of countries,” says the WHO. “This remains one of the most significant and profound successes in public health in history.”

This success is not easy to repeat in other epidemics – such as covid-19 – because the diseases have very different characteristics from each other, explains Tania Fernandes.

The “advantage” of fighting Baztanga (and now monkey) is that the patients are symptomatic – they present with very special skin lesions and blisters, which facilitate the identification of the disease..

In addition, smallpox family viruses, such as smallpox and monkeys, are considered stable, meaning they do not undergo many mutations. Therefore, immunization is usually long-term for those who are infected or have been vaccinated.

Sars-CoV-2, the covid-19 virus, is quite different: it is often transmitted symptomatically, so it goes unnoticed in many people.

And the RNA molecule is a virus that usually undergoes many mutations – and some of them can escape the human body’s immunization and, in some cases, the vaccine.

So like measles, for example, covid-19 it is more difficult to eradicate completely — and it serves more to control public health strategies for these and other diseases than to eradicate them.

From the vaccine uprising to the monkey herd

It is noteworthy that the history of smallpox is very old – what we told above were only its last chapters.

The WHO estimates that the virus is more than 3,000 years old, and that its vaccine was invented in 1796 by the English physician Edward Jenner.

Appearances, however, date back to the 19th and 20th centuries.

In Brazil, a historic milestone was the Vaccine Uprising in 1904. when the country was suffering from a particularly virulent outbreak of the disease. In Rio de Janeiro alone, the country’s capital, 3,500 people died as a result of the disease that year, according to Fiocruz’s archives.

Jenner’s vaccine already existed here, but its mandatory nature was not strictly established. Until Oswaldo Cruz proposed submitting a bill to strengthen the mandatory campaign to Congress.

This provoked a strong reaction from various sectors of society, including the fear that the vaccine would spread the disease (unfounded), and the social discomfort of married women showing their arm or leg to be vaccinated in public. . .

Revolta da Vacina was one of the milestones in the fight against the disease in Brazil; above, the tram overturned in the Praça da República, in Rio de Janeiro, in protest against the compulsory vaccination law, on November 14, 1904 – Photo: ACERVO FIOCRUZ

In November 1904, thousands of people took to the streets of Rio to protest, ending up trying to overthrow the federal government itself and violently repressing it in a revolt.

Over the next few decades, vaccination progressed rapidly in Brazil and around the world until a successful global campaign was launched in the 1960s.

After the end of the world, The smallpox virus was still stored in laboratories – and there was a widespread fear that it could be used as a biological weapon against younger populations who were no longer vaccinated..

That’s why, The WHO and some countries maintained first-generation smallpox vaccine stockpiles. And now, with the latest breakthrough in monkeypox, which has rarely been seen outside of West and Central Africa until now, immunization workshops are now being set up to produce vaccines for these two types of virus.

The vaccine against human smallpox is thought to be very effective – 85% – against the monkey, precisely because the virus is similar and stable, with little chance of mutation.

Another important point is that the monkey is a much milder disease than the human smallpox. Its mortality rate is estimated to be between 1% and 10%, depending on the strain of the virus and the type of patient (younger children and those affected by the immune system are at higher risk) compared to the 30% mortality rate of smallpox.

“The Batangela virus was very dangerous, it killed a lot, (…) and it was very easy to infect,” says Fernandes.

But, with all the devastation it caused, his control ended up teaching a useful lesson to the monkey to this day: We already know more about the characteristics of the disease and the virus that causes it, and we have also created stronger structures to deal with it, with vaccination and case monitoring, worldwide and in Brazil..

“There is no doubt that the process of eradicating measles and (fight) measles has shaped the disease notification and control systems and immunization program in Brazil,” says Tania Fernandes.

In addition, “there was a very effective, mandatory, reasonably approved vaccine in Brazil. It is important to record this: the country (to date) has a very serious vaccine culture,” says the historian.

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