By Andrea Hargraves 
Researcher Anna Abecassis points out that the latest version of smallpox may be asymptomatic, but the possibility of transmission is not yet well understood, and that vaccination is the most effective way to combat it.
“It is possible that there are asymptomatic cases – which I think are less in this disease – but the possibility of transmission from asymptomatic people is still not well understood,” explains Llosa, associate professor at the Institute of Health and Tropical Medicine (IHMT) of the New University of Lisbon.
The latest outbreak of smallpox, previously called “monkeypox,” is caused by a “first branch” from central Africa, and is different from the one that caused the 2022 outbreak, with several cases in Europe, the “second branch,” from East Africa.
“These ‘groups’ have different characteristics in terms of symptoms,” he says.
The “second branch” caused a less frequent, more localized rash, while the “first branch” caused a more widespread rash all over the body, causing more severe symptoms. However, symptoms such as fever, headache, and swollen lymph nodes were also seen. [condição em que os nódulos linfáticos ficam com tamanho, consistência ou número anormais] “It's common in both,” he says.
The newer strain appears to be the most virulent, although the researcher said she has not yet found “clear information on mortality rates.”
“What has been described is that this strain has higher mortality rates, and the information I have found is that this has a mortality rate of 1 to 10%, while ‘clade II’ has 2 to 6%, but this also depends on the affected areas,” he highlights.
Anna Abikasis explains that the mortality rate between the strains should not be directly compared, as the 2022 outbreak had cases in Europe, which has a greater capacity to respond, and the current outbreak mainly affects Africa, where there is a lack of infrastructure and health professionals.
He stresses that “Clade 1” is frequently transmitted from person to person, which facilitates its spread, and on Thursday, in Sweden, the first case in Europe was announced, so “there is a great need for prevention.”
Regarding Africa specifically, “the best response (…) to overcome this outbreak is through prevention because, in terms of the capacity of human resources in health to respond to treatment, we know that we have limited resources in these contexts and it ends up being more difficult to represent,” he lamented.
Therefore, he advises prioritizing vaccination “would be the best strategy to try to overcome this shortage of human resources.”
The World Health Organization says it has a series of recommendations, ranging from early diagnosis, isolation of cases, notification of partners, identification of contacts and vaccination, but the number of vaccines available remains low.
At the moment, there is the issue of vaccine production, distribution and prioritisation of people at risk to start vaccination, but the local context can complicate this process.
However, the Global Alliance for Vaccines and Immunization, headed by Durão Barroso, the former Portuguese prime minister, has a response plan with a budget allocated for this type of emergency, amounting to $ 500 million (about 455 million euros) and announced on Friday the creation of a global reserve of vaccines against smallpox.
“In this case, we will have to ensure that these vaccines are distributed in a coordinated manner and that entities at the local level are able to control the cases that arise and identify contacts, in order to prevent the epidemic from spreading quickly,” the researcher says.
The professor believes that it is important to identify groups at risk.
“I have not yet seen anything that identifies the groups at risk in this case. We know that there are many infections among children, that there is vertical transmission, and in this case, the mortality rate is higher,” he stresses.
He says that since the previous outbreak in 2022, there has been a research and preparedness response to combat smallpox.
Regarding Portugal, “there must be awareness among health workers about the symptoms of this disease, or the group of symptoms, from the perspective of the possibility of imported cases, so that we can move immediately to isolate them,” the statement said.
“I also don’t know what is planned in terms of controlling the entry of people from these most affected areas, but it is important to do some monitoring, which will be an effective strategy,” he advises.
However, he stressed that there must be resource management and an understanding of how far-reaching testing at the border can be carried out.
He explains that there are already about 17,000 people in Portugal who have been vaccinated, who were at high risk of an outbreak in 2022.
The researcher also highlights that, in her opinion, “all available vaccines should be directed to countries currently facing an outbreak, but at some point it may make sense to vaccinate the Portuguese population as well and there should also be a definition of a vaccination strategy that identifies priority groups, that is, healthcare professionals, who are most likely to deal with patients.”