From May 3-12, 2022, 2 sexual health clinics in Lisbon, Portugal were concerned that a small number of patients had unusual genital lesions, skin rashes and systemic symptoms including fever and swollen lymph nodes.
Dr Margarida Tavares is the director of the National Sexually Transmitted Infections and HIV Infection Program and an infectious disease consultant at Centro Hospitalar Universitário de São João, Porto, and remembers how unable they were to explain the disease .
“At that time, the cause of these symptoms was unclear, but the correlation of having a number of similar cases over the same period made us wonder what was going on and report them. so we can hopefully get some answers. .”
Identification of monkeypox
Without being able to give a diagnosis, the national reference laboratory registered the unexplained cases on the EpiPulse online portal – a tool set up by the European Center for Disease Prevention and Control (ECDC) through which the authorities European public health and global partners can collect, analyze, share and monitor infectious disease data.
Three days later, the UK reported 4 lab-confirmed monkeypox infections, allowing authorities in Lisbon to ‘join the dots’ and gain confirmation that they were also dealing with an outbreak of monkeypox .
Responding to the epidemic and involving civil society
As soon as the first case was confirmed to be the monkeypox virus, a rapid response team was set up on May 17, made up of sub-teams responsible for the main pillars of the response (including coordination, clinical burden, laboratory analyses, vaccination, epidemiological surveillance and risk communication).
From the start, this team engaged in close dialogue with community organizations working with men who have sex with men (MSM), as it is in this group that the vast majority of cases have been found. The team also liaised with sexually transmitted infection (STI)/HIV testing and care centers, as well as venues, such as bars and on-site sex businesses, to consult with them on key messages. regarding monkeypox and the best approach to communicating it, especially in view of the upcoming Pride Marcha do Orgulho events on June 18 and Arraial Lisboa Pride on June 25.
“Together, Pride events attract up to 100,000 attendees and are the highlight of the city’s LGBTQI+ calendar. They provided us with a perfect opportunity to identify actionable and clear messages, raise awareness of monkeypox to those most at risk of infection, and provide information on what symptoms to look out for, how to avoid it, and what to do. you have to do if you catch it,” explained Ricardo Fuertes, a psychologist working at the National Program and community liaison officer.
As messages were released at Pride events, testing sites and hospitals were preparing to receive patients concerned about their symptoms in other parts of the city and country.
Event organizers are part of the solution
The organizers of the two Pride events, as well as the Grupo de Ativistas em Tratamentos (GAT), a community-based organization that provides counseling and testing services for HIV and other STIs, were also involved in the design and distribution of information materials, including a full-sized bilingual (in Portuguese and English) pocket-guide that used images of a prickly pickle to draw attention to the lesions and rashes characteristic of monkeypox. Additionally, the organizers received briefing information for staff and participated in the production of educational videos which were shown on large public screens at one of the events.
Rapid responses in coordination with the community
Portuguese health authorities made the most of existing contacts and networks of services and community representatives – relationships developed in response to HIV and their work with MSM, migrants and sex workers – to react quickly . Community representatives were consulted prior to national media announcements, and venues such as bars and saunas were engaged and encouraged to display information posters.
“This alliance between health authorities, event organizers, community organizations and venues has been crucial to our response,” says Dr Tavares. “And over time, that alliance expanded as we realized we needed to include other subgroups, such as chemsex networks, and new geographies, such as Porto.”
GAT and the national health authority have worked together to set up a monkeypox hotline to answer questions about infection, transmission and vaccination of the disease, as well as where to go. get tested if you suspect infection.
Dr Tavares and Ricardo Fuertes believe that being pragmatic about recommended prevention measures and targeting groups most at risk, without stigmatizing or blaming, were important factors in getting people to take notice of their messages and for success. of their campaign. As Portugal continues to see reported cases of monkeypox, the country was one of the first to show signs of stabilization in transmission. Now the work must focus on reducing the number of cases and stopping the epidemic completely.
Preparation of a national immunization program
Measures similar to those described above are currently being taken with a view to setting up a national preventive vaccination programme. Community partners and site owners were again consulted on many of the practical considerations needed in this regard, including deciding on the appropriate eligibility criteria for vaccination, the location of vaccination points and how information will be communicated to reach those most at risk. .
GAT’s CheckpointLX, a testing center for HIV and other STIs, plays a key role in these plans and has already been designated as one of 3 monkeypox vaccination points in the Lisbon metropolitan area due to its close ties with most-at-risk MSM. communities. With vaccines as a new response tool for Portugal, the continued engagement and involvement of the affected community in all its interventions will be key to ending the epidemic in the country.