0000-0002-9951-1737

Universidad Nacional de Rosario, Argentina

Consejo Nacional de Investigaciones Científicas y Técnicas

Rosario, Argentina

Anastasia Razumovskiy

ORCI: https://orcid.org/0000-0002-8653-7479

Arizona College of Nursing

Florida, USA

Melissa L. Morgan

ORCI: https://orcid.org/0000-0003-4044-6763

University of California Santa Barbara, California.

Santa Barbara, USA

Nelson Portillo

ORCI: https://orcid.org/0000-0001-7628-2786

Universidad Nacional de Rosario,

Argentina

Tomás Caycho-Rodríguez

ORCI: https://orcid.org/0000-0002-5349-7570

Universidad Privada del Norte

Lima, Perú

Carlos Carbajal-León

ORCI: https://orcid.org/0000-0001-7439-2332

Universidad Norbert Winner

Lima, Perú

Marlon Elías Lobos-Rivera

ORCI: https://orcid.org/0000-0002-7995-6122

Universidad Tecnológica de El Salvador

Pedronel González Rodríguez

ORCI: https://orcid.org/0000-0001-7578-4039

Universidad Jesús de Nazareth

San Pedro Sula, Honduras.

Wendy Matute Rivera

ORCI: https://orcid.org/0000-0002-1430-5038

Universidad Jesús de Nazareth.

San Pedro Sula, Honduras

Ana María Florez

ORCI: https://orcid.org/0000-0003-2060-5202

Asociación Panameña de Psicólogos

Panamá

Ibeth Vergara Jaen

ORCI: https://orcid.org/0000-0003-4914-1560

Universidad Latina de Panamá,

Pablo Martino

ORCI: https://orcid.org/0000-0002-5633-2050

Universidad Nacional de Rosario

Consejo Nacional de Investigaciones Científicas y Técnicas

Rosario, Argentina

Recibido: 13/09/2024 – Aceptado: 01/10/2024 – Publicado: 16/12 /2024

Resumen

Objetivo: Se presentan datos sobre la percepción de riesgo de pandemia por el brote de viruela símica en Centroamérica. Materiales y Métodos: Se utilizó una sola pregunta: ¿En qué medida considera que la viruela del simio podría convertirse en la próxima pandemia? La encuesta se administró entre el 8 y el 22 de julio de 2022. Resultados: Los datos indican que existe una baja percepción de riesgo en la población encuestada, solo entre el 22,7 % y 31,1 % de la muestra considera que la viruela símica podría convertirse en la próxima pandemia. Conclusiones: Estos datos deberían servir para orientar las acciones de alfabetización de enfermedades y establecer medidas gubernamentales de preparación y respuesta.

Palabras clave: viruela símica; salud pública; epidemiología.

Monkeypox: perception of pandemic risk in Central America

Abstract

Objective: Data are presented on the perception of pandemic risk due to the outbreak of monkeypox cases in Central America. Materials and Methods: A single question was used: To what extent do you consider that monkeypox could become the next pandemic? The survey was administered between July 8 and July 22, 2022. Results: The data indicate that there is a low perception of risk in the surveyed population, with only 22.7% to 31.1% of the sample believing that Monkeypox could become the next pandemic. Conclusions: These data should serve to guide disease literacy actions and establish government preparedness and response measures.

Keywords: monkeypox; public health; epidemiology.

Viruela del simio: percepción del riesgo de pandemia en Centroamérica

Resumen

Objetivo: Se presentan datos sobre la percepción del riesgo de pandemia por el brote de casos de viruela del simio en Centroamérica. Materiales y métodos: Se utilizó una sola pregunta: ¿En qué medida considera usted que la viruela del simio podría convertirse en la próxima pandemia? La encuesta se aplicó entre el 8 y el 22 de julio de 2022. Resultados: Los datos indican que existe una baja percepción de riesgo en la población encuestada, ya que solo entre el 22,7% y el 31,1% de la muestra cree que la viruela del simio podría convertirse en la próxima pandemia. Conclusiones: Estos datos deben servir para orientar las acciones de alfabetización sobre la enfermedad y establecer medidas de preparación y respuesta de los gobiernos.

Palabras clave: viruela del simio; salud pública; epidemiología.

Introduction

The World Health Organization (WHO), on July 23, 2022, indicated that monkeypox disease constitutes a Public Health Emergency of International Concern (PHEIC), due to the fact that more than 16,000 cases had been detected in more than 75 countries, with 5 deaths (Gallegos et al., 2022a; Kozlov, 2022). In a short time, the spread of new infections has expanded to many countries where monkeypox was not endemic. It is a zoonotic virus first detected in humans in the 1970s in Africa, although its existence in laboratory monkeys had been recognized as early as 1958 (Cohen, 2022; Kozlov, 2022). In the last two decades, local outbreaks were detected in different cities such as the United States in 2003, Sudan in 2005, the United Kingdom in 2018 and 2019, Israel in 2018, and Singapore in 2019, among others (Nakazawa et al., 2013; Simpson et al., 2020).

Transmission of monkeypox can occur through contact with body fluids, blood, skin lesions, respiratory droplets from infected animals or people, and also through contaminated objects and clothing (Altindis, Puca, & Shapo, 2022; Walter & Malani, 2022). The spread of infection has been predominantly among men, and particularly in men who have sex with men. Common symptoms include fever, headache, muscle aches, fatigue and swollen lymph nodes. Visible rashes develop on the face and body, which may heal in several weeks. Several antiviral medications have been developed (Velavan & Meyer, 2022), although many are in the experimental phase, and some vaccines are also available, but have not been widely applied. Treatment is focused on the common symptoms, except in severe cases or in at-risk persons who may require antiviral treatment (Osterholm & Gellin, 2022; Rizk et al., 2022). For the time being, low mortality is reported, and people are recovering normally after several weeks, however, there have been some deaths from severe cases (Menezes & Miranda, 2022).

Unfortunately, this new public health emergency overlaps with the COVID-19 pandemic that began in March 2020 and is still ongoing with significant consequences for human health (Gallegos et al., 2020; Gallegos et al., 2022c; Gallegos et al., 2022d: Hemati et al., 2022). Although it has been noted that the spread of monkeypox infections is much less than that reported for COVID-19 (Kozlov, 2022), it still poses a challenge to national public health systems and international health coordination, adding an extra burden of concern. Therefore, this paper presents preliminary results on the perception of the severity of monkeypox among people in three Central American countries. In the Central American region, El Salvador, Costa Rica, Honduras, Guatemala and Panama have already confirmed cases of monkeypox, according to follow-up data from the Pan American Health Organization as of October 3, 2022. Although the prevalence for Central America is currently low (66 confirmed cases), the United States, Canada, and Mexico have already recognized 28,699 confirmed cases. It is therefore crucial that policy makers in these countries are well informed and prepared for the potential increase in monkeypox cases.

Materials and methods

We surveyed 1969 adults from El Salvador (n = 830), Honduras (n = 723) and Panama (n = 416) with an average age of 34.9 years (SD = 13.1), where 724 were male, 1239 were female and 6 persons did not report their sex. To collect information on the perception of risk for monkeypox, a single question was used: To what extent do you consider that monkeypox could become the next pandemic? Response options were as follows: I do not know about the virus = 0; Disagree = 1; Neither agree nor disagree = 2; Agree = 3. This single question was created ad hoc for a much larger study analyzing the impact of the COVID-19 pandemic in Latin America and the Caribbean.

The survey was administered between July 8 and July 22, 2022, prior to the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization. The data collection procedure was similar in all countries. An online questionnaire was used and distributed through different social networks. Participation in the study was voluntary and there was no reward or financial compensation of any kind. The study followed the ethical recommendations of the Declaration of Helsinki and the protocol was approved by the Ethics Committee of the Universidad Privada del Norte, Perú (registration number: 20223012).

Results

Table 1 shows the results of this survey conducted between July 8 and July 22, 2022, prior to the declaration of PHEIC (Gallegos et al., 2022a). As can be seen, the results indicate that between 22.7% and 31.1% of the sample believe that monkeypox could become the next pandemic. Strikingly, a sizeable percentage of people reported not knowing about this new virus, particularly in Honduras (27.4%).

Table 1

Perceived risk of monkeypox pandemic in Central America
	¿To what extent do you consider that monkeypox could become the next pandemic?
Country	I do not know about the virus		Disagree		Neither agree nor disagree		Agree		Total
	n	%	n	%	n	%	n	%	n	%
El Salvador	162	19.5	163	19.7	247	29.7	258	31.1	830	100.0
Honduras	198	27.4	141	19.5	214	29.5	170	23.6	723	100.0
Panama	41	9.9	157	37.8	123	29.6	95	22.7	416	100.0

Discussion

The percentage of lack of knowledge is in relation to another study carried out in Europe where it was indicated that the state of knowledge about the disease was quite unsatisfactory (Riccò et al., 2022). Lack of knowledge is one of the current challenges that may contribute to increased severity of the disease (Alsanafi, Al-Mahzoum, & Sallam, 2022). Although the case fatality rate of the disease is low, the percentage of unawareness, together with the percentage of people who disagree that "monkeypox" may become the next pandemic (ranging from 19.5% to 37.8%), would suggest that the substantial riskiness of the disease may be being overlooked, compared with others such as COVID-19. Despite the emotional burden of even the COVID-19 pandemic, the emergence of a potentially serious new disease was not associated with the perception of serious consequences.

It should be remembered that these data were collected prior to the declaration of PHEIC, which may vary the future opinions of participants. Nevertheless, the dissemination of these preliminary data may serve to draw attention to the importance of more information and better communication about this new disease. It may also serve to encourage governments to strengthen preparedness and response mechanisms in the face of this new international public health threat (Hemati et al., 2022). Lack of adequate understanding of monkeypox and its characteristics could undermine the development of preventive measures, including potential immunization against the disease. In addition, failure to act in a timely manner, with preventive measures, could lead to synergy between pandemics.

References

Alsanafi, M., Al-Mahzoum, K., & Sallam, M. (2022). Monkeypox knowledge and confidence in diagnosis and management with evaluation of emerging virus infection conspiracies among health professionals in Kuwait. Pathogens, 11(9), 994. https://doi.org/10.3390/pathogens11090994

Altindis, M., Puca, E., & Shapo, L. (2022). Diagnosis of monkeypox virus – An overview. Travel Medicine and Infectious Disease, 50(102459), 102459. https://doi.org/10.1016/j.tmaid.2022.102459

Cohen J. (2022). Monkeypox outbreak questions intensify as cases soar. Science, 376(6596), 902–903. https://doi.org/10.1126/science.add1583

Gallegos, M., Zalaquett, C., Luna Sánchez, S. E., Mazo-Zea, R., Ortiz-Torres, B., Penagos-Corzo, J. C., Portillo, N., Torres Fernández, I., Urzúa, A., Morgan Consoli, M., Polanco, F. A., Florez, A. M., & Lopes Miranda, R. (2020). Cómo afrontar la pandemia del Coronavirus (Covid-19) en las Américas: recomendaciones y líneas de acción sobre salud mental. Revista Interamericana de Psicologia. Interamerican Journal of Psychology, 54(1), e1304. https://doi.org/10.30849/ripijp.v54i1.1304

Gallegos, M., Razumovskiy, A., & de Castro-Peçanha, V. (2022a). Viruela símica: actualización y orientaciones. Gaceta Médica de México, 158(6). https://doi.org/10.24875/gmm.22000249

Gallegos, M., Portillo, N., Martino, P., & Cervigni, M. (2022b). Long COVID-19: Rethinking mental health. Clinics, 77(100067), 100067. https://doi.org/10.1016/j.clinsp.2022.100067

Gallegos, M., Martino, P., Calandra, M., Razumovskiy, A., Portillo, N. & Cervigni, M. (2022c). Síndrome Post COVID-19 en América Latina y el Caribe: un llamado de atención. Revista Médica de Rosario, 88, 114-118. https://revistamedicaderosario.org/index.php/rm/article/view/190

Gallegos, M., Martino, P., Caycho-Rodríguez, T., Calandra, M., Razumovskiy, A., Arias Gallegos, V., Castro Pecanha, V. & Cervigni, M. (2022d). Qué es el síndrome post COVID: definición y actualización. Gaceta Médica de México, 158(6), 442-446. https://doi.org/10.24875/gmm.22000144

Hemati, S., Farhadkhani, M., Sanami, S., & Mohammadi-Moghadam, F. (2022). A review on insights and lessons from COVID-19 to the prevent of monkeypox pandemic. Travel Medicine and Infectious Disease, 50(102441), 102441. https://doi.org/10.1016/j.tmaid.2022.102441

Kozlov M. (2022). Monkeypox goes global: why scientists are on alert. Nature, 606(7912), 15–16. https://doi.org/10.1038/d41586-022-01421-8

Menezes, Y. R., & Miranda, A. B. de. (2022). Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil. Revista da Sociedade Brasileira de Medicina Tropical, 55. https://doi.org/10.1590/0037-8682-0392-2022

Nakazawa, Y., Emerson, G. L., Carroll, D. S., Zhao, H., Li, Y., Reynolds, M. G., Karem, K. L., Olson, V. A., Lash, R. R., Davidson, W. B., Smith, S. K., Levine, R. S., Regnery, R. L., Sammons, S. A., Frace, M. A., Mutasim, E. M., Karsani, M. E., Muntasir, M. O., Babiker, A. A., Opoka, L., … Damon, I. K. (2013). Phylogenetic and ecologic perspectives of a monkeypox outbreak, southern Sudan, 2005. Emerging infectious diseases, 19(2), 237–245. https://doi.org/10.3201/eid1902.121220

Osterholm, M. T., & Gellin, B. (2022). Confronting 21st-century monkeypox. Science (New York, N.Y.), 377(6604), 349–349. https://doi.org/10.1126/science.add9651

Riccò, M., Ferraro, P., Camisa, V., Satta, E., Zaniboni, A., Ranzieri, S., Baldassarre, A., Zaffina, S., & Marchesi, F. (2022). When a neglected tropical disease goes global: Knowledge, attitudes and practices of Italian physicians towards Monkeypox, preliminary results. Tropical Medicine and Infectious Disease, 7(7), 135. https://doi.org/10.3390/tropicalmed7070135

Rizk, J. G., Lippi, G., Henry, B. M., Forthal, D. N., & Rizk, Y. (2022). Prevention and treatment of Monkeypox. Drugs, 82(9), 957–963. https://doi.org/10.1007/s40265-022-01742-y

Simpson, K., Heymann, D., Brown, C. S., Edmunds, W. J., Elsgaard, J., Fine, P., Hochrein, H., Hoff, N. A., Green, A., Ihekweazu, C., Jones, T. C., Lule, S., Maclennan, J., McCollum, A., Mühlemann, B., Nightingale, E., Ogoina, D., Ogunleye, A., Petersen, B., Powell, J., … Wapling, A. (2020). Human monkeypox - After 40 years, an unintended consequence of smallpox eradication. Vaccine, 38(33), 5077–5081. https://doi.org/10.1016/j.vaccine.2020.04.062

Velavan, T. P., & Meyer, C. G. (2022). Monkeypox 2022 outbreak: An update. Tropical Medicine & International Health: TM & IH, 27(7), 604–605. https://doi.org/10.1111/tmi.13785

Walter, K., & Malani, P. N. (2022). What Is Monkeypox?. JAMA, 328(2), 222. https://doi.org/10.1001/jama.2022.10259

Contribución de autoría

ROLES	AUTORES QUE ASUMIERON EL ROL
Conceptualización	Miguel Gallegos, Mauricio Cervigni, Tomás Caycho-Rodríguez, Pablo Martino
Curación de datos	Tomás Caycho-Rodríguez, Carlos Carbajal-León,
Análisis formal	Tomás Caycho-Rodríguez, Carlos Carbajal-León
Investigación	Miguel Gallegos, Melissa L. Morgan, Tomás Caycho-Rodríguez, Carlos Carbajal-León, Marlon Elías Lobos-Rivera, Pedronel González Rodríguez, Wendy Matute Rivera, Ana María Florez, Ibeth Vergara Jaen
Metodología	Miguel Gallegos, Mauricio Cervigni, Tomás Caycho-Rodríguez, Pablo Martino
Administración del proyecto	Tomás Caycho-Rodríguez, Miguel Gallegos, Mauricio Cervigni
Recursos	Anastasia Razumovskiy, Melissa L. Morgan, Nelson Portillo
Software	Carlos Carbajal-León
Supervisión	Mauricio Cervigni, Melissa L. Morgan, Nelson Portillo, Carlos Carbajal-León, Marlon Elías Lobos-Rivera, Pedronel González Rodríguez, Wendy Matute Rivera, Ana María Florez, Ibeth Vergara Jaen
Validación	Tomás Caycho-Rodríguez, Carlos Carbajal-León
Visualización	Tomás Caycho-Rodríguez, Carlos Carbajal-León
Redacción – borrador original	Miguel Gallegos, Tomás Caycho-Rodríguez, Melissa L. Morgan, Nelson Portillo

Responsabilidades éticas:

Los autores declaran que en esta investigación no se realizaron experimentos con seres humanos.

Financiación:

Esta investigación no contó con financiamiento de entidades públicas y/o privadas.

Conflictos de interés:

Los autores declaran no tener conflictos de interés respecto a esta investigación.