Portugal at the heart of the monkeypox response

30 August 2022

Monkeypox cases across the WHO European Region have now exceeded 22 000, since the current outbreak first started.

Given the central role of sexual transmission in this outbreak, a sexual rights approach, which includes reduction of stigma and discrimination, must permeate all preparedness and response activities. The meaningful participation of affected populations in these activities – including review of local epidemiological data, research and analysis, and planning, implementing, monitoring and evaluating public health interventions – will be critical for success.

Public health authorities at national and subnational levels should identify and actively work with relevant civil society groups, community-based organizations and stakeholders, and leverage the trust they have to ensure that at-risk groups are properly informed, engaged in response activities and empowered to protect themselves.

Portugal was one of the first countries to detect monkeypox cases as part of this outbreak, and one of the first countries to see a slowdown in new cases. While new monkeypox cases are still being found in Portugal, the country’s early actions are an example of how all of society can work together to curb this disease and to help bring this outbreak to an end.

Meet some of the people at the heart of this response:

Luis is a nurse working at the clinic for sexually transmitted infections (STIs) in the Hospital de Santo António dos Capuchos in Lisbon. Every week, he sees patients who suspect they have monkeypox.

Luis takes a swab from a patient to test for monkeypox virus.

One of his patients today is Ricardo, 33, a designer. WHO met him at the hospital following monkeypox diagnosis.

“I started to feel symptoms 3 days ago – I have a mark on my chin, a sore and swollen throat and have had a fever. A friend told me about this clinic. He said to come here at 7 am and talk to a doctor.”

“The doctor told me that I have monkeypox. It’s okay. I’m feeling okay.”

"Now I just have to be patient and take care of myself, and take the medications, paracetamol and anti-inflammatories. I have to work from home, and stay at home for 10 days to 2 weeks until I can return to my normal life.”

Specimens from STI clinics across Portugal are sent here, to the National Institute of Health where they will be analysed.

Ana is one of the technicians who is in charge of the laboratory testing to detect monkeypox virus in specimens collected from patients.

The laboratory extracts the DNA from the sample.

Ana works inside biosafety cabinets to reduce the risk of any possible contamination and to ensure the accuracy of results.

Meet Dr Cândida Fernandes , the head of an STI clinic in Lisbon. She reports on monkeypox cases in Portugal.

“All our patients at the clinic are men who have sex with men. We start by explaining to them that this is a self-limiting disease, with symptoms that usually last for 1–2 weeks. Most of the time the mild symptoms will go away without any specific treatment. But we also give medicinal relief for pain and for fever.”

“We give advice to patients on how to reduce the risk of transmission to other people, for example, by limiting physical contact with others.”

“That includes sexual contact, but also physical contact with people at home or at gatherings. We also give an email address to our patients, so if they have questions or problems, we will advise them on the best thing to do.”

Vaccines are one tool among others to contain monkeypox.

“I thought I was at risk and I was advised to take the monkeypox vaccine,” says Tom, 34, after he got vaccinated against monkeypox at GAT CheckpointLX, a screening centre for STIs in Lisbon. WHO recommends targeting vaccination to only those exposed to someone with monkeypox and those at high risk of exposure.

Dr João Paulo Gomes, Head of the Genomics and Bioinformatics Unit in the National Institute of Health in Lisbon told us about their preparedness for a new health emergency.

“I think we were much more prepared than we were a couple of years ago. We have learned a lot from the 2009 swine flu pandemic and from COVID-19. The European Union is releasing a huge amount of funds to launch research projects to promote cooperation between authorities and scientific communities, and between different countries, to work together, and specifically, to rapidly detect and control emerging threats.”

Rapid responses in coordination with the community.

Health authorities across Portugal are working with communities of men who have sex with men to control the outbreak, using sound information and the public health measures available.

Making the most of existing contacts and networks of community services and representatives, health authorities in the country reacted quickly to the emerging situation.

Dr Margarida Tavares is Director of the National Programme for Sexually Transmitted Infections and HIV Infection and infectious diseases consultant at Centro Hospitalar Universitário de São João, in Porto.

“This alliance between health authorities, event organizers, community organizations and venues was crucial to the success of our response,” says Dr Tavares. “And over time, this alliance has expanded as we realized we needed to include other subgroups, such as chemsex networks, and new geographic areas, such as Porto.”

WHO/Europe continues to work with a range of partners, including the European Centre for Disease Prevention and Control (ECDC) and Member State health authorities and service providers, together with civil society organizations and organizers of large events, such as those for Pride, to ensure a multisectoral and collaborative approach to addressing the monkeypox outbreak across the Region.

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