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Brazil’s Ministry of Health has updated its contingency plan as it records more than 700 people infected with the transmissible disease this year, and the world experiences a spike in cases amid the emergence of a new variant
Resurgence of cases
As informed in this circular, in 2022, a severe outbreak of infections caused by the monkeypox virus (mpox) emerged and spread outside of Africa, where the viral disease is endemic. The World Health Organization (WHO) then declared mpox a Public Health Emergency of International Concern (PHEIC), leading Brazil to set up a Public Health Emergency Operations Centre for Monkeypox (COE Monkeypox) and heighten port health controls at national ports, airports and ground crossings.
By May 2023, the reported cases of mpox had consistently declined, leading the WHO to declare the health emergency over. However, they maintained their guidelines to prevent further spread and monitor new cases. Brazil then demobilised the COE Monkeypox.
Although person-to-person mpox transmission has been sustained globally since the 2022 outbreak, there was a sharp slowdown in cases. Unfortunately, this downward trend was interrupted earlier this month as the Democratic Republic of Congo and other African countries experienced a significant resurgence of cases due to the rapid spread of a new, deadlier strain of the virus known as clade Ib. As a response, the WHO declared the ongoing mpox outbreak a PHEIC last week.
Mpox in the Americas
In the Americas, according to the Pan American Health Organization (PAHO), there have been 63,270 confirmed cases of mpox since the pandemic broke out in 2022, resulting in 131 deaths across almost all countries in the region, including some that have never experienced this viral zoonosis before. Brazil is second only to the United States in the number of confirmed mpox cases, accounting for about half of all reported cases in South America, followed from a distance by Colombia and Peru.
Port health authority guidance
Since January 2024, the Ministry of Health has confirmed 709 cases of mpox, including 16 deaths, mainly in Southeast Brazil, notably in the states of Sao Paulo and Rio de Janeiro.
On 15 August 2024, the National Health Surveillance Agency (ANVISA), Brazil’s port health authority, issued Technical Note 14/2024. The regulation updates procedures for epidemiological surveillance at ports, airports, and ground crossings to address the new variant currently circulating in African territory.
Key guidelines
Given that the new mpox variant is currently confined to Africa, ANVISA does not impose specific health measures to be taken by visiting ships. However, it advises health authorities and professionals at all levels of the federation to take the following steps:
- Update and enforce local contingency plans and protocols for responding to the PHEIC at the points of entry;
- Remain vigilant to signs and symptoms typical of mpox; and
- Report suspect or confirmed cases to the health authority at the point of entry as soon as possible
Procedures on board vessels
According to Technical Note 14/2024, attendance onboard vessels with suspect cases must be performed wearing personal protective equipment (PPE), including protection goggles or face shields, aprons, masks and surgical gloves. Used PPE and waste should be disposed of following the ship’s solid waste management plan.
While ANVISA recommends isolating suspected cases in individual cabins with daily monitoring, it advises against segregating asymptomatic close contacts. Instead, these individuals should be monitored for clinical signs and symptoms for 21 days after the onset of symptoms in the infected person.
Duty to notify
Mpox is a disease that requires mandatory notification. All suspected, probable or confirmed cases must be reported to the local health surveillance service through ANVISA. Failing to report a disease of compulsory notification (or any evidence of a public health risk on board) breaches health regulations and may result in penalties, including fines.
ANVISA requires shipmasters to document all health events in the hospital’s logbook and the Maritime Declaration of Health (MDH), strictly in the format mandated by the WHO under the International Health Regulations (IHR 2005), when requesting free pratique or sanitary inspection for renewal of ship sanitation certificates. The master must mark “Yes” on the relevant field on the MDH to report any condition that could be a symptom of an infectious disease, including “fever, persisting for several days, glandular swelling, and acute skin rash or eruption”, to flag a suspected case of mpox.
The technical note is silent on whether vessels with isolated suspected or confirmed cases on board are allowed to operate cargo or move crew and passengers. This decision would be made on a case-by-case basis at the discretion of ANVISA in conjunction with the Ministry of Health and municipal health surveillance services.
Crew changes
To date, no restrictions have been imposed on the boarding or disembarkation of seafarers (or passengers) from vessels and platforms in Brazilian territorial waters due to the ongoing mpox outbreak. Nevertheless, shipmasters must record and report health events that may indicate the circulation of infectious diseases among those on board and ensure that the crew is aware of the measures and practices recommended by the health authorities to prevent the spread of the disease.
We are monitoring the development of the matter before the relevant authorities. We will endeavour to publish additional information as the health emergency evolves worldwide and in Brazil.
Risk to shipping
While there have been mpox infections in Brazil, some of which resulted in deaths, the Ministry of Health has reported no cases of infection by clade Ia mpox at this time. So far, the disease has not caused challenges for ships visiting Brazilian ports. Nevertheless, shipowners and operators should remain vigilant and report any confirmed or presumed cases of mpox infection as soon as possible.
Source of information
Please follow the links below to websites of authoritative international authorities with detailed information on the monkeypox signs and symptoms, prevention, vaccination, treatment, and how the virus spreads.
- Ministry of Health (*)
- Public Health Emergency Operations Centre for Monkeypox (COE Monkeypox) (*)
- National Health Surveillance Agency (ANVISA) (*)
- World Health Organization (WHO)
- International Maritime Organization (IMO)
- Pan American Health Organization (PAHO)
- Centers for Disease Control and Prevention (CDC)
* Portuguese only
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