Brazilian federal health agency ANVISA issued recommendations to tackle the transmission of monkeypox in Brazilian ports, airports, and land crossings.
According to the new ANVISA regulation, individuals of any age or gender are considered suspected cases of monkeypox if, as of 15 March 2022, they have a sudden-onset fever and enlarged lymph nodes (lymphadenopathy) with an acute and progressive rash.
On the other hand, probable cases involve individuals who meet the suspected case definition and manifest one or more of the conditions listed below, and have no laboratory confirmation:
- Has an epidemiological link (prolonged, face-to-face exposure without respiratory protection; physical contact, including sexual contact; or contact with contaminated bodily fluids or contact with materials, such as clothing, bedding, and utensils);
- Contact with a probable or confirmed case in the 21 days before the onset of signs and symptoms;
- History of travel to countries where the disease is endemic or where cases of monkeypox have been confirmed in the 21 days prior to the onset of symptoms
Confirmed cases are individuals who fit the definition of a suspected or probable monkeypox case and have the diagnosis confirmed by laboratory tests. At the same time, those ruled out due to negative test results or diagnosed as having another disease are considered discarded cases.
The diagnosis must be validated by a laboratory referred by the Ministry of Health. Currently, there are eight of them distributed across seven federation states:
- Rio de Janeiro
- São Paulo
- Minas Gerais
- Rio Grande do Sul
- Pará PA
- Federal District.
So far, there is no indication of how long the reference facility will take to release the test results, especially for suspected cases on board vessels and platforms in Brazilian waters. We understand that currently, it may be weeks until the results are disclosed by any of the eight accredited public labs
Guidance for vessels
ANVISA recalls that its Resolution 584/2021, as amended, remains in effect. This regulation addresses crew changes, seafarers repatriation, and shoreside personnel access to vessels and platforms amid the ongoing COVID-19 pandemic.
The federal health agency considers that as the transmission of SARS-CoV-2 occurs mainly through droplets from the respiratory tract, the measures recommended in that regulation, such as the use of masks, respiratory etiquette, distancing and cleaning of surfaces, apply synergistically to reduce the risk of spreading both COVID-19 and monkeypox.
ANVISA requires the masters of visiting vessels to record all health events in the hospital’s logbook and the Maritime Declaration of Health (MDH), strictly in the World Health Organization (WHO) format, when requesting free pratique.
The master must mark “Yes” on the relevant field on the MDH to report any condition that could be a symptom of infectious disease, including “fever, persisting for several days, glandular swelling, and acute skin rash or eruption“, to flag a suspected case of monkeypox.
Isolation of cases and quarantine
ANVISA requires that suspected and confirmed cases are promptly notified. The persons affected must be isolated in individual cabins to avoid contact with the others on board, with daily monitoring for symptoms, including body temperature, for 21 days. The information collected during the health monitoring must be logged and made available to the health authority for verification.
Disembarkation of suspected or confirmed cases for medical assistance remains allowed with the consent of the port health authority and following local contingency plans.
Those visiting or treating patients must wear a face mask, apron and gloves, which should be replaced and discarded after use. The waste generated during the isolation must be disposed of as potentially infectious residues.
Currently, the port health authority does not advise isolating asymptomatic close contacts. However, it recommends that they be monitored at least daily for up to 21 days.
The regulation is silent about quarantining vessels with cases in isolation, which is otherwise at the discretion of ANVISA in conjunction with the Ministry of Health and other relevant authorities.
To date, no restrictions have been imposed on the embarkation and disembarkation of seafarers (or passengers) from vessels and platforms in Brazilian territorial waters due to the monkeypox 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 competent authorities to prevent dissemination.
Brazil please cancel the travel restriction to Get into the country [covid test ] , The United States and Europe do not require tests anymore, As many other countries in the world