Context

• Several countries are reporting cases of monkey pox virus, all of which are non-endemic for monkey pox and outside Africa. This has alerted public health authorities around the world.
• The identification of confirmed and suspected cases of Monkey pox with no direct travel link to the endemic area represents a highly unusual event. This is another concern that raises an alarm.

About Monkey Pox Virus

• Cause: Monkey pox is caused by the monkeypox virus which belongs to the orthopoxvirus genus.
• Source: Discovered in colonies of monkeys in 1958, the virus is normally seen in African countries.
• Sub-genus: There are two clades of monkey pox virus, the West African clade and the Congo Basin (Central African) clade.
• Fatality rate: Human infections with the West African clade appear to cause less severe disease compared to the Congo Basin clade, with a case fatality rate of 3.6% compared to 10.6% for the Congo Basin clade.
• Cases reported: New cases of monkey pox have been reported in 18 countries since May 13, 2022. All these 18 countries are non-endemic for the monkey pox and outside Africa and reported cases belonging to the West African clade.
• Transmission: Monkey pox is a viral zoonosis (a virus transmitted to humans from animals), for example, bites of infected rodents and squirrels and is also transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.
• Incubation period: The incubation period (period between exposure to an infection and the appearance of the first symptoms) of monkey pox is usually from 6 to 13 days but can range from 5 to 21 days.
• Symptoms: Though this disease goes through four different phases, the Phase 1^st is very important for the disease per se.
  • The first invasion period, which is between 0-5 days, is characterised by fever, headache, weakness or lack of energetic.
  • Skin eruptions usually show up within two days of fever. The rash is more concentrated on the face as is apparent in 95 per cent cases. In 75 per cent cases, it is found in the palm and sole of the feet.
  • It affects the oral mucous membrane in 70 per cent of the cases. The conjunctiva, cornea of the eye and the genital area can also get affected.
  • Though it is largely a self-limiting disease, it can lead to some difficult phases when it affects the lungs and the eyes.
• Most severe symptom: The most worrying symptom is the enlargement or swelling of lymph nodes/lymph glands
• Vulnerability: The high risk group comprises children, pregnant women and immune-compromised patients, including those who have diabetes. They can have more severe consequences compared to others.
• Diiference from other rash causing diseases: The swelling of the lymph-nodes is one of the characteristic feature of Monkeypox and is not observed in similar rash causing diseases like measles and chickenpox.
• Severity compared to small pox: Monkeypox is less contagious than smallpox and causes less severe illness.
• Medication: For rashes, doctors suggest anti-allergic medication as baseline treatment. An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox as per WHO.

Earlier cases of spread of Monkey-pox to non-endemic countries

• In 2003, the first outbreak outside Africa was reported in the USA. It was linked to contact with infected pet Prairie dogs. The dogs had been co-housed with infected rodents imported from Ghana.  This outbreak led to over 70 cases in the US.
• Monkey Pox was also reported in travellers from Nigeria to Israel in September 2018.
• UK reported cases in September 2018, Singapore in May 2019 and the US in July and November 2021.

Difference with Covid-19

• Source: Coronaviruses normally contain a single strand of genetic material called RNA, and the monkey pox virus carries its genetic code in the DNA, which is double-stranded.
• Size: Also, the monkey pox virus is much larger than the one that causes Covid-19, and it produces proteins that disrupt the defenses in the human immune system.
• Symptoms: In case of Covid, the symptoms are more flu-like, like fever, headache, and runny nose. And if not contained, it can lead to breathlessness, loss of taste, and loss of smell. While monkeypox too has flu-like symptoms, it is more of fever, headache, body aches with lymph node enlargement and the rashes and the skin lesions.
• Transmission: While monkeypox is also spread by coughing, the droplets are very large compared to Covid-19 where they are very small and spread only within a few feet. So, these particles (of monkeypox) do not spread very far.
• Diagnosis and treatment: Diagnosis of monkeypox is specifically through microscopy. In two to three weeks, the person may recover. This disease can be easily contained and giving vaccination to the whole population at this point in time may not be necessary unlike Covid-19. The treatment is mainly supportive and symptomatic, however, the person has to be isolated for two to three weeks, and they normally recover by themselves.
• But, unlike Covid-19, it’s not air-borne. However, it does spread when in contact with air around an infected person.

India specific findings of disease prevalence

• Earlier, Smallpox was a very dangerous disease but using mass immunisation programme it was eradicated in 1978.
• In India, there is another disease related to the same family: cowpox and buffalopox. Sporadic cases have been reported not only in cows or buffaloes but in humans too, indicating animal to human transmission.
• Matter of concern: However, till now, Monkey pox cases has never been reported in the country. Hence, it is an exotic
• Hence more precautionary measures are needed in place because it is a new disease that we have not been exposed to and don’t have immunity against it. That is a big challenge and matter of concern.

India’s preparedness

• Travel guidelines: Amid threat of a new viral disease, travel advisory and a preparedness alert has been issued to all states. The international travel to the endemic and the currently ongoing outbreak regions would be under the surveillance at the entry points to check for the importation of the Monkey pox cases.
• Lab testing: The samples of the symptomatic patients will be referred to National Institute of Virology (NIV), Pune. Since it is a DNA virus, there is need to do a PCR test and sequencing of genome. India also has orthopox PCR test, which can rule out other pox viruses, not just the Monkeypox.

Way Forward

• Evolving scenario: The situation is evolving and WHO expects there will be more cases of monkeypox identified as surveillance expands in non-endemic countries.
• Urgent action: Immediate actions could be focused on informing those who may be most at risk
• Ramp up Public health systems: Further public health investigations including extensive case finding and contact tracing, laboratory investigation, clinical management and isolation provided with supportive care to limit further onward transmission.
• Prioritize vaccination: Vaccination for monkeypox, where available, is being deployed to manage close contacts, such as health workers.
• Awareness: The identification of confirmed and suspected cases of monkeypox without any travel history to an endemic area in multiple countries is atypical, hence, there is an urgent need to raise awareness about monkeypox.