[Editorial] Handling the Monkeypox Issue

What is monkeypox?

  • Monkeypox is an infectious disease caused by the Monkeypox virus, which is an Orthopoxvirus, the same family as Variola virus (causes smallpox).
  • It is a zoonotic disease i.e. transmitted from animals to humans. It was discovered among research monkeys in 1958.
  • Infections have been reported in Gambian poached rats, squirrels, dormice and some monkeys.
  • There is only limited human-to-human transmission of the virus. The first known human case was recorded in 1970.
  • The cases predominantly occur near tropical rainforests. The disease is being reported since the 1970s in African countries. For instance, Nigeria witnessed a huge outbreak in 2017. Cases have also been reported in the USA, UK and Israel.

What are its symptoms?

  • The disease causes mild small-pox like symptoms but with lower fatality rate:
    • Fever with chills
    • Headaches
    • Muscle ache
    • Sore throat
    • Swollen lymph glands
    • Blistering rash
  • The virus spreads through direct contact (such as prolonged physical contact or sexual contact) and indirect contact (like contact with infected person’s clothes).
  • The incubation period of the infection is 1-2 weeks. The entire course of the disease lasts between a fortnight and a month.

What about the current outbreak?

  • There are 2 sub-types of MPXV– the West African subtype and the Congo Basin subtype. The current outbreak is because of the West African subtype.
  • The disease has been reported in 72 countries across 6 WHO regions. These include non-endemic countries and countries that have no previous history of the disease.
  • Most of the recent cases are being reported from Europe and the Americas.
  • According to WHO, most of the recent cases are being reported among men– especially those identifying themselves as gay, bisexual and other MSMs (men who have sex with men) in urban areas. These cases are occurring in clusters in social and sexual networks.

How much of a danger is it?

  • The West African subtype has a higher probability of causing scarring from the rash but has a lower fatality rate (1%) compared to the Congo Basin subtype (10%).
  • According to WHO, the large number of cases being detected across the countries in a short time period suggest that the viral transmission among humans could have been going on undetected for some time.
  • While many cases have been tied to super-spreader events like the rave parties in Belgium and Portugal, some cases have no epidemiological link to such parties, travel history to African countries or even contact with other infected people.
  • There is a concern that MPXV mutates at a higher rate than previously thought. Scientists at the University of Edinburgh reported 47 mutation in the viral genome. This is an unusually large number of mutation to have taken place in just 3-4 years. Some opine that this could point to sustained transmission for the last 4-5 years.
  • The WHO has declared the outbreak to be PHEIC i.e. Public Health Emergency of International Concern.
  • India has now reported its first casualty from monkeypox infection.

What is being done?

  • The Health Ministry had released guidelines:
    • Suspected cases would include those with a history of travel to affected countries within the last 21 days and showing unexplained acute rash and one or more of the other symptoms.
    • It recommends monitoring of an infected person’s contacts (direct and indirect) every day for a period of 21 days for onset of any signs/ symptoms.
    • All clinical specimens are to be taken to ICMR-NIV, Pune, through the IDSP (Integrated Disease Surveillance Program) network.
    • The guidelines also covers clinical management aspects.   
  • The government has constituted a task force to provide guidance regarding expanding diagnostic facilities and exploring emerging vaccination trends.
  • To strengthen the diagnostic capacity, the Indian Council of Medical Research network labs have been operationalized.
  • The National Aids Control Organisation and Directorate General of Health Services are working on a communication strategy to enable timely reporting, detection and management of monkeypox cases.
  • The ICMR has isolated a strain of the MPXV and has invited pharma companies to develop a vaccine against it. It has also called for proposals to develop diagnostic kits.

What is the way ahead?

  • Though this virus rarely causes fatalities, the experience with SARS CoV 2 shows that there could be variation based on the population at hand.
  • According to the WHO, case fatality ratio has ranged between 0-11% in general population. Recently, the range is between 3% and 6%. The risk of complication is higher among young children, those with co-morbidities, immune-compromised individuals, etc.
  • Though the disease has been around for several decades now, the surge in case load outside Africa, in non-endemic countries, has elevated its risk profile. There is also the realization of the considerable gap in knowledge of whether it poses more risk to specific groups (as it happened in case of COVID-19).
  • That the disease mainly spreads through close contact and not through the airborne route shouldn’t lead to complacence among the health authorities.
  • The recent monkeypox death in India shows the need for a thorough probe and public disclosure on case progression. This patient was admitted because of a fever (as opposed to being confirmed as monkeypox-positive). It was only later when the characteristic blisters showed up that the healthcare personnel took note. The fact that he had tested positive was disclosed to the health authorities only a day before his death.
  • Fortunately, monkeypox appears to be a self-limiting disease. However, the government shouldn’t be slack in communicating the disease’s potential severity.
  • Historically, smallpox vaccines have been effective against monkeypox. The EU has approved a smallpox vaccine Imvanex for monkeypox. However, there is a concern that the vaccine hoarding done by the Global North in case of the COVID pandemic could see a repeat in a potential monkeypox crisis as well.
  • In this context, the Indian research institutes and pharmaceuticals need to step up efforts to develop indigenous vaccines.

Conclusion:

While monkeypox isn’t as serious a threat as COVID-19 with respect to transmissibility and fatality, there is a need to remain vigilant- especially after WHO labelled it a PHEIC. Clear communication, thorough surveillance, contact tracing and strengthening healthcare infrastructure are the key requirements.

Practice Question for Mains:

What is monkeypox? What are the learnings from the COVID-19 pandemic that need to be applied in this PHEIC? (250 words)

Referred Sources

https://www.thehindu.com/sci-tech/health/what-is-the-monkeypox-virus/article65403907.ece

https://www.thehindu.com/opinion/editorial/unpacking-a-conundrum-on-potential-severity-of-monkeypox/article65711345.ece

https://www.thehindu.com/news/cities/chennai/chen-health/who-declares-monkeypox-a-global-emergency/article65675161.ece

https://www.thehindu.com/sci-tech/health/explained-what-are-the-health-ministry-guidelines-on-monkeypox/article65493818.ece

https://www.thehindu.com/news/national/task-force-to-be-set-up-to-provide-guidance-to-govt-on-tackling-monkeypox/article65692827.ece

https://www.ndtv.com/health/monkeypox-here-are-the-basics-you-need-to-know-about-3214589

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