Monkeypox Emergency

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Monkeypox, a viral disease, with symptoms similar to chickenpox, may enter the country, this newspaper in an article yesterday said. At the time of writing, India had detected four such cases.

The current monkeypox outbreak is 10 times bigger than the number of cases reported from the past three years combined, media reports said.

Analysing the recent spread of the virus, the article titled “Monkeypox Virus Infection in humans across 16 countries  April – June 2022,” it said, before April 2022, monkeypox virus infection in humans was seldom reported outside African regions, where it is endemic.

A paper on 528 monkeypox cases in 16 nations published on 21 July indicates that a sexual relationship between men could be a possible link behind the spread.

“We reported 528 infections diagnosed between 27 April and 24 June 2022 at 43 sites in 16 countries. Overall, 98 per cent of persons with infection were gay or bisexual men, 75 per cent were white and 41 per cent had human immunodeficiency virus infection; the median age was 38 years,” said the article.

Transmission was suspected to have occurred through sexual activity in 95 per cent of the persons with infection.

The analysis concludes that ‘simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.’

The authors of the article – more than 30  formed an international collaborative group of clinicians who contributed to an international case series to describe the presentation, clinical course, and outcomes of polymerase-chain-reaction–confirmed monkeypox virus infections.

The authors come from a variety of backgrounds, including Queen Mary University of London, and the Department of Infection and Immunity, Barts Health NHS Trust, Homerton University Hospital, Clinical Infection Unit, St. George’s University Hospitals and McGill University Health Centre, Montreal, among others. In this case series, monkeypox manifested with a variety of dermatological or skin-related issues.

The most common is skin lesions which are part of the skin that has an abnormal growth or appearance compared to the skin around it. According to the analysis, 95 per cent of the persons presented with a rash (with 64 per cent patients having less than 10 lesions), 73 per cent had anogenital lesions and 41 per cent had mucosal lesions (with 54 having a single genital lesion).

Common systemic features preceding the rash included fever, lethargy, myalgia and headache and swelling of the lymph nodes, the report said. The reasons for hospitalisation were pain management, mostly for severe anorectal pain, soft-tissue superinfection, sore-throat limiting oral intake, eye lesions, acute kidney injury, inflammation of the heart muscles.

 Antiviral treatment was given to five per cent of the persons overall, and 70 patients were hospitalised. No deaths were reported, the report further said. Condoms protect against sexually transmitted infections, but they do not prevent monkeypox being transmitted, media reports however warned.

People with the virus and those who have had direct exposure to a person infected with monkeypox, should isolate for three weeks. People infected with monkeypox may be infectious long after their scabs and rashes have disappeared.

Some strains can cause severe disease, with recent fatality recorded at 3 to 6 per cent, according to the World Health Organisation (WHO). Monkeypox symptoms usually last between two to four weeks.

According to Gavi, the vaccine alliance, comprising the WHO, UNICEF, the World Bank and the Bill & Melinda Gates Foundation; “At present, there is no specific treatment recommended for monkeypox by WHO, but there are antivirals licenced to combat orthopoxviruses, such as tecovirimat.

The smallpox vaccine was key to eradicating smallpox decades ago, and this vaccine can be highly effective – 85 per cent – in preventing monkeypox. However, the original first-generation smallpox vaccines are no longer available to the general public. A newer vaccinia-based vaccine was approved for the prevention of smallpox and monkeypox in 2019 but it is also not yet widely available.”