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Monkeypox: A Reason to Worry?

As over 1000 cases of Monkeypox are reported in 29 non-endemic countries across four World Health Organisation regions, the Indian population is likely to be immune due...

As over 1000 cases of Monkeypox are reported in 29 non-endemic countries across four World Health Organisation regions, the Indian population is likely to be immune due to our robust smallpox vaccination program. Along with nine Endemic-African countries, several non-endemic European nations such as Britain, Spain and Portugal are reporting the majority of cases. No deaths have been reported so far in non-endemic countries and patients have been successfully managed by medication in isolation.

Symptoms and Treatment of Monkeypox

As discussed earlier, symptoms of monkeypox are extremely similar to smallpox but the presentation is at much milder levels. The major difference between the two is lymph node swelling caused by monkeypox - which smallpox does not.

Fever, Headache, Muscle aches, Swollen lymph nodes, Chills and excessive tiredness are some of the common symptoms of monkeypox. However, several patients in the ongoing outbreak are not presenting the classical symptoms. In cases reported so far, genital and peri-anal lesions, fever, swollen lymph nodes, and pain when swallowing are common presentations of the infection.

From the time of exposure, it takes about 7-14 days for the symptoms to present but the same can vary between 5-21 days. The patient is likely to develop Fever, followed by a rash within the first three days of infection after which the rash spreads to other parts of the body. IN most patients, the symptoms continue anywhere between 14-30 days. Though no death is reported due to monkeypox in non-endemic countries, it has proved to be fatal for about 10% of patients in the African continent. Overall hospitalisation rate has remained low across the non-endemic countries and minor complications are successfully managed by pain management and secondary infection management.

Origins of Monkeypox

Monkeypox shares its genus with smallpox and cowpox viruses. Squirrels, rats and monkeys are known carriers of the virus. Almost 12 years after it was first discovered in colonies of research monkeys, the first human transmission of monkeypox was reported in the Democratic Republic of the Congo (DRC) in 1970. Ironically, the country then was undergoing intensified clinical programs to eliminate smallpox at the time.

Transmission

The virus can spread by coming in contact with an infected animal, person or fluid, contaminated with the virus. A bite or scratch of an infected animal or handling products contaminated by infected animals can cause transmission of the virus from animals to humans. Though not all animals responsible for the spread are yet identified, rodents, squirrels and monkeys are some known carriers and known sources of transmission.

Recent studies have also proved in-vitro transmission of the virus to the fetus through the placenta. As the virus can spread through bodily fluids including saliva, scabs, sores of an infected person, semen, vaginal fluid and respiratory secretions, intimate sexual contact is a known cause of person-to-person transmission. The majority of cases from the 2022 spread of monkeypox are also reported through sexual contact, mainly among men who have sex with men (MSM).

Mumbai Scenario

Though no case of monkeypox is reported in India so far, local health machinery in Mumbai has already initiated precautionary measures. A 28-bedded exclusive isolation facility was set up recently at Kasturba Hospital Maharashtra's largest infectious disease hospital, run by the civic administration. All international passengers, with a history of travel to endemic and non-endemic regions, are currently being screened thoroughly. All samples are being tested at the National Institute of Virology, Pune to contain any possible traces of infection.