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Is monkeypox a concern for India?

Monkeypox cases continue to be announced across the globe, sparking panic of a new pandemic in the making. Just how realistic is this prospect, and should India be worried?

One of the symptoms of monkeypox are lesions that can develop across the body. (CDC’s Public Health Image Library) Media ID #2329

Monkeypox, much like COVID-19, is another zoonotic condition – spread to humans from animals. Typically the disease is endemic only to a few regions of Africa. The disease suddenly spread across May to a list of non-endemic countries including the United States, Canada, Australia, Israel and twelve European countries. The European CDC noted on Wednesday several other countries with confirmed or suspected cases, including Argentina, Morocco and the United Arab Emirates.

The sudden emergence of a non-endemic or new disease to several countries within a short time period is evocative of the early days of the COVID-19 pandemic. However, there are key differences between the two conditions that make the chances of a monkeypox pandemic far less worrying. 

First and foremost, the means of transmission. COVID-19 is airborne – and so, able to rapidly spread throughout a population simply through individuals standing in the vicinity of each other – monkeypox is also airborne, but it is far less virulent than COVID-19, which can transmit even through short periods of contact. According to the Centers for Disease Control and Prevention (CDC)

“Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.”

COVID-19 is extremely contagious. It spreads rapidly in situations where numerous people are confined to small, densely populated areas. Such a situation is not uncommon, and occurs in instances such as public transportation, or in shops and schools. In India, the mass exodus of day labourers flocking from cities back to their home towns and villages was one such instance where thousands of people were in close proximity – and so, was thought to have spurred on the spread of the disease. 

Monkeypox, however, as noted by the CDC, typically requires either skin contact, or prolonged exposure to large respiratory droplets. In the current caseload, scientists are concerned about the spread among men who have sex with men (MSM), who make up a disproportionate number of the cases so far. The high rate of spread within MSM has created speculation of spread through sexual contact.

Animal-to-human spread is unlikely in the context of many of the non-endemic countries currently affected. According to the CDC, animal-to-human transmission may occur via bites or scratches from affected animals, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding. The reservoir species is not currently established – having only been isolated in an animal species twice in the past – though is suspected to be linked to African rodents.

Early symptoms are flu-like, such as a fever, headaches, aching muscles and swollen lymph nodes. Rashes can develop, often beginning on the face and then spreading to other parts of the body, this can be followed by more severe lesions, which allow spread of the disease via skin contact.

Confusion can occur when diagnosing the disease, as the initial flu-like symptoms can be mistaken for many other infections. Even when lesions occur, monkeypox is sometimes misidentified as chicken pox – which, despite the name, is not another pox virus, but a result of a herpes infection. In Greece, local media reported that the country’s first suspected monkeypox case tested positive for chickenpox, not monkeypox.

According to a review published in PLoS Neglected Tropical Diseases in February, cases of monkeypox have been rising since the 1970s. “Based on initial literature review, we thought there was an increase [in the] number of cases of monkeypox, which was not systematically reported at that moment,” Bernard Hoet, MD, vice president of medical strategy at Bavarian Nordic, told Healio.

Protection against monkeypox was formerly present from the mass application of the smallpox vaccine due to the close relation of the two diseases. However, since the declaration of smallpox eradication in 1980, use of the vaccine has declined, leading to a rising number of monkeypox cases. 

The National Centre for Disease Control (NCDC), New Delhi, has issued an advisory stating that while monkeypox has not yet been detected in India, the chances of a spread from abroad is always a threat.

A 28-bed ward has been set up at the Kasturba Hospital for Infectious Diseases, Chinchpokli specifically to deal with any potential monkeypox cases. Health authorities have been told to be prepared for cases coming from international travel. Isolation for 21 days has been suggested or until all lesions have been resolved and the patient has been checked over by a doctor. 

While the disease may not yet be in India, awareness is key. With knowledge of the symptoms cases can be picked up early and isolated, preventing further spread. While unlikely to become the next COVID-19, monkeypox still poses a threat to people’s health.

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