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Monkeypox outbreak: It’s time to act, not panic

Giridhara R Babu writes: It's a self-limiting disease. But the recent outbreak along with the Covid pandemic should make us think about how best to check zoonotic diseases

Giridhara R Babu writes: Public awareness of disease transmission should be prioritised to reduce the stigma associated with the diagnosis. (Express/Nirmal Harindran)

A virus belonging to the poxviruses family causes a rare contagious rash illness known as monkeypox. This zoonotic viral disease (a disease transmitted from animals to humans) has hosts that include rodents and primates. What was previously limited to the disease’s local spread in central and west Africa, close to tropical rainforests, has recently been seen in various urban areas and now in more than 50 countries. The good news is that most infected people will have minor illnesses and recover on their own.

It is a self-limiting disease with symptoms lasting two to four weeks and a case fatality rate of 3-6 per cent. A skin rash on any part of the body (even if only 1 or 2 spots) should raise suspicion because it could be the only presenting symptom. Swollen lymph nodes are another distinguishing feature. Aside from these, other symptoms of a viral illness include fever, chills, headache, muscle or back aches, and weakness. Touching skin lesions, bodily fluids, or clothing or linens that have been in contact with an infected person can result in transmission. Prolonged face-to-face contact can also result in the spread. So far, evidence suggests that sexual or intimate contact are the most common modes of transmission. It can also be spread by sharing a bed, towel, or unwashed clothes. It’s also worth noting that monkeypox does not spread from person to person through everyday activities like walking next to or having a casual conversation with an infected person. Because symptoms usually appear 5-21 days after exposure, people with rashes, sores in the mouth, rash, eye irritation or redness, or swollen lymph nodes should be monitored. What begins as a rash progresses through several stages, including macule, papule, or vesicle, pustule, and crust.

When symptoms appear, it is critical to isolate the infected from other people and pets, cover their lesions, and contact the nearest healthcare provider, preferably by phone if possible. It is also critical to avoid close physical contact with others until instructed to do so by our healthcare provider. Because most people know the importance of isolation and quarantine during Covid outbreaks, it is preferable to use home isolation whenever possible. In addition to the precautions taken during Covid-19 (mask, washing, and distance), people should avoid contact with sick or dead wild animals and thoroughly cook animal meat. Priority should be given to educating grassroots workers about symptoms, specimen collection, disease detection, acquiring sample collection equipment, and maintaining cold storage of specimens.

Public awareness of disease transmission should be prioritised to reduce the stigma associated with the diagnosis. Increased surveillance and detection of monkeypox cases are critical for controlling the disease’s spread and understanding the changing epidemiology of this resurging disease.

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Most people will recover completely. Preventive health measures, such as avoiding infected animal or human contact and practising good hand hygiene, are the best option. Monkeypox is mostly treated by managing symptoms and preventing complications if it is diagnosed. In the minor proportion who are immunocompromised, complications can occur; pulmonary failure was the most common complication with a high mortality rate. In the US, pre exposure vaccination with JYNNEOS® is available to healthcare workers and lab workers exposed to this group of poxviruses. The smallpox vaccine is 85 percent effective against the disease. Another vaccine, ACAM2000, is a live vaccinia virus vaccine that is otherwise recommended for smallpox immunisation and can also be used for high-risk individuals during monkeypox outbreaks. In addition, Tecovirimat, an antiviral drug used to treat smallpox, is recommended for monkeypox.

Despite mild illness and a low transmission rate, the WHO has declared monkeypox, a public health emergency of international concern (PHEIC) to contain the disease. The increase in monkeypox cases in a short span of time in many countries necessitated the declaration of PHEIC and additional research studies. It is unclear whether the recent sudden outbreaks in multiple countries result from genotypic mutations that alter virus transmissibility. SARS-CoV-2 and monkeypox virus co-infection can alter infectivity patterns, severity, management, and response to vaccination against either or both diseases. As a result, there is a need to improve diagnostic test efficiency. We also need to examine if a newer variant of concern (VOC) of SARS-CoV-2 can emerge due to their interaction. It’s also unclear whether the Covid-19 pandemic is exacerbating the current monkeypox outbreaks.

Smallpox vaccination programmes have been discontinued for the past 50 years, resulting in a scarcity of effective vaccines. There are approved drugs and vaccines, but they are not widely available to scale up controlling monkeypox. This is not the last such difficulty we will face, as the world is still witnessing more such public health crises. Zoonotic diseases are caused by various factors, including unchecked deforestation, climate coupled with a failure to prioritise public health, poverty, and climate change. Instead, a robust plan for pandemic preparedness should be accelerated, guided by a single health agenda. Never before in history have three infectious diseases (poliomyelitis, Covid-19, and Monkeypox) been declared PHEIC at the same time. Regrettably, this will not be the last time. There will almost certainly be more of these occurrences in the future. The world is yet to recognise emerging and re-emerging infectious diseases as a genuine threat. The immediate priority is to strengthen the surveillance infrastructure, including hiring public health professionals and field workers who can participate in outbreak detection and response during many future PHEICs. Mechanisms for initiating contact tracing, quarantining exposed people, and isolating infected people should be institutionalised. Without prioritising public health strengthening, the threat of new and re-emerging infectious diseases, as well as the enormous social and economic challenges that accompany them, is real and grave.


The writer is a professor and heads life-course epidemiology at the Public Health Foundation of India in Bengaluru

First published on: 25-07-2022 at 18:49 IST
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