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Monkeypox or Mpox, a little less deadly cousin of the dreaded smallpox, has bared its ugly fangs again, travelling from Africa and Sweden to neighbouring Pakistan and setting alarm bells ringing in India.
To note, the World Health Organisation has declared an international public health emergency over a new outbreak of Mpox in several African nations, with several cases now reported outside of the continent. The public health emergency was declared by the group’s director general, Dr Tedros Adhanom Ghebreyesus on August 14. The disease has seen an uptick in the Democratic Republic of Congo (DRC) and cases are being reported from countries across the African subcontinent. More than 17,000 cases have so far been confirmed across Africa, with the WHO saying the outbreak is of “international concern”.
Small wonder the Indian government is closely monitoring the situation. It has directed hospitals to identify patients with rashes and prepare isolation wards. Airports have also been alerted and told to take necessary precautions.
Recently, as advised by Prime Minister Narendra Modi, Dr PK Mishra, Principal Secretary to the Prime Minister, chaired a high-level meeting to review the status of preparedness for Mpox in the country and related public health measures. The high-level meeting was briefed that as of now, there was no reported case of Mpox in the country. As per the present assessment, the risk of a large outbreak with sustained transmission was low.
The principal secretary to the Prime Minister was informed that Mpox infections were generally self-limiting lasting between 2-4 weeks; Mpox patients usually recovered with supportive medical care and management. Mpox transmission happens through prolonged and close contact with an infected patient. It took place largely through the sexual route, direct contact with the body/lesion fluid of the patient, or through the contaminated clothing/linen of an infected person.
It was informed by the Health Secretary that the following steps had already been taken in the last one week: A meeting of experts was convened by the National Centre for Disease Control (NCDC) on August 12 to assess the risk for India. A Communicable Disease (CD) Alert on Mpox issued earlier by the NCDC was being updated to capture the newer developments. Sensitization of the health teams at International Airports (Ports of Entry) was done. The Principal Secretary to the Prime Minister directed that surveillance be enhanced and effective measures be taken for prompt detection of cases. He further directed that the testing laboratories network should be geared up for early diagnosis. Presently 32 labs are equipped for testing. Dr P.K. Mishra directed that the protocols for prevention and treatment of the disease may be disseminated on a large scale. He further emphasised an awareness campaign among the healthcare providers regarding the signs and symptoms of the disease and the need for timely notification to the surveillance system.
Cases in Pakistan
With another Mpox case reported in Pakistan-occupied Kashmir on Monday, the number of people affected by the virus in that country went up to four. The patient, a 47-year-old PoK resident, had returned from Jeddah in Saudi Arabia. The earlier three cases of Mpox were from the Khyber-Pakhtunkhwa province.
What is Mpox?
The monkeypox virus is an orthopoxvirus that causes Mpox (monkeypox), a disease with symptoms similar to smallpox, although less severe. While smallpox was eradicated in 1980, mpox still occurs in central and west Africa. Since May 2022, cases have also been reported from countries without previously documented Mpox transmission outside the African region. Two distinct clades of the monkeypox virus have been identified: Clade I (previously known as the Congo Basin (central African) clade and Clade II (the former West African clade). Mpox is a zoonosis, a disease transmitted from animals to humans, with cases often found close to tropical rainforests where animals carry the virus. Evidence of monkeypox virus infection has been found in animals including squirrels, Gambian pouched rats, dormice, different species of monkeys and others. The disease can also spread from humans to humans. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.
How is it transmitted?
According to the World Health Organisation, person-to-person transmission of Mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is face-to-face (talking or breathing), skin-to-skin (touching or vaginal/anal sex), mouth-to-mouth (kissing),mouth-to-skin contact (oral sex or kissing the skin), respiratory droplets or short-range aerosols from prolonged close contact. The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and sex partners. People with multiple sexual partners are at higher risk. Animal-to-human transmission of Mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway. People can contract Mpox from contaminated objects such as clothing or linens, through sharp injuries in health care, or in community settings such as tattoo parlours.
Signs and symptoms
Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system. Common symptoms of mpox are rash, fever, sore throat, headache, muscle aches, back pain, low energy and swollen lymph nodes. For some people, the first symptom of Mpox is a rash, while others may have different symptoms first. The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off. Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body such as the palms of hands and soles of feet face, mouth and throat, groin and genital areas, and anus. Some people also have painful swelling of their rectum or pain and difficulty when peeing. People with Mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed. Children, pregnant people and people with weak immune systems are at risk for complications from Mpox. Typically for Mpox, fever, muscle aches and sore throat appear first. The Mpox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of Mpox. Some people can be infected without developing any symptoms.
Treatment and vaccination
The goal of treating Mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems. Getting an Mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has Mpox (or within up to 14 days if there are no symptoms).
Prevention
Patients should be isolated. Contact with infected animals (especially sick or dead animals) must be avoided. Contact with bedding and other materials contaminated with the virus must be avoided. All foods that contain animal meat or parts must be thoroughly cooked. Hands should be washed frequently with soap and water. Contact with infected people must be avoided. Safe sex should be practised. Mask covering nose and mouth must be worn when in public places or among people. Frequently touched surfaces must be disinfected. (With inputs from WHO website)
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