Health Watch (Monkeypox/Mpox)

WHO Raises the Alarm About Monkeypox!

The spike in the rate of monkeypox cases, more popularly known as mpox, is pushing the panic button for the medical community across the globe. This is looming as a second prospective threat on the health map post the COVID-19 era, which saw the world reeling under a pandemic only in the recent past. Whether the planet awaits another global viral emergency to grapple with or not, only time will tell. As of now, medics, health experts and healthcare personnel are keeping close tabs on the prevalent situation.

Photo Credit: Wikimedia Commons

By PRAMITA BOSE

Many countries including India are on high alert to combat any unwarranted exigency. From prepping with diagnostic PCR test kits, reserving beds to quarantine patients if suspected to carry the virus or else found infected with the disease to thoroughly screening passengers arriving from international flights— the concerned authorities are leaving no stone unturned to remain well-equipped for checking the spread of mpox if things spiral out of control.
Worldwide, as of August 2024, the number of reported cases have exceeded 14,000 while fatalities have logged above 450 so far, reflecting a surge from the figure recorded last year. Incidentally, a new strain of the mpox virus — clade 1b — is gripping Africa and extending its tentacles to other continents like Asia and Europe too.
 
The clade Ib mpox virus (MPXV) was first discovered in DRC during September 2023 and is intensifying its impact on adjoining countries like Burundi, Kenya, Rwanda and Uganda.
 
Tell-Tale Signs

Symptoms of mpox are said to be similar to smallpox but clinically far less severe. The first human case was reported way back in 1970 in the Democratic Republic of Congo (DRC). There are two distinct clades of the virus, namely clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb).
 
It is important to detect the early indications of mpox. Dr Mala Kaneria, consultant of infectious diseases at Mumbai’s Jaslok Hospital & Research Centre, shares that “the rash may precede the onset of fever and is as same as the smallpox rashes (now eradicated) running through various stages in the form of vesicles, papules and pustules. People contract mpox through close contacts with infected individuals, including skin to skin, mouth to skin contact or even via talking and breathing, which release respiratory droplets. It can also be transmitted sexually, especially men to men or even during pregnancy from mother to child.”
 
Mpox Versus COVID

Monkeypox is caused by a completely different virus resulting in vesicular lesions on the body, resembling conditions like smallpox or chickenpox unlike COVID-19. Mpox is not a new virus and does not spread the same way as coronavirus.
“Mpox was first discovered in 1958, while the novel coronavirus causing COVID-19 was unearthed in 2019. COVID is extremely infectious and can spread through tiny droplets in the air, even from asymptomatic individuals. In contrast, mpox is less contagious and spreads through only close contact and physical connections,” distinguishes reputed medical microbiologist Prof. Ashok Rattan, who is also the lead adviser at the medical committee and quality of Redcliffe Labs pathology centre.
 
Experts assert that the respective symptoms of the two viruses— mpox and coronavirus — are also distinct, thus providing a clear differentiation for the masses. COVID-19 symptoms include fever, cough, headaches, trouble in breathing and the loss of taste and smell, while mpox symptoms denote low energy, flu-like symptoms, rashes and fever. However, in both cases, it is imperative to stay at home in isolation and call a healthcare provider.
 
Mpox to Turn Lethal?
 
With the deadlier variant Clade 1b spreading all over, one wonders if mpox will turn out to be life-threatening gradually. “The Congo variant of mpox can cause a mortality rate of up to 10% but the West African type has a much lower mortality rate of around 1%,” dispenses Dr. Dinesh Kumar Tyagi, director of internal medicine at Fortis Hospital, Greater Noida.
 
Virologists reflect on the query that probes whether monkeypox can assume the enormous capacity that COVID had attained in emerging as a global health emergency.
 
“MPOX virus is rife in Central and West Africa. The first case outside Africa was noticed in the USA during 2003. A global outbreak of clade IIb happened in 2022 and persists to this day in some African countries. In a slew of currently-reported cases, it is the first time that chains of transmission are reported in countries with no known epidemiological links being established to West or Central Africa, which is concerning. With its recent spread beyond the African boundaries, mpox emerged as a significant health menace worldwide, posing a major challenge to all countries including India,” states Dr Kaneria.
 
Notably, in view of the emergence of a new clade of mpox and its rapid spread in eastern DRC plus several neighbouring countries, the WHO pronounced mpox as PHEIC on Aug 14, 2024. “There is indeed potential for mpox to escalate. So it's highly important to take pre-emptive measures and remain cautious,” advises Dr. Tyagi.
 
“Sad but true, the stigma attached to mpox might cause people to be more reluctant to come forward and seek treatment, which in turn, could neutralise the public health efforts or prolong the rampant spread,” Dr Kaneria.
As far as India is concerned, the risk of a large outbreak of pandemic proportion is considered low. Good news is that there are no reported cases of the monkeypox virus in India to date.
 
Health Advisory
 
A health advisory is issued by the Indian administration from its health department for the medical fraternity to take note of and diligently conform to for ramping up the preparedness in the face of any eventuality.

 
“Though there have been no reported cases of mpox in India so far, the Government of India adopted a list of measures that includes training the staff in healthcare units at all airports, seaports and borders and enforcing tight vigilance to stem the entry of the virus via international travellers. The testing laboratories (32 in number) have been readied already to address the situation. Health facilities are put on high alert with beds set up at a designated hospital to isolate positive cases,” elaborates Dr Kaneria.
 
Spurt in Mpox Via Sex
 
It is important to note that mpox can be transmitted through sexual contact or intimacy in relationships like AIDs.
 
Backed by statistical figures, Dr. Honey Savla, internal medicine, Wockhardt Hospitals in Mumbai Central confirms that “the 2023 outbreak data is indicative of many patients being diagnosed with mpox, who reportedly possess high-risk sexual behaviour, such as having sex with multiple partners.”
 
Mpox is commonly seen in men engaged in sexual activity with other men and having direct exposure to infected individuals or their bodily fluids during intimate contact, which in turn, can facilitate transmission.
 
“While mpox is not classified as an STI (sexually transmitted infection), the close contact during sexual activities can increase the risk of spreading the contagion,” she states.
 
Mpox Spell
 
The duration of mpox may vary but the illness typically progresses from its initial systemic symptoms (fevers, chills, myalgias) to the characteristic rash, evolving through different stages (macules to papules, vesicles, pseudo-pustules and scabs). “The entire process right from its advent to the resolution of the rash usually lasts several weeks. The exact time period can depend on the severity of the disease and individual factors,” inputs Dr. Savla.
 
Mpox Killer
The monkeypox virus can be disabled by common disinfectants and sanitising agents. The virus is sensitive to sterilisers containing chlorine, hydrogen peroxide and alcohol. Proper cleaning and fumigation of surfaces as well as personal items can help eliminate the virus. Additionally, heat and ultraviolet (UV) rays of sunlight render the virus inactive.
 
Mpox & Loss of Life
It’s a harsh fact that mpox can be critical enough to cause death, although in rare cases only. The mortality rate varies by epidemic status and population. “During the 2023 outbreak in DRC, the overall case fatality rate was about 4% with a massive 11% rate noticed among children aged below five years, which was worrisome. In previous reports from Central Africa, the casualty rate was approximately 10%, signifying that while most cases are mild, grave cases can be life-endangering,” warns Dr. Savla.
 
 
TITBITS

Will mpox be another COVID-19 through community transmission is very difficult to predict:

(i)              COVID 19 was definitely more contagious as it was transmitted through small droplets in contrast to mpox virus, which is transmitted through larger droplets.
(ii)           Besides, having dealt with a pandemic in recent past, the level of preparedness for mpox is definitely higher.
(iii)         Mpox infections are generally self-limited and unlike COVID-19, which was highly transmissible, mpox requires close and prolonged contact.

VIRAL IMPACT

The mpox virus spreads by coming in direct contact with an infected person or animal, their scabs, clothing, touching contaminated materials or by kissing and committing sexual activities. Children, pregnant individuals and people with low immunity, including those with HIV, are at high risk of contracting mpox and experiencing severe complications.
 
People can contract the mpox virus through the following ways:

Close or intimate contact:
●      Direct skin-to-skin contact and spread of the virus
●      Contact with saliva, upper respiratory secretions, bodily fluids or lesions around the anus, rectum or vagina from a person with mpox
●      Pregnant women can transmit the virus to the fetus
●      Sexual activities like oral, anal or vaginal sex or touching the genitals
●      Prolonged face-to-face interactions
 
Touching objects:
The mpox virus is transmitted when a person comes in contact with objects, fabrics and surfaces that someone with mpox already infected. These items may include clothing, bedding, towels, fetish gear or sex toys.
 
Infected animals:
●      Through small wild animals in West and Central Africa
●      Direct contact with infected animals, fluids, waste or getting bitten or scratched
●      During activities like hunting and trapping

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