The Union government has decided to increase laboratory capacity for testing monkeypox as Delhi on July 24 reported the first case of the disease in a man with no history of international travel, a day after the World Health Organisation (WHO) declared it a ‘public health emergency of international concern (PHEIC)’.
Over the last one week, four cases of monkeypox have been identified in India, including three cases in Kerala in men who had just returned from abroad. This is the first time that cases of the infectious viral disease, native to central and West Africa for decades, have been detected in India and several other countries.
In the current outbreak, over 16,000 cases have been reported across more than 70 countries so far this year, and the number of confirmed infections rose 77 percent from late June through early July, as per WHO data.
Men who have sex with men, at present, are deemed to be at the highest risk of infection.
In India, a high-level review meeting chaired by the director general of health services under the health ministry was called on July 25.
Government sources said the panel decided to nudge states on raising surveillance in hospitals, point of entry and communities and following rigorous contact tracing of confirmed patients of monkeypox.
“In addition, there was also discussion on increasing the lab capacity so that samples from suspected cases can be processed quickly,” a senior official who attended the meeting told Moneycontrol. “As it happened in the case of COVID-19, we are closely monitoring the situation and will be quickly able to scale up our laboratory network.”
Samples from all the four confirmed cases so far were sent to the National Institute of Virology in Pune under the Indian Council of Medical Research—one of the few laboratories in India that has the capacity to detect monkeypox as of now.
The official added that rapid detection, contact tracing and isolation may be the key to control the spread of the virus in India.
What next after the highest alarm from WHO?
Virologist and scientist Dr Gagandeep Kang said that every country needs to gauge its own threat for issues of public health.
“A WHO declaration of a PHEIC means that there will be more guidance, expert convenings and tracking of the outbreak, which will require member states to share data and participate in regional and global interactions,” she said.
Dr K Srinath Reddy, president of the Population Health Foundation of India (PHFI), said the declaration raises the level of alert but should not trigger alarm. “As of now, the vast majority of patients are men and most of them have a history of sex with multiple male partners,” he said.
Infectious disease expert Dr Ishwar Gilada said that implications of the WHO declaration of the disease as PHEIC are grave. “However, now WHO should change the nomenclature, drop the monkeypox name as it is no longer spread from monkeys, in that sense it is a misnomer,” he said.
According to epidemiologist Dr Giridhara R Babu, the PHEIC declaration can help control the spread across international borders. “Within India, this can renew the efforts to prevent and manage new and re-emerging infectious diseases,” he said.
‘Local case bigger worry’
Satish Koul, director, internal medicine, Fortis Memorial Research Institute, based in Gurugram, Haryana, underlined that as a young man from Delhi who had recently attended a party in Himachal Pradesh has tested positive for the disease, everyone should understand the transmission root of this virus. “It spreads by close contact, skin-to-skin contact and droplet infection,” he said.
Dr Kang said that of more concern than the WHO’s declaration is the detection of a case with no travel history in Delhi which means that undetected infections are already present.
“We can and should ramp up education and information sharing, increase laboratory capacity beyond a few labs as we already know that we can scale testing so restricting the number of labs that receive samples makes little sense,” she said.
Kang said that tecovirimat, a drug approved for monkeypox treatment by the US Food and Drug Administration at the moment, should be looked at and suggested the stockpiling of the drug.
“Since cases will not climb to lakhs if we have the right detection and isolation policies in place, we do not need large amounts of drugs for patients or vaccines for ring-vaccination of contact, but the sooner we get in line for them the better,” she said.
Lessons from HIV programme may help
PHFI’s Reddy pointed to the country’s track record on the HIV-AIDS programme as the basis on which to promote risk avoidance and personal protection practices.
“We should avoid stigmatising infected persons or states where efficient surveillance systems are quickly detecting cases,” said Reddy, adding that it is important to trace contacts and test both cases and contacts to identify the nature of the viral strain that is spreading in each area.
Persons who had not received smallpox vaccine would need to be vaccinated, prioritising areas of increasing case numbers, he said, adding that health communication must be stepped up.
One- health agenda
According to Babu, since most of the PHEICs will be zoonotic in nature, it is time to strengthen the one-health agenda to prioritize balancing environmental sustainability with animal and human health.
“Strengthening the surveillance platforms for early identification and timely response against zoonotic diseases are part of this agenda,” he stressed.
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