Explained I Why India should worry as monkeypox clusters emerge in Europe and the disease reaches North America 

Monkeypox often starts with flu-like symptoms before causing a chickenpox-like rash on the face and body.

Monkeypox, a rare viral disease primarily associated with the tropical rainforests of Central and West Africa, is hitting the international headlines after cases were discovered in Europe and in the US. 

A total of 75 monkeypox cases—33 confirmed and 42 suspected—have been reported across seven countries outside Africa. Most experts downplay concerns of a wider spread because the cases seem to have been imported and the clusters are limited. 

No case has been so far been detected in India, where no active surveillance effort has been mounted yet against monkeypox. 

“The bigger problem is that the Polymerase Chain Reaction (PCR) test required to diagnose the disease is not widely available in India, and most clinicians may not be aware about the specific symptoms and illness of this disease,” said a biologist attached with a top government institute.  

What is monkeypox? 

It is a potentially serious viral disease caused by the monkeypox virus, a member of the orthopoxvirus genus, which usually begins with a flu-like illness and swelling of the lymph nodes and progresses to a widespread rash on the face and body. 

The clinical manifestation of monkeypox is similar to that of smallpox, a related orthopoxvirus infection declared eradicated worldwide in 1980. 

The zoonotic virus is transmitted from one person to another through contact with lesions, body fluids, respiratory droplets and contaminated materials such as beds and bed linen.

The latest evidence suggests that the pathogen can also get be transmitted by sexual intercourse and a number of cases have been associated with homosexual men. 

Dr  Trupti Gilada,  an infectious disease expert at Masina Hospital in Mumbai, said there are two monkeypox virus variants—the Congo strain that has a mortality rate of 10 percent and a relatively milder West African strain with a mortality rate of 1 percent. Typically, most deaths occur in the younger age groups. The UK has confirmed that cases discovered in the country are of the West African strain. 

Experts say the Vaccinia vaccine used against smallpox offers protection against monkeypox but it is now not used in most countries because smallpox has been eradicated long ago. 

When and where was it detected first? Where have cases been reported subsequently?   

According to the World Health Organisation, monkeypox was first detected in the Democratic Republic of the Congo, formerly Zaire, in a region where smallpox had been eliminated in 1968. Since 1970, human cases of monkeypox have been reported from 11 African countries, but in 2017 Nigeria experienced the largest documented outbreak, 40 years after the last confirmed case. 

WHO says the virus has been exported from Africa a few times and in 2003, monkeypox cases were confirmed in the US, where most patients were reported to have had close contact with pet prairie dogs infected by African rodents that had been imported from Ghana. 

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Recently, monkeypox was carried to Israel in September 2018, to the UK in September 2018 and December 2019 and to Singapore in May 2019 by travellers from Nigeria who fell ill with monkeypox after arrival. 

In the current outbreak, cases have been reported from the UK, Spain and Portugal—largely among homosexual men—while a most recent case has also been confirmed in the US, a person who recently travelled from Canada. New York on May 19 announced another suspected case of monkeypox. 

What are the treatment and prevention options? 

Monkeypox is usually a self-limited disease with symptoms lasting from two to four weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, the health status of the patient and the nature of complications. 

Complications of monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. 

The WHO says that there is no specific treatment for the disease but symptomatic treatment may help. 

For prevention, the US Centers for Disease Control, in an advisory issued on May 18, said that people who may have symptoms of monkeypox, particularly men who have had sex with other men, and those who have close contact with them, should take note of any unusual rashes or lesions and contact a doctor for a risk assessment. 

Should India worry? 

Raising awareness of risk factors and educating people about the measures they can take to reduce exposure to the virus should be the main prevention strategy for monkeypox, medical experts say. 

 “I really don’t see a need to be concerned, at least not about imported cases. India has freely roaming monkeys in every city, but, yes, awareness is important,” said virologist Dr Shahid Jameel, a fellow at the Green Templeton College, University of Oxford, and a visiting professor at Ashoka University. 

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Clinician and public health expert Dr Rajeev Jayadevan said the cases reported so far seem travel-related and non-severe. 

“We need more details on how these cases are connected, and whether they had additional risk factors such as immunosuppressive conditions,” he said. 

Given that the disease has already crossed continents, India definitely needs to be watchful, said Gilada. “Viral diseases are quick to spread in the current era of a shrinking globe,” she said.