A fortnight after India confirmed its first case of monkeypox, it has reported its first casualty. A 22-year-old man, from Thrissur in Kerala, died due to suspected monkeypox symptoms, a day after which Kerala’s Health Minister Veena George said he had tested positive in the United Arab Emirates (UAE). The patient was undergoing treatment in a private hospital for severe fatigue and brain fever, six days after his arrival in the State on July 21. His swab samples have been sent to the ICMR-National Institute of Virology (NIV) centre in Alappuzha for confirmation. Death from the virus is reportedly rare, though as the experience of COVID-19 shows, it could vary depending on the population at hand. According to the World Health Organization, the case fatality ratio of monkeypox has historically ranged from 0% to 11% in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3%-6%. While the disease has been around in Africa since the 1970s, it has also been reported in the U.S., the U.K. and Israel. In 2017, Nigeria experienced a large outbreak, with a case fatality ratio of approximately 3%; cases continue to be reported. It is the surge outside Africa, in 78 countries, that has elevated the risk profile of the disease along with the realisation that there are considerable gaps in knowledge on whether the disease poses a greater risk to specific population groups, just as it was eventually determined for COVID-19. In monkeypox deaths in Brazil and Spain, the patients were reported to have had serious associated syndromes such as encephalitis and lymphoma, though it is unclear what role the virus played in their disease outcome.
That monkeypox spreads mainly through sexual transmission and close contact — it is not an airborne disease — should not be of comfort to health authorities. The death in Thrissur highlights the need for a thorough probe as well as a public disclosure on the case progression. For instance, Kerala’s health authorities say the person was admitted not after being confirmed to be monkeypox-positive but due to a fever and experiencing fatigue. It was only later that the rashes and blisters showed up. Intriguingly, that he had tested positive for monkeypox was disclosed to the health authorities a day before he died. It is to rule out a misdiagnosis of monkeypox (by the UAE) that the NIV has undertaken a re-test. India has announced a task force to monitor the disease spread. The Indian Council of Medical Research has isolated the strain of the virus and invited vaccine makers to develop a vaccine. It has also invited proposals to develop diagnostic kits. While it is fortunate that the disease so far appears to be self-limiting, the Government must not be slack in transparently communicating the potential severity of the disease.
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