The story so far: India’s Health Ministry has issued guidelines on the management of monkeypox disease. So far, no cases of the virus have been confirmed in India but reports of the virus’ spread in non-endemic countries have led to guidelines being issued.
What do the guidelines say?
The 23-page document, available on the Health Ministry website, is an information sheet that lists out the global prevalence of the disease as of May 31, its epidemiology or disease characteristics including the kind of virus that causes the disease, its likely origins, incubation period, how long before symptoms manifest and so forth. It also highlights how long it takes to subside, modes of transmission, symptoms, the probable modes of exposure, the test to confirm the presence of the virus, the government’s surveillance strategy in place to identify cases and clusters of infection.
What are the most important recommendations?
The guidelines recommend that contacts be monitored every day for the onset of signs/symptoms for a period of 21 days (as per case definition) from the last contact with a patient or their contaminated materials during the infectious period. Suspected cases of monkeypox include a person of any age with a history of travel to affected countries within the last 21 days and presenting an unexplained acute rash and one or more of symptoms, including swollen lymph nodes, fever, head/body ache and profound weakness.
Other symptoms include pain in the eye or blurring of vision, shortness of breath, chest pain, difficulty in breathing, altered consciousness, seizure, decrease in urine output, poor oral intake and lethargy.
A case of monkeypox is confirmed in a laboratory by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing, much like a test for COVID-19. However, there are no commercial tests for monkeypox yet and all clinical specimens are to be transported to the apex laboratory of the ICMR-NIV (Pune) routed through the Integrated Disease Surveillance Programme (IDSP) network of the respective district/State.
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There is no treatment protocol or medicines specific to monkeypox and a patient has to be managed on the basis of the symptoms they present. For instance, dehydration ought to be treated with oral fluids; fever with sponging and paracetamol, nausea and vomiting with antiemetics.
How prevalent is monkeypox globally?
The World Health Organization has said that cases of monkeypox have been reported from 12 member states that are not endemic for monkeypox virus. Reported cases thus far do not have established travel links to endemic areas. Based on currently available information, cases were mainly, but not confined to, men who have sex with men (MSM) seeking care in primary care and sexual health clinics.
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To date, all cases whose samples were confirmed by PCR testing have been identified as being infected with the West African clade of the virus. The genome sequence from a swab sample from a confirmed case in Portugal, indicated a close match of the monkeypox virus causing the current outbreak, to exported cases from Nigeria to the U.K., Israel and Singapore in 2018 and 2019. Countries where the virus was endemic are, according to the WHO, Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.
Are there vaccines?
Historically, vaccination against smallpox had been shown to be protective against monkeypox. While one vaccine (MVA-BN) and one specific treatment (tecovirimat) were approved for monkeypox, in 2019 and 2022 respectively, they aren’t widely available. A vaccination with small pox is said to be protective against monkeypox but this vaccine would be in individuals over 40-50 years of age, who’ve been inoculated with the small pox vaccine and here too it’s unclear how long lasting the protection is.
- The Health Ministry’s guidelines recommend that contacts be monitored every day for the onset of symptoms for a period of 21 days from the last contact with a patient or their contaminated materials during the infectious period.
- Suspected cases of monkeypox include a person of any age with a history of travel to affected countries within the last 21 days and presenting an unexplained acute rash and one or more of symptoms, including swollen lymph nodes, fever, head/body ache and profound weakness.
- A case of monkeypox is confirmed in a laboratory by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing, much like a test for COVID-19. There is no treatment protocol or medicines specific to monkeypox and a patient has to be managed on the basis of the symptoms they present.
Published - June 05, 2022 03:20 am IST
