Healthcare e-Compendium
A joint initiative of DPSRU & DRSC
Healthcare e-Compendium
A joint initiative of DPSRU & DRSC
Author: Medical Team (Alniche Life Sciences)
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According to latest update by the World Health Organization on 21 May 2022 more than 250 cases of a viral zoonotic disease called have been reported in at least 16 countries. However, no case of monkeypox has been reported in India till now.
Epidemiology of the Monkeypox virus
Monkeypox is a viral zoonotic disease caused by Monkeypox virus that belongs to the orthopoxvirus genus of the Poxviridae family. The virus was first discovered in monkeys in a Danish laboratory in 1958, thus it is named as monkeypox. The monkeypox virus is divided into two clades: West African and Congo Basin (Central African The first case of this virus in human was identified in 1970 in Democratic Republic of Congo. Since then, cases have been reported in 11 African countries i.e., Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Côte d’Ivoire, Liberia, Nigeria, South Sudan, Sierra Leone, and the Republic of the Congo.
In countries not endemic to this virus, cases are occasionally reported in people that have travelled to the endemic countries. However, unlike the past pattern of this disease multiple cases were identified in the non-endemic countries.
Following the smallpox eradication in 1980 and end of the Smallpox Eradication Program in the early 1980s, the decline of vaccine-induced immunity in population and lack of protection among younger age groups may have contributed to the disease comeback.
Transmission & Symptoms of the disease
Close contact with lesions, bodily fluids, respiratory droplets, and infected surfaces such as bedding allows the monkeypox virus to spread from one person to another. Monkeypox takes 7-14 days to incubate although it can take anywhere between 5 and 21 days.
The symptoms of the disease begin with fever, severe headache, fatigue, back pain and enlarged lymph nodes which is the distinguing symptoms of monkeypox with small which otherwise have similar symptoms Lesions in the disease start from the development of the Macules which then turn to Papules and progress into Vesicles and then finally into Scabs before the fall off. Lesions might be flat or slightly elevated, filled with clear or yellowish fluid, crusted and dried up. A single person might have anything from a few to thousands of lesions.
In most cases symptoms disappear on their own within a few weeks, however in some individuals, they can lead to medical complications and death. Monkeypox can cause more serious symptoms and mortality in new-borns, toddlers, and adults with pre-existing immune weaknesses. Skin infections, pneumonia, disorientation, and eye infections which can lead to vision loss are all complications of severe instances of monkeypox.
In recent years, 3–6% of reported cases in endemic nations have resulted in mortality, most commonly in youngsters or people with underlying health problems.
Diagnosis
CDC has recommended Polymerase chain reaction (PCR) for the diagnosis of the disease. For this, optimal diagnostic samples from skin lesions such as the roof or fluid from vesicles and pustules and dry crusts should be taken. If possible biopsy is recommended. In order to interpret the test results, patient information such as date of onset of fever, specimen collection and stage of lesion should be checked.
Treatment
Monkeypox clinical therapy should be thoroughly adjusted to reduce symptoms, manage complications, and minimize long-term consequences. To maintain proper nutritional status, patients should be fed drinks and food. Treatment for secondary bacterial infections should be done as directed. Smallpox immunization has been found to protect against Monkeypox in the past. Although a vaccination (MVA-BN) and a specialized therapy (tecovirimat) for Monkeypox were authorized in 2019 and 2022, respectively, these countermeasures are still not generally available. USFDA has also licensed small pox vaccine JYNNEOSTM (also known as Imvamune or Imvanex), to treat Monkeypox virus.
Way forward
The frequency with which Monkeypox has transmitted into non-endemic countries has raised the possibility of another Pandemic. However, experts worldwide have invalidated the claims. As per the experts what differentiate Monkeypox virus from SARS-COV-2 is the novelty of the later virus, lack of understanding of the disease and non-availability of the vaccine. However, the knowledge of Monkeypox virus is existing from the 1970’s. The vaccines for the Monkeypox virus such as Bavarian Nordic’s live attenuated vaccine marketed as Jynneos in the U.S. and Imvanex in Europe and Emergent BioSolutions smallpox shot ACAM2000 are already available.
However, the rate at which the disease has been progressing many countries have initiated measures in order to curb the spread of the disease. Patients with monkeypox in Belgium are subject to a 21-day quarantine. WHO has also been keeping a close watch on the disease. Hence it is recommended that Indian health authorities should also prepare a framework for the disease and keep a close watch on the cases.
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World Health Organisation Recommendations for the Clinical Management, Prevention & Control of the disease
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