Experts: Surveillance of monkeypox cases can be strengthened screening at-risk groups
The surveillance process of suspected monkeypox (MPXV) cases can be strengthened screening at-risk population such as men who have sex with men (MSM) and female sex workers (FSW) the National AIDS Control Organisation. Besides this, adhering to Covid-19 protocol during air travel will be beneficial for reducing transmission among co-passengers and crew through respiratory droplets, according to a study Indian Council of Medical Research-National Institute of Virology (ICMR-NIV).
ICMR-NIV researchers have reported the detection and genomic characterisation of the first two MPXV cases who travelled from the United Arab Emirates to India during July 2022. Published on August 23 this year in the Journal of Infections, the study was approved the Institutional Human Ethics Committee of ICMR-NIV, Pune, India under the project ‘Providing diagnostic support for referred samples of viral hemorrhagic fever and other unknown etiology and outbreak investigation’.
Currently, there are 11 reported cases of monkeypox in the country and one death. After analysis of the two confirmed monkeypox cases in India, the study suggests travel-associated introduction of MPXV infection in the country.
Before April this year, monkeypox virus infection in humans was seldom reported outside African regions, where it is endemic, according to a report in the New England Journal of Medicine. According to the study published in the NEJM (August issue), 528 cases were diagnosed between April 27 and June 24 across 43 sites in 16 countries. Overall, 98 per cent of patients with the infection were gay or bisexual men and 41 per cent also had HIV. Transmission was suspected to have occurred through sexual activity in 95 per cent of persons with infection.
The report said it was not possible to confirm sexual transmission and although the current outbreak was disproportionately affecting gay or bisexual men and other men who have sex with men , monkeypox is no more a ‘gay disease’ than it is an `African disease’. It can affect anyone, the report has said.
On July 23 this year, the World Health Organisation declared Public Health Emergency of International Concern considering global monkeypox outbreaks. Transmission of monkeypox virus occurs through large respiratory droplets, and close or direct contact with skin lesions, according to the report.
The current monkeypox outbreak in the USA represents the circulation of MPXV lineage A.2 from 2021, which has evolved from lineage A that caused the Nigeria outbreak in 2017–2018. The MPXV genome retrieved from confirmed monkeypox cases, with travel hory from UAE to India, also demonstrated the circulation of A.2 lineage in UAE.
Since the detection of monkeypox cases in India, the Health Minry has taken some containment measures such as quick screening of all symptomatic contacts, strict adherence to personal protective equipment and hand hygiene, hospital infection control practices and intense health education in the community.
According to ICMR researchers, in the first case, a 35-year-old male engineer and resident of UAE had developed low-grade fever and myalgia on July 5 ,2022. The next day, he developed multiple vesicular rashes in the oral cavity and lips followed a single lesion on the genital organ . He visited a medical facility on July 9 and 11. He also revealed hory of similar lesions amongst his friends and contact with suspected monkeypox cases, but denied any sexual contact with them, a week prior to onset of symptoms. The clinician had advised the screening for MPXV and prescribed tablet Acyclovir.
He travelled from UAE to his hometown in Kerala on July 12. On his return, he developed a sore throat with worsening of oral lesions for which he visited a hospital in Kerala. Considering his hory of contact with suspected monkeypox cases, he was referred immediately to the Government Medical College in Thiruvananthapuram. The patient had no known co-morbidities but gave a hory of self-limiting genital lesions 18 months ago.
