Understanding Monkeypox!!

First time outbreak of Monkeypox is seen in Europe and West without any known epidemiological links

As world is still trying to recover from the COVID pandemic another virus is in rise and the WHO Director -General Dr Tedros Adhanom Ghebreyesus has declared Mpox virus second time in August 2024 as a public health emergency of international concern.¹ According to WHO the current outbreaks reported are a first time in Europe without any known epidemiological links to West or Central Africa where is it endemic in nature. Monkeypox has been reported in non-endemic countries like USA, UK, Belgium, Germany, Italy, Netherlands, Sweden, Canada, Austria, Canary Islands and Switzerland.² At present India has one suspected case of mpox in Kerala’s Malappuram district.

Monkeypox is a viral zoonotic disease with symptoms similar to smallpox but less clinical severity. It is and double stranded enveloped DNA virus belonging to Orthopoxvirus genus of the Poxviridae family. There are two distinct clades of the virus: clade I and clade II. In 2022-23 clade IIb strain was responsible for the global outbreak.⁴ The natural reservoir of the virus is not yet known but rodents like squirrels, rats and dormice and known to be susceptible to monkeypox virus. The incubation period is 6 – 13 days and can go upto 21 days as well. The period of maximum communicability is 1-2 days before the rash till all the scabs fall off.² Mpox spreads from person to person through large respiratory droplets or direct contact with body fluids or lesion material> Transmission can occur from animal to human as well by bite or scratch of infected rodent animal or non-human primates like monkeys or apes or through bush meat preparation.³ Monkeypox can be transmitted to the fetus during pregnancy. It can be dangerous for the fetus or newborn and can also lead to stillbirth, loss of pregnancy and death of the newborn.

Monkeypox is a self-limited disease with symptoms lasting from 2 – 4 weeks. The usual symptoms seen are rash, fever, sore throat, headache, swollen lymph nodes, muscle ache, back pain and low energy. The rash usually begins on face and the spreads all over the body including the palms and soles of the feet. It begins as a flat sore and then develops into blister filled with liquid which can be itchy or painful and the rash heals by drying up of lesions and crusting of the rash that ultimately falls off. Some people may have proctitis and dysuria. People with compromised immune system tend do have more severe illness and may develop complications like secondary bacterial infection of the skin lesions leading to abscess formation, pneumonia, encephalitis, myocarditis, balanitis, vomiting and diarrhea causing dehydration.

The preferred diagnostic test for mpox is detection of viral DNA by polymerase chain reaction4. The best diagnostic specimen is swab directly taken from rash -skin, fluid or crusts. If skin lesions are not present swab can be taken from throat or anus.²

Treatment is usually supportive management with isolation of the patient. It Management comprises of protection of the compromised skin and mucous membranes, maintaining hydration of the patient with nutritional management and symptom alleviation. Strict monitoring to be done to prevent complications. No antiviral agent is available for treatment of mpox. Mpox vaccine is available and can help prevent infection and is recommended for people who are at high risk like health care workers and household contacts of person who has got mpox.⁴ In contacts the vaccine can be administered as part of post exposure prophylaxis in less than 4 days after contact and can be given up to 14 days if person has not developed symptoms.

Although India does not have any proven case at present global travel makes the whole world susceptible to this condition. Hence prevention and awareness regarding the disease is required.

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