Is Mpox a new threat?

Dr. Karuna Hazarika 

(drkaruna97@gmail.com>to:sentinelgroup@gmail.com)

As per the International Health Regulations (2005) (IHR), the current outbreak of Mpox (earlier known as Monkey Pox) in the Democratic Republic of the Congo (DRC) and several other African countries has been declared a public health emergency of international concern (PHEIC) by WHO Director-General Dr. Tedros Adhanom Ghebreyesus on August 14.

In the past two years, this PHEIC determination for Mpox is the second. An orthopoxvirus is the cause of Mpox, which was first observed in humans in the Democratic Republic of the Congo in 1970. It is thought that countries in central and western Africa are endemic to the condition. Due to the rapid spread of the virus through sexual contact in several previously uninfected countries, the multi-country Mpox epidemic was designated a PHEIC in July 2022. It was determined in May 2023 that the PHEIC was over due to a consistent decline in instances around the globe. Reports of Mpox have come from the Democratic Republic of the Congo for about ten years, and throughout that period, there has been an annual increase in cases. The previous episode saw a substantial increase in the number of reported incidences, and already the number of cases reported rose dramatically the previous year. As of now, this year’s total—more than 15,600 cases and 537 deaths—has surpassed that of the previous year.

An infectious viral disease called Mpox can affect both humans and other animals. Fever, swollen lymph nodes, and a rash that boils and then crusts over are among the symptoms. Most infected people recover within a few weeks without therapy, as the sickness is usually minor. Primarily harming humans and animals, monkey pox is a viral zoonotic illness with symptoms similar to smallpox. Although the virus’s natural reservoir is yet unknown, human-to-human transmission is known to occur. While there is a difference in the mode of transmission between Mpox, COVID-19, and swine flu, experts are concerned that Mpox may be just as dangerous. While both COVID-19 and swine flu were highly contagious due to their airborne nature, Mpox is spread through close skin-to-skin contact, close contact with an infected person, or contact with soiled clothes or bed sheets. Mpox is very unlikely to become a pandemic like COVID-19, mostly due to its mode of spread. It requires very close and physical contact as well.

The incubation period, which is the interval between exposure to the monkey pox virus and the beginning of symptoms, usually lasts between 6 and 13 days, though it can also go up to 21 days. Communicability lasts for one to two days prior to the rash’s onset and lasts until all of the scabs have fallen off or lessened. Transmission of monkey pox occurs from humans to animals as well as between humans and humans.

Human-to-Human Transmission: This occurs predominantly through big respiratory droplets, which often need prolonged close contact. Additionally, direct contact with bodily fluids, lesion material, or indirect contact with contaminated linens or garments can all result in transmission. Animal species that bite or scratch humans can spread the infection to humans. Examples of these species are non-human primates and small mammals, including rodents. It can also happen when bush meat is being prepared.

Symptoms include a sore throat, rashes, fever, tiredness, swollen lymph nodes, and muscle aches. The illness typically resolves on its own after two to four weeks of symptoms. Severe cases, however, especially in youngsters, can result in complications and increased death rates. In the past, the case fatality ratio varied from 0% to 11%; current outbreaks have resulted in a ratio of 3–6%.

The prodrome and skin involvement are the two stages that make up the clinical appearance of monkeypox.

n Prodrome (0–5 days): This phase is marked by a sore throat and cough, fever, headache, muscle aches, tiredness, chills, or sweats.

n Skin Involvement (Rash): The rash usually appears 1-3 days after the fever starts and lasts for 2-4 weeks. It is well-circumscribed, deeply seated, and frequently becomes umbilicated. The skin reaction develops in multiple phases:

n Enanthem: The mouth and tongue show the first signs of lesions.

n Macular Stage: Centrifugal dispersion causes macules to spread from the face to the arms, legs, palms, and soles in less than a day.

n Papular Stage: The lesions develop into papules by the third day.

n Vesicular Stage: The lesions elevate and fill with fluid by the fourth or fifth day.

n Pustular Stage: The lesions become hard, deeply seated, sharply elevated, filled with opaque fluid, and pustular by the sixth or seventh day. They might have confluence or umbilicate.

n Crust Stage: The lesions become dry and start to scab by the end of the second week.

In India, the Centre has alerted border, airport, and port authorities in Bangladesh and Pakistan to be on the lookout for arriving foreign travellers exhibiting symptoms of Mpox, according to sources. Globally, Mpox has been spreading. It is reported that the viral strain is distinct, more ferocious, and more contagious this time. However, the current evaluation of the nation indicates that there is little chance of a significant outbreak with ongoing transmission. In order to facilitate early disease diagnosis, the Health Ministry has directed officials to make sure the network of testing laboratories is ready. Currently, 32 labs across the nation are set up to test Mpox. In Kerala in 2022, a tourist from the United Arab Emirates reported having the first incidence of Mpox in India. The virus quickly spread throughout the nation, with cases showing up in Delhi from people who had not recently travelled outside. Till now, 30 cases have been reported in India, including one in Kerala. However, no new instances have been reported in the nation since the previous incidence, which occurred in Kerala in March of this year.

According to Adhanom Ghebreyesus, the Mpox outbreak in the Democratic Republic of the Congo (DRC) and a growing number of African nations meets the criteria for a public health emergency of international concern (PHEIC). In the past two years, this PHEIC determination for Mpox is the second. The orthopoxvirus responsible for Mpox was first identified in humans in the Democratic Republic of the Congo in 1970. It is thought that countries in central and western Africa are endemic to the condition. After more than 15,600 cases, 537 deaths, and the discovery of more cases in Pakistan and Sweden, the World Health Organisation (WHO) was forced to classify this as a pandemic. The decision was also forced by the discovery of the deadly virus strain Claude Ib, which is currently spreading rapidly and was found in the Democratic Republic of the Congo (DRC). The director-general of WHO said on X, “The #Mpox Emergency Committee met today and informed me that, in their opinion, the situation is a public health emergency of international concern. I’ve taken their advice to heart. The World Health Organisation is on the ground, assisting the impacted nations and those in danger through our country and regional offices, as well as with partners including the @AfricaCDC, NGOs, civil society, and more.”

The central government as well as state governments have acted swiftly in response to the WHO’s alert. Public health precautions are being taken, and advisories regarding monkey pox are in effect. The issue is being continuously monitored, and global trends are being examined by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC). The Directorate of Public Health and Preventive Medicine (DPH) in Tamil Nadu has already sent out warnings. According to reports, port health workers and airport health inspectors are keeping tabs on travellers arriving from the Democratic Republic of the Congo and other Central African nations. A high alert has also been issued for Hyderabad, Bangalore, Coimbatore, and New Delhi, the places that are well-liked by African students seeking higher education.

Communities need to be made aware of the threat posed by Mpox without being stigmatized. This includes utilising dependable community members as messengers to convey unambiguous information about safeguarding against transmission within households. It may be more difficult for people in some African nations to obtain vaccinations or medical care if same-sex relationships are illegal. Coordinated, immediate action is required, particularly with regard to the fair distribution of vaccines. COVID-19 and far too many other health tragedies have shown us that everyone is at risk from inaction and complacency. Consequently, the focus for containing the outbreak and eradicating human-to-human transmission of Mpox in all circumstances continues to be on monitoring, diagnostics, risk communication, and community participation.