Mpox outbreak: Do you need to worry?

Mpox or monkeypox is an infectious disease prevalent in the African subcontinent, especially endemic to Democratic Republic of Congo and Nigeria, where cases are reported every year. Concerns raised when new cases of mpox appeared rapidly in Europe, America and later in other WHO regions in 2022. As of 2024 the disease has spread to over 120 countries with over a lakh confirmed cases and 220 deaths worldwide. WHO has marked the disease a Public Health Emergency of International Concern (PHEIC).

Situation in India

Despite a global outbreak, Indian health authorities state that the risk of a surge in mpox infections in India is very low. Though India was the first country to report a confirmed case in southeast Asia in July 2022, since then only a total of 30 confirmed cases and only one death (3.3% case fatality rate) have been reported, most of which are post travel history or among African nationals in the country. The last case was detected in March 2024 in Kerela.

As per the review of situation by The Union Health Ministry, no new cases have been detected in India recently. Moreover the government is on high alert post the PHEIC warning by WHO, and “heightened surveillance measures” have been obligated at airports, seaports and land borders to prevent import of the disease from endemic areas.

Three central hospitals in the capital- Ram Manohar Lohia Hospital, Safdarjung Hospital and Lady Hardinge Medical College have been designated especially for care of mpox patients and readied with services pertaining to isolation, treatment and management of such cases. Presently, 32 laboratories in the country have testing facilities for mpox and a network of labs have further been directed to prepare for early and rapid diagnosis of the disease. A communicable disease alert has been issued in the country and awareness programmes have been set into action to caution people of the symptoms and nature of the disease.

Risk of outbreak in the country

As stated earlier, there is no active case of mpox in the country currently. The disease spreads in humans by close contact i.e. skin to skin, mouth to skin or mouth to mouth (during acts of kissing or sex). It may also spread by prolonged closeness (during talking/ breathing) via respiratory droplets. However these aerosols are very short ranged and hence the chances of widespread transmission in crowded areas are low. Transmission is also possible during handling of contaminated objects (clothing/personal items/needle stick injuries/tattooing etc.). Animal to human transmission occurs due to biting/scratching/hunting/handling carcasses or any kind of contact with an infected animal.

Clearly mpox is much less transmisable than most viral infections (reproducibility rate ~1.0). Thus the spread of disease is easily controllable by robust surveillance and monitoring in general population and effective containment measures in suspected cases.

Experts have clarified that monsoon season won’t affect the transmissibility of the virus. However due to an increase in other monsoon related illnesses, the healthcare system may get burdened. Hence, it is important that the government is alert and prepared.

High-risk groups

Mpox virus in general causes disease in all age groups. However following groups of people are more at risk of acquiring the disease:-

1. People with multiple sexual partners.

2. Family members of infected individuals

3. Healthcare workers and people involved in handling infected material

5. People living in endemic areas.

6. Men who have sex with men (MSM)

7. Immunocompromised individuals

8. Individuals not vaccinated against smallpox.

Children and Elderly at a higher risk of developing severe disease. The infection can be transmitted from mother to baby during pregnancy and infection in pregnancy can lead to Intrauterine Death of the fetus, Stillbirth and gestational complications.

How severe is the disease

Mpox is less transmittable, but slightly more fatal disease than COVID-19. As per available data, the case fatality rate for the disease ranges between 1-10%, varying slightly as per geographical area & clade of the virus on an average,CFR of about 3% has been documented globally by WHO.

Most cases are mild and resolve spontaneously or with supportive treatment in 2 to 4 weeks. In moderate to severe cases, individuals may require hospitalization & specialized care to recover in time without complications. Severe disease and fatality is more common in high risk groups.

Signs & Symptoms

Signs and symptoms usually appear in 1-21 days post exposure and last for 2-4 weeks. Fever, Rash, Muscle aches and Sore throat are earliest and most common symptoms. Mpox rash (like smallpox) begin to appear first over face (or at the site of contact like genitals) and then spread to other parts of the body and extremities. Rashes start as flat sores mature into blisters and later dry up spontaneously. Swollen lymph nodes are a common finding in most cases. Other painful skin lesions, swelling of rectum (proctitis) and dysuria, dysphagia can also be seen in patients rarely. Superadded bacterial infections can lead to a variety of complications.

Patients typically transmit the disease until all rashes have healed. Asymptomatic cases may rarely contribute to secondary infections.

Individuals are advised to get checked by a physician as soon as they notice any symptoms. Early diagnosis and care ensures rapid recovery without complications.

Vaccine

The good news is that the disease gas already been widely studied. Vaccines are available and recommendes for high risk groups like medical professionals, close contacts of diseased and travellers to endemic areas. especially in times of an outbreak. Both pre and post exposure prophylaxis is approved with the vaccine, given that post exposure administration must be done within 4 days after contact ideally (can be guven upto 14 days if the patient has not developed symptoms). Mass vaccination is not recommended yet.

Smallpox vaccination offers some degree of cross protection against the disease.

Treatment

No specific treatment is recognised yet. Certain antivirals are approved for use in some countries though. Isolation, symptomatic management and close vigilance to detect complications early is the regimen of treatment currently.

Limiting transmission of disease by robust detection and treatment of cases by the authorities and adoption of simple and safe preventive measures by individuals are the key to curtail the outbreak in our country.

References –

Mpox, information page by WHO
Maitree Baral, Monkeypox preparedness in India, 13 big questions answered here: TOI dated Aug 21, 2024.
Bharti Mishra Nath, Opinion: Is India Really at a risk of monkey outbreak?: NDTV world, dated Aug 19,2024
Sara Reardon & Nature magazine: How Deadly Is Mpox, What Vaccines are Effective, and Other Questions Answered: SCIAM, August 29, 2024
Expert sees no reason to panic over mpox, Mini Thomas / TNN / Aug 24, 2024

–Bhumika Arora, Author (Med College Darshan), MBBS (GMC Amritsar), Member (NMO Punjab).

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