Monkeypox is no COVID, but Indian experts are being abundantly cautious

Monkeypox, a viral disease that has its roots in the Congo forest and other parts of the African continent, has now made its way to as far as the UK, the US, Canada, Portugal, Israel, Australia and some other countries. In India, too, a close watch is being kept on the situation.

As a precautionary measure, Indian authorities have stepped up surveillance at airports. Officials have been asked to collect samples of passengers exhibiting symptoms of the disease, such as rashes, skin lesions, etc., especially of those people arriving from African countries. And in Mumbai, the civic-run Kasturba Hospital set aside a 28-bed isolation ward on Monday, in case an infection is detected.

However, there is no cause for concern as yet, say experts.

Also read: Antiviral drugs may reduce monkeypox symptoms, shorten contagious phase: Lancet study

“Monkeypox is not a new disease,” Professor Ranga Reddy Burri, President of the Infection Control Academy of India, told The Federal. “I don’t think we (India) need to be overly worried (about monkeypox) since transmission of the virus would only happen when there is very close contact over a long period of time with an infected person or animal. The majority of people born before 1977 in India are all vaccinated against the smallpox virus, which is also a part of the poxvirus family. Hence, a large chunk of our adult population is covered (with vaccine) against the disease (monkeypox).”

According to him, the global alarm over the outbreak of the disease, especially among public health specialists in Europe, is because this is the first time monkeypox has made its way to non-endemic countries.

Cases from 12 WHO member-states

Since May 13, 2022, cases of monkeypox have been reported to the WHO from 12 of its members-states, where the virus is not endemic, and across three WHO regions. According to the WHO’s Disease Outbreak News, epidemiological investigations are ongoing, but reported cases so far have no established travel links to endemic areas.

“Based on currently available information, cases have mainly, but not exclusively, been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics,” said WHO in its May 21 notification.

As of May 21, there were 92 laboratory-confirmed cases and 28 suspected cases of monkeypox, all from non-endemic countries. No associated deaths have been reported to date.

Burri said the WHO’s global notification is a routine protocol followed by the organisation in order to “identify and isolate” the infected. “It (the procedure) is not something unusual. International health regulations dictate the WHO to sound an alarm to countries whenever there is any outbreak…and India, as a member country, has to take the alarm seriously and do the necessary preparation work. This doesn’t necessarily mean that there is an impending crisis.”

Skin-to-skin transmission

Monkeypox is transmitted via skin-to-skin or extremely close physical contact — primarily with animals that are already infected with the virus. According to WHO, the respiratory droplets produced by coughing or sneezing can also cause the virus to spread.

Burri said airborne transmission “is not a possibility at all” and that one can catch the disease only through close physical contact with somebody who already has symptoms such as rash, body fluids, and puss or blood from skin lesions.

“There is absolutely no comparison in terms of transmission (between Sars-COV2 and Monkeypox),” he said. “The instruction given to the local infectious disease hospital (Kasturba) in Mumbai is part and preparation for any outbreak that happens in the world. We have learnt from previous pandemics and are trying to be ready in case there is an outbreak like there has been in the UK and six other European countries,” Burri added.

Need to chart the travel route

Dr Jugal Kishore, Director of Community Medicine at Safdarjung Hospital in New Delhi, who is also an epidemiologist, also said India doesn’t have much to worry about just yet. The real concern right now is to figure out how the disease has been travelling to non-endemic countries.

“Countries should be prepared for all kinds of diseases that have the potential to be a pandemic or epidemic,” he told The Federal. “We have learnt our lesson from COVID, which is why we (the Indian medical community) have already started training people and disseminating information about the disease. We have anti-viral drugs and a known vaccine that is available for monkeypox. We just have to switch the terminology from COVID to monkeypox,” he said.

Also read: Rise in Monkeypox cases raises alarm

Dr Ishwar Gilada, an infectious disease specialist with the Unison Medicare & Research Centre, who is also secretary-general of the Organised Medicine Academic Guild, a federation of 15 post-graduate doctors’ associations across the country, told The Federal: “Around 85 per cent of monkeypox cases can be prevented with the smallpox vaccine — which was one of the cheapest vaccines that we (India) used to manufacture. We have to look at reviving the facility for the smallpox vaccine.”

Worried about mutations

However, past experiences notwithstanding, some doctors are concerned over monkeypox virus developing a mutated strain, as had happened with the Sars-COV2 virus.

“If a virus that is originating from a place like Wuhan can bring the entire world to its knees for two years…we cannot neglect any kind of new viral infection,” said Gilada. “It (monkeypox outbreak) is moving and is not static. More importantly, we have hardly come across any new parasitical or bacterial infections in the last few years…they have all been viral in nature. We have potent antibiotics for fungal, bacterial, and parasitical infections, but we don’t have any potent antivirus for most viral diseases. These (viral) diseases can only be prevented through behaviour or vaccines.”

He also said that India has a “rudimentary system of screening” passengers from other countries at its international ports of entry. Thermo-scanning is an “ornamental” measure and does little to detect infected people since the infection can be temporarily suppressed by simply taking paracetamol.

WHO expects that more cases in non-endemic areas will be reported in the coming days. Currently, available evidence suggests that people who are most at risk are those who have had close physical contact with someone with monkeypox, while they are symptomatic.

“While the exact mechanisms of transmission of the present monkeypox outbreak are still being investigated, and they likely differ from those of SARS-CoV-2, it is important to remind that the general precautionary measures recommended against Covid-19 are also expected to largely protect from monkeypox virus transmission,” the WHO said.