Monkey Pox Disease

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Union Health Ministry issues Guidelines to States/UTs on Management of Monkeypox Disease.

As per the Guidelines, a confirmed case is laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing.
All the clinical specimens should be transported to the Apex Laboratory of ICMR-NIV (Pune) routed through the Integrated Disease Surveillance Programme (IDSP) network of the respective district/state.
The guidelines stresses on surveillance and rapid identification of new cases as the key public health measures for outbreak containment, mandating need to reduce the risk of human-to-human transmission.
It explains the Infection Prevention and Control (IPC) measures, IPC at home, patient isolation and ambulance transfer strategies, additional precautions that needs to be taken care of and duration of isolation procedures.
As per the Guidelines, contacts should be monitored at least daily for the onset of signs/symptoms for a period of 21 days (as per case definition) from the last contact with a patient or their contaminated materials during the infectious period.
Raising awareness of risk factors under risk communication and preventive measures, the Guidelines further explain in detail about raising awareness and educating people about the measures for Monkeypox virus.

The monkeypox virus is an orthopoxvirus, which is a genus of viruses that also includes the variola virus, which causes smallpox, and vaccinia virus, which was used in the smallpox vaccine.
Monkeypox causes symptoms similar to smallpox, although they are less severe.
While vaccination eradicated smallpox worldwide in 1980, monkeypox continues to occur in a swathe of countries in Central and West Africa, and has on occasion showed up elsewhere.
According to the World Health Organisation (WHO), two distinct clade are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.
Monkeypox has been reported as endemic in several other central and western African countries such as: Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon, Liberia, Nigeria, Republic of the Congo, and Sierra Leone.
However, caseshave been also reported in certain non-endemic countries e.g. USA, United Kingdom, Belgium, France, Germany, Italy, Netherlands, Portugal, Spain, Sweden, Australia, Canada, Austria, Israel, Switzerland etc.

Monkeypox is a zoonosis, that is, a disease that is transmitted from infected animals to humans.
According to the WHO, cases occur close to tropical rainforests inhabited by animals that carry the virus.
Monkeypox virus infection has been detected in squirrels, Gambian poached rats, dormice, and some species of monkeys.
Human-to-human transmission is, however, limited — the longest documented chain of transmission is six generations, meaning the last person to be infected in this chain was six links away from the original sick person, the WHO says.

Transmission, when it occurs, can be through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.

According to the US Centers for Disease Control and Prevention (CDC), monkeypox begins with a fever, headache, muscle aches, back ache, and exhaustion.
It also causes the lymph nodes to swell (lymphadenopathy), which smallpox does not.
The WHO underlines that it is important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
The incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days.
Usually within a day to 3 days of the onset of fever, the patient develops a rash that begins on the face and spreads to other parts of the body.
The skin eruption stage can last between 2 and 4 weeks, during which the lesions harden and become painful, fill up first with a clear fluid and then pus, and then develop scabs or crusts.
According to the WHO, the proportion of patients who die has varied between 0 and 11% in documented cases, and has been higher among young children.

The CDC’s monkeypox overview says the infection was first discovered in 1958 following two outbreaks of a pox-like disease in colonies of monkeys kept for research — which led to the name ‘monkeypox’.
The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC) during a period of intensified effort to eliminate smallpox.
According to the WHO, 15 countries on four continents have so far reported confirmed cases of monkeypox in humans.
Locally acquired cases have been confirmed in the DRC (which has the largest incidence of the infection in the world), Central African Republic, Republic of the Congo, Gabon, Cameroon, Nigeria, Côte d’Ivoire, Liberia, and Sierra Leone.