Monkeypox double whammy: The Tribune India

Aditi Tandon

Just when the world thought it might be entering the post-Covid phase, a new public health emergency surfaced. In less than 100 days, monkeypox, a viral illness with symptoms similar to smallpox but clinically less severe, has spread from two cases in the UK on May 13 to more than 26,000 cases in 87 countries.

About the virus

Monkeypox is caused by the monkeypox virus, a member of the orthopoxvirus genus in the Poxviridae family. It is usually a self-limiting disease with symptoms lasting two to four weeks. Serious cases can occur. Lately, the case fatality rate has been around 3-6%. It is transmitted to humans through close contact with an infected person or animal or with material contaminated with the virus. The route of transmission is from person to person through close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.

The United States has the most cases

The United States has the highest number of cases in the world (over 7,000), prompting the government to declare a public emergency. The second highest burden is in Europe in Spain, UK, Germany and France.


Suspected case: a person of any age who has traveled to affected countries within the last 21 days and presents with an unexplained acute skin rash and one or more of the following symptoms: swollen lymph nodes, fever, headache, body aches, profound weakness.

Probable case: a person meeting the case definition of a suspected case and a person who has been exposed face-to-face, including healthcare workers without appropriate personal protective equipment; direct physical contact with the skin or damage to the skin, including sexual contact; or contact with contaminated materials such as clothing, bedding, or utensils suggests a strong epidemiological link.

Confirmed case:

A laboratory-confirmed case by detection of unique viral DNA sequences either by polymerase chain reaction or sequencing.


Various animal species have been identified as susceptible to the monkeypox virus. This includes rope squirrels, tree squirrels, Gambian pouch rats, dormice, non-human primates, and other species.


Skin rash with blisters on the face, hands, feet, eyes, mouth and/or genitals; fever; swollen lymph nodes; headache ; muscle aches; low battery. You can catch monkeypox if you have close physical contact with someone with symptoms. This includes touching and being face to face.


Over time, most human infections have resulted from primary animal-to-human transmission. Unprotected contact with wild animals, especially sick or dead ones, including their meat, blood and other parts should be avoided. Also, all foods containing meat or animal parts should be thoroughly cooked before eating. Human-to-human transmission can be prevented by avoiding close contact with infected people.

At the time of the first WHO emergency committee meeting on June 25, there were 3,000 cases of monkeypox in 47 countries. By July 23, when the panel regrouped for follow-up, cases had more than quintupled to 16,000, affecting 75 countries, prompting the global body to declare a public health emergency of international concern. Since May this year, monkeypox has traveled fast, with India recording nine cases since it was first detected on July 14. India has also recorded one death, one of only six reported worldwide so far, outside of Africa.


Historically, monkeypox has been present in Central and West Africa, with the animal hosts of the virus being a range of rodents and non-human primates. After the eradication of smallpox in 1980 and the discontinuation of smallpox vaccination, monkeypox became the most important orthopoxvirus for public health responders. The disease, however, remained confined to Africa. The first human case of monkeypox was detected in 1970 in a nine-month-old boy in Congo. Since then, human cases have been reported in 11 African countries. The first outbreak outside of Africa – in the United States in 2003 – was traced to pet prairie dogs that had been housed with Gambian rats and later brought to the United States.

This year it’s different. The disease has spread to countries with no history of cases and scientists are still trying to establish the route of acquisition of the virus in the first reported cases in the UK.

“No sources have yet been confirmed. Based on the information available, the infection appears to have been acquired locally,” the WHO says. This means that monkeypox has not only entered non-endemic countries, it has found ways to sustain itself locally.This is a hot topic of current research around the world.


This is the first time in history that the world has witnessed two public health emergency responses to Covid and monkeypox at the same time. Although monkeypox spreads from animals to humans and from humans to humans through close skin or respiratory contact with infected people, experts say it is not as transmissible as Covid.

Pragya Yadav, head of the maximum containment facility at NIV Pune which tests for the highest-risk pathogens, says there is currently little evidence to suggest that asymptomatic patients can spread monkeypox.

“Covid can be easily transmitted by asymptomatic patients. But there is no current evidence to suggest the same for monkeypox, although precaution is advised. Worldwide, the majority of monkeypox cases have been spread through close sexual contact and most patients are male, although France has now reported one female patient over 60. Among the confirmed cases in India, one is a Nigerian,” Yadav says, advising people to avoid contact with infected and symptomatic people. On India’s preparedness, Yadav, whose lab has now isolated the monkeypox virus enabling the ICMR to invite private actors to show interest in indigenous vaccine development, says that testing capacity is adequate and will be further developed.

Currently, NIV Pune and 15 virus diagnostic research laboratories across India are equipped to detect monkeypox in India. The severity of the disease remains debatable, with experts urging caution but not panic.

Former ICMR additional DG Samiran Panda said people should continue to wear masks and practice hand hygiene.

“Until a vaccine is developed, we will have to respond with behavioral change. We know that monkeypox is spread through close skin-to-skin contact with a patient, their clothes, linens, and through the respiratory route. Having a particular sexual orientation does not make a person more prone to infection. The key is to avoid contact with those who show symptoms, ”explains the scientist. India moved quickly to invite private industry to produce monkeypox diagnostics and vaccines. “We still have time because the disease burden is low,” Yadav says.


Symptoms of monkeypox resemble those of smallpox, a related orthopoxvirus infection that has been eradicated. Smallpox, however, was more easily transmitted and more often fatal, with about 30% of patients dying. The last case of naturally occurring smallpox occurred in 1977, and in 1980 smallpox was declared eradicated worldwide after a global vaccination and containment campaign.

It has been 40 or more years since all countries stopped routine smallpox vaccination with vaccinia-based vaccines. As smallpox vaccines previously protected people against monkeypox in West and Central Africa and these vaccines are no longer available, unvaccinated populations are now more susceptible to infection with monkeypox virus. While a vaccine (MVA-BN) and specific treatment (tecovirimat) were approved for monkeypox in 2019 and 2022, respectively, these countermeasures are not yet widely available and populations under 40 or 50 around the world no longer enjoy the protection offered by previous smallpox vaccination programs, which may explain why a greater proportion of patients are young.

A recent New England Medical Journal study found that 98% of those infected were gay and bisexual men, while 41% of patients were infected with the human immunodeficiency virus (HIV). The research also found that the median age of those infected was 38, and transmission was suspected to have occurred through sexual activity in 95% of those with the disease. The study followed 528 patients between April 27 and June 24 at 43 sites in 16 countries. No research subject died, but 13% required hospitalization. On July 5, Britain’s health watchdog lowered the threat level of monkeypox, noting that it rarely causes serious illness and does not spread beyond MSM (men who have sex with men). ).

With more evidence emerging, WHO has asked countries with recently imported cases to mount surveillance and containment and ensure a stigma-free health response.

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