CME INDIA Presentation by Dr. S. K. Gupta, MD (Med), FICP, CFM (France) Clinical Asst. Professor GS Medical College, CCSU, Uttar Pradesh, India. Visiting Consultant, Max Super Specialty Hospital, New Delhi.
Monkeypox
Barely few months that people had some respite from Covid 19, another virus came knocking – Monkeypox. The outbreak is rising slowly and attracting headlines, WHO too declared it a Global emergency. Will monkeypox become a global pandemic like COVID-19? It is the biggest question causing anxiety among citizens.
It is pretty unlikely that Monkeypox will snowball into another massive pandemic
Because there are important differences that make monkeypox a much less serious threat than COVID-19.
10 reasons that MPX may not spread like Covid:
1. Transmission is not airborne
- Monkeypox is primarily transmitted by close contact – prolonged physical contact or direct contact with body fluids or lesions. Though MPX virus may also spread through respiratory droplets but this has not been the primary mode of spread during this pandemic as evidenced by a low secondary attack rate of 9% which may be partly attributed to contact with contaminated bedding or clothing or body fluids.
- Most importantly MPX doesn’t primarily spread through the air like COVID-19.
2. Asymptomatic people don’t spread the disease
- Unlike COVID-19, monkeypox isn’t contagious until the infected person becomes symptomatic. Though ICMR website mentions infectivity period of MPX to start 2 days prior to onset of symptoms but most evidence worldwide comes with infection spreading through symptomatic persons only. That makes it much easier to isolate infected individuals and prevent the spread.
3. Takes long time to develop symptoms
- Long incubation 5 to 21 days period could be protective. Effective Vaccination during this period may prevent severe disease. Though more data on vaccination is needed to prove same.
4. We already have a vaccine
- And the fact that we already have an effective vaccine is another factor that sets monkeypox apart from COVID-19, which was a novel virus that required development of a new vaccine. Though the availability of doses of vaccine can be issue presently.
5. Population already has immunity from past Smallpox vaccination
- The smallpox vaccine or a newer smallpox/monkeypox vaccine that came out in 2019 can possibly prevent the disease in a person who has been exposed or who is at risk of being exposed, such as a caregiver or household contact.
6. We are better equipped
- We know how to handle monkeypox because it’s so closely related to smallpox. Covid has sensitized people about pandemics.
7. We already have a treatment for Monkeypox
- Most people don’t require any specific monkeypox treatment. But tecovirimat – antiviral drug that were developed for smallpox are effective against monkeypox. Cidofovir is 8. another good bet.
8. Mortality from Monkeypox is currently low
- Four deaths have been reported up to 2nd August 2022 among more than 26800 cases detected so far. Indian Clade A.2 is even milder than European Clade B.1
- Most people will have a relatively minor illness. West African strain that is spreading has a case fatality rate of less than 1 percent in Africa. It might be even lesser in places with better back up. Some previous African studies has reported higher mortality but present Health management systems are capable of delivering better results.
9. Virus is presently manifesting in MSM population (Gay population)
- It is important to note that vulnerable populations (children, elderly and immunocompromised people) have been spared from infection so far. Though some women have been infected.
- Noteworthy statement by WHO “It is important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk.”
10. MPX virus doesn’t change often
- MPX virus is large DNA virus. It does not change (mutate) as frequently as small RNA viruses like Covid 19. MPX Genome is 6 times larger than Covid 19 virus
Then what is cause for alarm? Should we take the viral outbreak casually?
NO
1. Right now, the monkeypox outbreak is primarily contained in adult men, who can fight the virus in most cases. If the virus jumps to large populations of children or seniors, the outlook could quickly change. Virus can change though chances are remote.
2. The other concern is that monkeypox could jump to our rodent population and become endemic.
3. The monkeypox virus seems manageable, but it is becoming a bigger deal every day.
4. More than 70 countries where monkeypox is not endemic have already reported outbreaks of the viral disease including India.
5. 4 people have died already – one in India, another in Brazil and 2 in Spain.
6. COVID-19 brought to light deficiencies in our underfunded public health system and now monkeypox reminds us that strong public health is our best defence.
7. There is another strain from Central Africa that is more severe. That strain is not involved in the current outbreak in India. But who knows?
So, stay alert. Take precaution and be watchful – early diagnosis and isolation are the key.
CME INDIA Tail Piece
| Dr. Rajeev Jayadevan via CME INDIA group – 10 issues of current interest |
| 1. Wrong name |
| 2. Wrong classification |
| 3. Wrong messaging worldwide |
| 4. Deaths are rare |
| 5. Number is underestimate |
| 6. Fear of stigmatisation |
| 7. Spill over is inevitable |
| 8. A dead end is what we need |
| 9. How to reach out to the correct networks? |
| 10. Vaccination is not for everyone |
Dr. Rajeev Jayadevan has answered scientifically to all. Please see this –https://www.onmanorama.com/lifestyle/health/2022/08/05/monkeypox-mess-what-went-wrong-how-to-fix.html
References:
Links to webpage on Monkeypox by MOHFW, Govt of India and WHO.
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