MonkeyPox: Now a PUBLIC HEALTH EMERGENCY

By- Dr. Dinesh Eshwar

With cases swelling across the world, causing WHO to promulgate the Monkeypox disease as public Health Emergency of International Concern. Countries gearing up to address the surging cases.. what do we know about the disease? Read on… to know more 

While the world was still recovering from the COVID trauma, monkeypox suddenly ended up adding the fuel to the fire. Adding to our dismay, the WHO Director-General declared the escalating global monkeypox outbreak a Public Health Emergency of International Concern (PHEIC) on the 23rd of July 2022.

However, unlike SARS coV-2 which caused the recent pandemic, the Monkeypox virus isn’t a novel one. Cases of this disease were first identified in the Democratic republic of Congo in 1970. Outbreaks have been reported since then in and outside of Africa. Monkeypox is a zoonotic disease implying caused by the virus belonging to Poxviridae family, the same family as smallpox. Astonishingly, this raises questions as to why the virus couldn’t cause worldwide outbreaks so far. One of the reasons could be that the vaccination against smallpox was found to be 85% effective in preventing Monkeypox indicating cross immunity. Routine Smallpox vaccination activities were stopped by many countries 40 years ago for the reason that smallpox was eradicated. This stirred up the emergence of cases of Monkeypox. 

Monkeypox is almost indistinguishable from smallpox. Although, Monkeypox (CFR=11%) is not as infective & fatal as compared to smallpox (CFR =30%), however, the potential of the Monkeypox virus to cause a pandemic is unclear. The epidemiological factors of the disease are ambiguous and need vigorous investigation. This disease is infective to monkeys, and squirrels, thus, rightly called Monkeypox. 

The disease is mainly contracted when in contact with respiratory secretions, contaminated objects, and skin lesions of the infected. Zoonotic transmission though not common is possible. Close Physical contact is the most established route of transmission. Since 99% diagnosed cases are from homosexuals, the sexual route may also be seen as a mode but it’s still unclear whether it’s the physical contact that is causing the disease or the sexual intercourse. 

Symptoms can last for 2 to 4 weeks similar to smallpox but are clinically less severe in Monkeypox and may include: Fever, Skin rash, Headache, Muscle aches and backaches, Chills, Fatigue, and Swollen lymph nodes. Severe cases of Monkeypox have been seen in children because of fatal complications such as encephalitis, sepsis, bronchopneumonia.  The majority of the cases are self-limiting and do not require hospitalization provided there are co-morbid conditions. Monkeypox like measles, chickenpox, and smallpox is a RASH illness but LYMPHADENOPATHY is distinctively seen in Monkeypox only. Intense Headache, Myalgia, and Asthenia are common in the first 5 days of the illness. Skin eruptions start 3 days after the fever. The rash is concentrated initially on the face & extremities and progresses later to other body parts. Rash evolves to form macules, papules, and pustules healing eventually forming a crust that falls off. 

The critical step in a newly encountered disease is the objective identification of the disease because there are not available diagnostic modalities. No rapid tests have been developed as of now but PCR of the fluid from skin lesions remains the gold standard. Serological detection methods don’t provide monkey pox specific confirmation because of cross-reactivity with orthopoxviruses and false negative results in patients vaccinated with vaccinia-based preparations. Tecovirimat an anti-viral agent developed against smallpox is presently approved by EMA (European Medicines Agency) for treating Small pox.   

So, now the most important question is how do we contain this disease or prevent the spread?? 

Some of the measures include:

Human-to-human transmission can be avoided by preventing physical contact. Unprotected contact with animals should be avoided.Last but not the least, one must keep washing your hand regularly with soap and water and maintain adequate personal hygiene. There’s no denying as to the vast degree of grey area with respect to the emergence of monkeypox, therefore, it’s time for us to remind ourselves of the so-called cliché proverb “PREVENTION IS BETTER THAN CURE!”

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