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India needs to be prepared to tackle cases of monkeypox in view of the increasing reports of cases in non-endemic countries, the Union Health Ministry said on Tuesday while issuing ‘Guidelines on Management of Monkeypox Disease’.
It confirmed that there are no reported cases as on date of monkeypox disease in India.
“We are maintaining a close watch on the situation. Monkeypox (MPX) is a viral zoonotic disease with symptoms similar to smallpox, although with less clinical severity,’’ said a Health Ministry official.
He added that monkeypox had been reported as endemic in several 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, cases have also been reported in certain non-endemic countries — USA, United Kingdom, Belgium, France, Germany, Italy, Netherlands, Portugal, Spain, Sweden, Australia, Canada, Austria, Israel, Switzerland etc,’’ said the Ministry.
Natural reservoir
Stating that the natural reservoir of the virus is yet unknown, the Ministry has said that certain rodents (including rope squirrels, tree squirrels, Gambian pouched rats, dormice) and non-human primates are known to be naturally susceptible to monkeypox virus. The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days, but can range from 5 to 21 days, and the period of communicability is 1-2 days before the rash until all the scabs fall off/get subsided.
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Suspected cases include a person of any age having a history of travel to affected countries within the last 21 days presenting with an unexplained acute rash and one or more of symptoms, including swollen lymph nodes, fever, head/body ache and profound weakness.
The Ministry said that a patient should be closely monitored for the appearance of symptoms, including pain in the eye or blurring of vision, shortness of breath, chest pain, difficulty in breathing, altered consciousness, seizure, decrease in urine output, poor oral intake and lethargy, during the period of isolation and nearby healthcare facility/ specialist must be contacted immediately in case of need.
Daily monitoring
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.
A confirmed case of monkeypox is virus confirmed by a laboratory 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 on Management of Monkeypox Disease include epidemiology of the disease, including host, incubation period, period of communicability and mode of transmission; contact and case definitions; clinical features and its complication, diagnosis, case management, risk communication, guidance on Infection Prevention and Control (IPC) including use of personal protective equipment.
The guidelines stress on surveillance and rapid identification of new cases as 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 need to be taken care of and duration of isolation procedures.
