Monkey Pox Arrives in India

• Discontinuation of small pox vaccine might have helped in resurgence in monkey pox cases.
• Monkey pox should not be confused with Covid.
• Males having sex with males having spurt in monkey pox cases has been attributed to direct skin to skin contact therefore is not truly STD.

New Delhi, September 20, 2022:

An editorial (attached) by researchers from Institute of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital published in current edition of Indian Journal of Medical Microbiology has shown some interesting insights.

According to Dr Chand Wattal, Corresponding Author and Chairperson, Institute of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, “The waning immunity in humans due to the discontinuation of small pox vaccine has established the scope for the resurgence of monkey pox, demonstrated by the re-emergence of outbreak after an absence of 30-40 years.

Currently many of the cases that are confirmed are prevalent amongst individuals below 40 years of age with a median age of 31 years. Since small pox vaccine provides 85% cross protection, the program for vaccination of the unvaccinated need to be considered & road map be framed now especially for people below 45 years. High risk person’s burden need to be considered & the possible drug Tecovirimat could be stock piled.“

According to Dr Sanghamitra Datta , Author and Senior Consultant, Institute of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, “Small pox has no known animal reservoir and has only human to human transmission with a high mortality rate of 30%. Monkey pox is zoonotic (an infectious disease that has jumped from non-human animal to humans), followed by human to human spread with average mortality of 3-6% as stated by WHO.

Lymphadenopathy is distinct in monkey pox which is not there in small pox. Most experts agree that though infection can occur through respiratory droplets from a close contact, it does not seem to be transmitted over the distances like the Sars-CoV-2 virus.”

“Though the number of cases is few at present, cases with no history of international travel to affected areas can be a warning sign. The health authorities need to be vigilant. The Kerala mode of containment & contact tracing is praise worthy & the prompt diagnosis made by NIV Pune by achieving the gold standard of having cultured & sequenced the virus in a shortest possible time, is encouraging by way of capacity building & rapid response eco system having come of age in India.

Moreover, since small pox vaccine provides 85% cross protection the program for vaccination of the unvaccinated need to be considered & road map be framed now especially for people below 45 years. High risk person’s burden need to be considered & the possible drug Tecovirimat could be stock piled. Though PHEIC has been declared, monkey pox cannot be equated to COVID in any way but our learning from the pandemic can help. Preparedness is the key. It wasn’t raining when Noah built the ark!.” Dr Wattal further added.

India has confirmed 9 monkey pox (MPXV) cases by the time this editorial is being written. The size of the outbreak clusters is growing each day, as is the geographical spread across international borders. More interestingly it is being recognized as a potent sexually transmitted infection (STI) as it is attributed to close contact with lesions, with no intention of stigmatizing it.

This zoonotic virus has a low level of endemicity since decades in west and central Africa, its place of origin. Now since it has spread to 75 countries and more joining, with over 25,539 plus cases, WHO declared it a public health emergency of international concern (PHEIC) on July 23, 2022.

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