Dr. Arvind Kumar*
When the world was recuperating from the damages done by the corona virus on our health and economy another scare of monkey pox is at our threshold. The issue of zoonotic diseases is a key emerging issue of global concern. The emergence and re-emergence of zoonotic diseases are closely interlinked with the health of ecosystems. The risk of disease emergence and amplification increases with the intensification of human activities surrounding and encroaching into natural habitats, enabling pathogens in wildlife reservoirs to spill over to livestock and humans. Within a short span of two months monkey pox has spread rapidly and as on the first of August this year, monkey pox has spread to 80 countries and confirmed cases of monkey pox stand at 23620. Viewed in a broad spectrum, monkeypox is not a new disease and in some African countries it is endemic. Nevertheless, the global outbreak which commenced in May 2022, has spurred the World Health Organisation (WHO) to declare it a global health emergency on23 July.
Monkeypox acquired its nomenclature in 1958 when it was detected in several laboratory apes and it was termed a zoonotic viral disease, meaning it can be transmitted from animal to human, and it can also pass from human to human. The first case of human monkeypox was detected in 1970 in the Democratic Republic of Congo (DRC) in a nine-month-old boy. According to some experts, symptoms of monkeypox are often similar to those, seen in the past, in smallpox patients but clinically these are less severe. As per the WHO, smallpox was eradicated globally in 1980; nonetheless, the first monkeypox outbreak outside Africa was reported in the United States in 2003 and was linked to contact with infected pet prairie dogs.
The Magnitude of the Menace
Found mostly in the rain forests of Central Africa and Western Africa where animals that can carry the virus are native and the disease is endemic, monkeypox is increasingly appearing in the urban areas of these regions, and on occasions, it can also be found elsewhere in people who could have been infected after visiting these countries. According to the WHO experts, symptoms of monkeypox generally include fever, severe headache, muscle aches, back pain, low energy, swollen lymph nodes, and skin rashes or lesions. The rashes often begin on the first or third day of the onset of fever, and the lesions may be flat or slightly raised, filled with clear or yellowish fluid, then crust over dry up, and fall off.
The tone and tenor of the rapid spread of monkeypox is worrisome. Cases of monkeypox were reported in more than 10 countries in non-endemic areas in May 2022, and additional cases were being investigated. Nevertheless, no clear link between reported cases and travel from endemic countries as well as no link to infected animals was reported in May 2022. The number of reported cases of monkeypox started swelling in July, and on 25 July the WHO reported 16016 laboratory-confirmed cases of monkeypox from 75 countries with 6 cases of death, and on the first of August this number had risen to 23620 and the disease had spread to 80 countries.
Not often considered highly contagious, monkeypox requires close physical skin-to-skin contact with someone who is contagious and in that eventuality the risk to the public is low. The WHO is responding to present outbreak as a high priority to prevent further spread, for many years monkeypox has been considered a priority pathogen, and now it is priority for the WHO to identify how the virus is spreading and protecting more people from becoming infected. Concurrently, there is also need for raising awareness about of this new critical situation.
WHO Response
Keeping in view the growing menace of the spread of monkeypox, the WHO on 23 July declared the monkeypox outbreak a public health emergency, as 75 countries had reported 16, 000 cases, with five deaths in Africa alone. In the aftermath of the second meeting of the Emergency Committee of the International Health Regulations in May 2022, the WHO released recommendations that aimed at controlling the international spread of monkeypox. Expressing concern at the rapid spread of monkeypox through new modes of transmission and availability of sparse information, the WHO Secretary-General clarified that while monkeypox outbreak was public health emergency of global concern, the viral disease was concentrated mainly among homosexual men, particularly those with multiple sexual partners. While emphasizing on deployment of the right strategies to design and deliver effective information and services, and to adopt to measures to protect the health, human rights, and dignity of affected communities, the WHO boss equally warned against stigma and discrimination.
The World Health Organisation (WHO) on 26 July recommended targeted vaccination for those exposed to someone infected and those at high risk of exposure, including health workers laboratory workers and people with multiple sexual partners.While not recommending mass vaccination at the current stage of monkeypox, the WHO Secretary-General informed that one smallpox vaccine called MVA-BN has been approved in Canada, the European Union, and the United States for use against monkeypox while two other vaccines LC16 and ACAM 2000 were currently under consideration.
Contending that there was still lack of data on the effectiveness of vaccines for monkeypox or how many doses might be required, the WHO boss urged all countries that were using vaccines to collect and share critical data on their effectiveness. The WHO is reportedly developing a research framework that can be used by countries to generate the data needed to better understand how effective these vaccines are in preventing both infection and disease and how to use them more effectively. Emphasising that vaccination does not provide instant protection against infection or disease and can take several weeks, the WHO cautions that those vaccinated should continue to take measures to protect themselves by avoiding close contact, including sex with others.
Conceding that currently there are challenges concerning the availability of vaccines, the WHO boss informs that there are 16 million doses of the smallpox vaccine MVA-BN worldwide, most of which are in bulk form, meaning they will take several months to ‘fill and finish’ into vials that are ready to use. The WHO has called upon countries with monkeypox cases that have secured supplies of the smallpox vaccines to share those vaccines with countries that don’t have it.
India’s Response
As of 2nd August, India has reported 9 cases of monkeypox with Kerala reporting five cases, three from Delhi and one case is that of a Nigerian national in India. The Union Health Minister said on 2nd August that the government was working to prevent the spread and there was no cause for fear. Stating that monkeypox was not a very risky disease and could be prevented through tracing contacts of the patients, and isolating them some days, the Health Minister informed that a task force had been constituted under the NITI Aayog member health Dr. V.K. Paul to monitor the situation.
Informing that monkeypox spreads through deep contacts – mother to child; husband to wife; and does not affect a particular community – the Health Minister stated that thus far there was paucity of comprehensive data on the efficiency of any vaccine, albeit Turkey had begun administering a vaccine which was previously used for smallpox since the two diseases are caused by related viruses. He further informed that ICMR had isolated the virus and hopefully it would be able to develop a vaccine for monkeypox as it did for COVID-19.
Way Ahead
Undeniably, vaccines are an important tool for the communities affected by monkeypox in all countries and regions; nonetheless, surveillance, diagnosis, and risk reduction are central to preventing transmission and stopping the outbreak of monkeypox. As per the WHO data, currently, more than 70 percent of the infected cases of monkeypox thus far reported are in the European Union and 25 percent in the Americas. Nearly six deaths have been reported so far and approximately 10 percent of all patients are admitted to hospitals.
Health experts emphasise that the outbreak can be prevented if countries, communities and individuals are kept informed, take the risk seriously and undertake the steps required to stop transmission and protect vulnerable groups. While striking an optimistic note that the monkeypox outbreak can be stopped, a WHO expert cautioned that time was going by and we all need to pull together to make that happen with the right strategies in the right groups. There is also a dire need for vaccine sharing in accordance with public health needs, country by country, and location by location. Besides, the healthcare experience garnered by many countries in managing COVID-19 can stand in good stead in dealing with monkeypox. If the lines between animal and human habitats are blurred then we will see more outbreaks of zoonotic diseases. We have to understand and address the critical relationship between a healthy environment and healthy people, and how human activities often undermine the long-term health and ability of ecosystems to support human well-being.
*Editor, Focus Global Reporter
