In response to rising global concerns about the spread of Mpox (monkeypox), India's Union Health Ministry has ordered increased vigilance at all international airports and land ports, especially those bordering Bangladesh and Pakistan.
The Ministry has also designated three central government hospitals in New Delhi—Ram Manohar Lohia Hospital, Safdarjung Hospital, and Lady Hardinge Medical College—as nodal centres for isolation, treatment, and management of Mpox patients. Additionally, all state governments have been directed to identify and prepare hospitals in their regions to handle the cases.
AIIMS Delhi has also issued a new advisory for managing suspected Mpox patients. Upon arrival, patients will be screened in the triage area, where they will be evaluated for fever, rash, or recent contact with a confirmed Mpox case, and then flagged for further assessment.
The World Health Organization (WHO) has declared a public health emergency over a new Mpox outbreak in Africa, with cases spreading outside the continent. Over 17,000 cases have been reported, mostly in the Democratic Republic of Congo. The outbreak is of "international concern".
A case of this new strain has been detected in Sweden, while Pakistan's Ministry of National Health Services has confirmed at least two Mpox cases.
How does Mpox spread?
On August 14, the WHO once again declared monkeypox a public health emergency of international concern, warning that the virus could rapidly spread to new countries. The previous outbreak, from July 2022 to May 2023, had also been classified as a Public Health Emergency of International Concern.
Since the start of 2022, India has reported 30 cases of Mpox, with the most recent case recorded in March this year. However, no cases have been detected in India during the current outbreak, according to the Ministry statement.
There are two identified strains of the Mpox virus: one originating from Central Africa (Clade I) and another from West Africa (Clade II). According to Dr Narendra Saini chairman of the Indian Medical Association Antibiotic Resistance Committee, the current outbreak is primarily driven by Clade I Mpox.
Saini said, "The virus mainly transmits from person-to-person when you come into contact with an infected person's sores, scabs, respiratory droplets, or oral fluids. It also spreads through sexual transmission."
Although Clade I has historically been transmitted through close contact or contact with infected droplets on surfaces, sexual transmission had not been previously reported.
The virus, discovered in 1958, was originally named monkeypox because it was first identified in monkeys, not because they are the source of infections. In recent years, the disease has been renamed 'Mpox' to avoid the stigma associated with its original name.
Symptoms, as per Saini, include, fever, rash, swollen lymph nodes, chills, headache, muscle aches and fatigue. "However, the most distinct feature is the presence of pus-filled blisters which originate as flat red rashes, which may last for almost 2-4 weeks"
Talking about the trajectory of rashes, general physician Dr Prachi Garg explained, "The rash initially appears as a blister or pimple, often itchy and painful. It develops within 1-3 days of fever and lasts 2-4 weeks. Starting as a simple rash, it becomes papular (skin tissue rises) by day 3, vesicular (composed of vesicles) by day 4-5, and pustular (containing pus) by day 6-7, eventually drying up by the 2nd week. Scabs form and fall off in the following week."
According to Garg, vigilant monitoring of these symptoms is extremely important as serious complications, such as, shortness of breath, altered consciousness, seizure and decrease in urine output, may occur if left untreated.
How to protect yourself from Mpox?
Both the experts advised taking precautions similar to those for other viral infections: maintaining hand hygiene, wearing masks, and practicing isolation if symptoms appear.
Saini also stressed on avoiding self-medication, especially with antibiotics. "Many patients mistakenly take antibiotics on their own, which is harmful as it can reduce their effectiveness when truly needed. This trend was also observed during the COVID-19 pandemic," he said.
He explained that in order to diagnose Mpox, the patient's contact history, travel history, and the presence of rashes on the body, is taken into account. "For definitive confirmation, an RT-PCR test is necessary," Saini added.
Adding to the discussion on treatment, Garg mentioned that patient isolation and rehydration therapy are the most crucial steps. "Isolation and wearing a triple-layer mask should be continued till the respiratory symptoms subside and all lesions have subsided and scabs have fallen off completely. Covering the skin lesions is of utmost importance to prevent the risk of contact with others," she said.
Is there a vaccine for Mpox?
Currently symptomatic treatment is relied in for Mpox treatment as we do not have a definitive vaccine available yet. Symptomatic treatment refers to alleviating the symptoms of a disease rather than addressing the underlying cause. This approach is often used when a specific cure for the disease is not available or when managing symptoms is the primary goal.
Meanwhile, the Serum Institute of India (SII) has announced that it is developing a vaccine against Mpox. "The SII is working on a new mRNA vaccine for the virus with US company Novavax. However, it may take over a year to develop. Hopefully, with the ongoing progress, we will have more updates and positive news to share within a year,” CEO Adar Poonawalla said.