Should India be worried about monkeypox?

Monkeypox is a viral zoonosis. It’s a virus that is transmitted from animals to humans. The disease symptoms are similar to those seen in smallpox patients, although less severe. Monkeypox outbreaks are not new and infections have been reported for over 50 years now, mostly in the rural and rainforest areas of Central and West Africa.

However, in the 2000s, countries outside Africa started reporting cases. But they too were in limited clusters.

Since April this year, the disease has spread worldwide, particularly in several non-endemic countries. Experts are still unsure why there is a sudden outburst of cases in many countries.

Even though the virus existed for years, it is interesting to note that the WHO currently knows “too little” about the new modes of transmission of the virus. Studies are also underway to understand sources of the infection.

Gagandeep Kang, Scientist and Professor, Christian Medical College, Vellore says monkeypox virus was generally ignored as it was mostly limited to Africa. People’s behaviour has changed and opportunities for the virus to spread are now more than before. Immunocompromised people and in young children, the disease could be severe. 

Currently, the disease is spread to over 75 countries. More than 16,000 infections are reported. Experts suspect the current outbreak worldwide was fuelled largely by sexual contact among men. The incidents were common among immunocompromised people and among the relatively younger population, including children.

In India, four cases of monkeypox were reported till now, three of which are in Kerala and one in Delhi. The fourth infected patient had no foreign travel history, which caused an alarm among health officials. Dr Suresh Kumar, MD of Lok Nayak Jai Prakash Narayan Hospital (LNJP) in Delhi said the patient is currently being treated as per standard procedures and is recovering well.

The union government has held a high-level meeting and the states have been advised to conduct strict surveillance. The health ministry has also advised airport and port health officers and regional directors from regional offices to ensure strict health screening of all international travellers at arrival.

So should India be worried? All public health emergencies clearly don’t turn out to be pandemics. In the last decade, over six diseases have been declared as public health emergencies including Swine Flu, Ebola, Zika, but none of them overwhelmed the health systems.

Even though human to human transmission of monkeypox is happening through respiratory droplets or close skin contact with lesions, the number of infected persons is limited, unlike the Covid outbreak. The monkeypox virus is also known for low case-fatality rates. In Africa, the fatality rate is about 3% and in the rest of the world, it is much less.

Since it is closely related to smallpox, people who received a smallpox vaccine in the past may have some protection from monkeypox. Experts say it is not necessary to vaccinate the entire population. A Harvard publication noted that ‘ring’ vaccination, or vaccinating only people around those who are infected would suffice in containing the outbreak.

Suresh Kumar, MD, Lok Nayak Jai Prakash Narayan Hospital, Delhi, says there is no neeed to panic. The disease is self-limiting and most patients recover well. Effective contact tracing and isolation of patients holds key.

Experts say even though there is no need to be worried over the Monkeypox threat to India, health officials must be alert. While the disease outbreak is miniscule so far when compared to Covid, it could be restricted through prompt and effective public health measures.