No one can say a virus will become pandemic, no need to panic: HIV expert Dr Gilada on monkeypox

NEW DELHI: With monkeypox spreading to many countries in Europe, North America and now Australia, globally acclaimed HIV expert Dr Ishwar Gilada on Saturday asked people not to panic, saying there is a need to study more about the disease.
“No one can say for a fact that a virus will become pandemic, especially after Covid-19, which travelled from one small city to the entire world, halting it for two years. But there isn't any need to panic. There is need is to study (more about the disease),” said Dr Gilada, who has worked extensively in the field of AIDS-control in India, told ANI in Pune.
Although there are no infections in India yet, cases have been reported from European countries like Britain, Italy, Portugal, Spain and Sweden, besides the United States and the latest two in Australia.
Explaining the monkeypox, Dr Gilada said it is a zoonotic disease like HIV that initially came as a monkey virus called simian immunodeficiency virus. “Such viruses spread in animals but jump to humans. In last 40 years, all (monkeypox) infections were virals,” said Dr Gilada who was the first person to raise an alarm against AIDS in India in 1985.
He added that very potent anti-viral is not available as of now as the virus keeps mutating.
How is monkeypox caused?
Monkeypox is caused by an orthopoxvirus that is closely related to the virus that caused smallpox, variola.
Monkeypox virus occasionally infects humans after they are bitten or scratched by a monkey or other animal. The virus can be transmitted through contact with skin lesions or droplets of bodily fluid from an infected person. Since, it’s a respiratory virus, it can also spread to humans without contact, probably through aerosols, besides material contaminated with the virus.
However, it does not usually spread easily between humans, and typically only in close contacts. Studies have found only about 3 per cent of contacts of a monkeypox case will be infected.
The fatality rate can vary from 1 per cent to about 10 per cent. It is more severe in children.
Symptoms
A week or two after exposure, infection starts with fever, headache, swelling of lymph nodes and muscle ache.
Skin eruptions — in most cases on face, hands and feet — usually appear within one to three days of the fever commencing.
The disease is usually self-limiting with the symptoms lasting from two to four weeks. Severe cases can occur.
Treatment
An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox, according to the WHO.
Re-emergence since 2017
It was first discovered in 1958 in monkeys kept for research and identified in humans in 1970 in the Democratic Republic of Congo. It re-emerged causing large outbreaks in Nigeria and DRC in 2017. In the current European outbreak, the first case in the UK had travelled from Nigeria, where there have been over 500 cases and eight deaths since 2017. This is the first time there has been travel-related spread from outside of the African continent, where the virus is endemic in animals. The current outbreak in the UK is also the largest outside of Africa. Apart from the UK, there have been a number of travel-related importations to Singapore, Israel and other countries from Nigeria and DRC since 2017, but now the source of spread appears to be Britain, which is unprecedented.
Also, clusters have occurred among gay men, a pattern not seen before. Just on Friday the Spanish health authorities said, a gay-friendly sauna in Spain's capital was forced to close over a suspected link to a monkeypox outbreak in the country. The World Health Organization (WHO) is also investigating whether some outbreaks spread within the gay community.
But why is it re-emerging now? According to an article in PTI, one of the reasons could be that the vaccine against smallpox also protects against monkeypox, and so in the past, mass vaccination against smallpox protected people.
It is 40 years since smallpox was declared eradicated, and most mass vaccination programmes ceased in the 1970s, so few people aged under 50 have been vaccinated.
Also, the vaccine gives immunity for anything from five to 20 years or more, but may wane at a rate of about 1-2 per cent a year. Now, the protection from the vaccine might have waned in the vaccinated group.
How further outbreak can be prevented?
As we have seen in Covid, any communicable disease can be prevented by isolation of cases and quarantine of contacts. Contact-tracing infrastructure developed during the Covid can be redrawn, so as to rapidly identify and quarantine the contacts to curtail the spread of the virus.
Then comes vaccination. As smallpox vaccine prevents monkeypox too, we are spared of the fresh research and trials. Hence, there are effective vaccines against monkeypox – the second and third generation smallpox vaccines, both live virus vaccines using the vaccinia virus. Vaccinia is another orthopoxvirus that confers immunity against smallpox and monkeypox, but can have serious side effects in some people, especially those with compromised immune systems.
So mass vaccination would not be warranted because of the side effects. The best strategy is to identify contacts and vaccinate them, rather than mass vaccination. This is called "ring vaccination" and was used to eradicate smallpox.
Monkeypox has a long incubation period (one to two weeks), so being vaccinated post-exposure can protect.
The third generation vaccines do not replicate in the body and can be used in immunocompromised people as well. However they are expensive.
(With inputs from agencies)