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Around 60 countries in which monkeypox is not endemic have reported outbreaks of the viral disease as confirmed cases cross 10,400. Monkeypox, which spreads through close contact and was first found in monkeys, mostly occurs in the west and central Africa and only occasionally spreads elsewhere.
In India, Kerala has reported a suspected case of monkeypox. Kerala's health minister said that the samples have been sent to the National Institute of Virology for testing. The person showed symptoms of monkeypox and he was in close contact with a monkeypox patient abroad.
Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. There are two distinct genetic clades of the monkeypox virus – the Central African (Congo Basin) clade and the West African clade.
Incubation period
The incubation period (interval from infection to onset of symptoms) of monkeypox is usually from 6 to 13 days but can range from 5 to 21 day.
Period of communicability
1-2 days before the rash to until all the scabs fall off/gets subsided.
Mode of transmission
Human-to-human transmission is known to occur primarily through large respiratory droplets generally requiring a prolonged close contact. It can also be transmitted through direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens of an infected person.
Animal-to-human transmission
May occur by bite or scratch of infected animals like small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes) or through bush meat preparation.
Suspected case:
A person of any age having history of travel to affected countries within last 21 days presenting with an unexplained acute rash AND one or more of the following signs or symptoms:
Swollen lymph nodes
Fever
Headache
Body aches
profound weakness
Probable case
A person meeting the case definition for a suspected case, clinically compatible illness and has an epidemiological link (face-to-face exposure, including health care workers without appropriate PPE; direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils is suggestive of a strong epidemiological link).
Confirmed case
A case which is laboratory confirmed for monkeypox virus (by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing).
Clinical Features
Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and nature of complications. The extent to which asymptomatic infection occurs is unknown. The case fatality ratio of monkeypox has historically ranged from 0 to 11% in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3-6%.
Hospital based Surveillance: -
Health facility-based surveillance and testing – in Dermatology clinics, STD clinics, medicine, paediatrics OPDs etc.
Targeted Surveillance:
This can be achieved by:
i) Measles surveillance by Immunization division
ii) Targeted intervention sites identified by NACO for MSM, FSW population.