First case of monkeypox in Kerala: How India is planning to beat the virus

A person who returned to Kerala from abroad and was hospitalised after showing signs of monkeypox tested positive for the disease, state Health Minister Veena George said on Thursday. It is the first case of the virus in India. Meanwhile, the Union Ministry of Health and Family Welfare is sending a high-level multi-disciplinary team to Kerala to collaborate with the State Health Authorities in instituting public health measures in view of the confirmed case of monkeypox in Kollam district. Earlier in the day, the minister told reporters that his samples of the symptomatic person have been collected and sent to the National Institute of Virology for testing. George said that the person showed symptoms of monkeypox and he was in close contact with a monkeypox patient abroad. In the evening, she confirmed that he tested positive for the virus. “One case of monkeypox has been confirmed. We are taking steps to ensure it does not spread to others. But he (patient) has 2-3 close contacts which include his parents. “There are 11 primary contacts which include his parents, those who sat next to him in the plane, the taxi driver who took him from Thiruvananthapuram to Kollam, the auto driver who took him to the hospital and the cabin crew of the flight. We are informing all of them,” the minister told reporters.

The minister also told media that there was no need for concern.

The department, however, had advised everyone to be cautious and vigilant. The central team to Kerala will comprise experts drawn from the National Center for Disease Control (NCDC), Dr RML Hospital, New Delhi and a senior official from the Ministry of Health along with experts from the Regional Office of Health and Family Welfare, Kerala. “The team shall work closely with the State Health Department and take stock of on-ground situations and recommend necessary public health interventions. The Government of India is taking proactive steps by monitoring the situation carefully and coordinating with states in case of any such possibility of outbreak,” it said. The Centre on Thursday wrote a letter to all the states and Union territories, reiterating key actions that should be taken in view of the monkeypox threat. Also, the World Health Organisation said Thursday it would reconvene its expert monkeypox committee on 21 July to decide whether the outbreak constitutes a global health emergency. A second meeting of the WHO’s emergency committee on monkeypox will be held, with the UN health agency now aware of over 9,200 cases in 64 countries. Let’s take a closer look at what monkeypox is, who is at risk, how it can be treated and the Centre’s guidelines for states and Union Territories: What is monkeypox? Monkeypox is a rare disease caused by monkeypox virus, which belongs to the same Orthopoxvirus genus that also includes smallpox-causing variola virus. Monkeypox is a zoonosis, a disease that is transmitted from infected animals to humans. Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox’, according to the US Centers for Disease Control and Prevention (CDC). The WHO says that cases occur close to tropical rainforests inhabited by animals that carry the virus. The infection has been detected in squirrels, Gambian pouched rats, dormice, and some species of monkeys. It spreads by a bite or direct contact with an infected animal’s or person’s blood, meat or bodily fluids, and initial symptoms include a high fever before quickly developing into a rash. People infected with it also get a chickenpox-like rash on their hands and face. Must read: Monkeypox: World already has vaccine, medicines to control the outbreak; details here What is the treatment? According to the WHO, vaccination against smallpox is about 85 per cent effective in preventing monkeypox. Thus, prior smallpox vaccination may result in milder illness. At the present time, the original (first-generation) smallpox vaccines are no longer available to the general public. A newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved for the prevention of monkeypox in 2019. This is a two-dose vaccine for which availability remains limited. Smallpox and monkeypox vaccines are developed in formulations based on the vaccinia virus due to cross-protection afforded for the immune response to orthopoxviruses. What guidelines did the Centre release? The Centre reiterated key actions that should be taken in view of the monkeypox threat.

#Monkeypox |Union Health Secretary Rajesh Bhushan writes to Additional Chief Secretary/Principal Secretary/Secretary (Health) of all States/UTs, reiterating some of the key actions that are required to be taken by all States/UTs in line with MoHFW's guidance issued on the subject pic.twitter.com/fb7jdZPz8U

— ANI (@ANI) July 14, 2022

Health secretary Rajesh Bhushan cited the letter sent by the ministry on 31 May in which it had issued a comprehensive ‘Guidelines for Management of Monkeypox Disease’ The health secretary asked all the states and union territories to take key actions like orientation and regular re-orientation of all key stakeholders including health screening teams at points of entries (PoEs), disease surveillance teams, doctors working in hospitals about common signs and symptoms, differential diagnosis, case definitions for s for suspect/probable/confirmed cases and contacts, contact tracing and other surveillance activities that need to be undertaken following the detection of a case, testing, IPC protocols, clinical management etc.

He further asked to screen and test all suspect cases at points of entries and in the community.  

“Patient isolation (until all lesions have resolved and scabs have completely fallen off), protection of ulcers, symptomatic and supportive therapies, continued monitoring and timely treatment of complications remain the key measures to prevent mortality,” he said. Bhushan said that the intensive risk communication directed at healthcare workers, identified sites in health facilities (such as skin, paediatric OPDs, immunization clinics, intervention sites identified by NACO etc.) as well as the general public about simple preventive strategies and the need for prompt reporting of cases needs to be undertaken. The hospitals must be identified and adequate human resource and logistic support should be ensured at identified hospitals equipped to manage suspect/confirmed cases of Monkeypox. “I am sure, States/UTs shall make all efforts to ensure effective preparedness and take required action as per the guidelines. Union Ministry of Health shall continue to monitor the situation closely and will extend all requisite support in this regard,” he added. As per the earlier guidelines released by the health ministry, for a person to be suspected to have the infection, they must have a history of travel to the affected countries in the last 21 days. Presence of an unexplained rash and any of the other symptoms such as swollen lymph nodes, fever, headache, body ache, and profound weakness should also be treated as suspected cases. The ministry said clinical specimens collected through a PCR test, similar to the one done for COVID-19, would have to be sent to the National Institute of Virology (NIV), Pune, through Integrated Disease Surveillance Programme network (IDSP). The IDSP has been asked to remain alert about the cases along with health facilities, especially skin clinics, clinics for sexually transmitted diseases, medicine clinics, and paediatrics clinics. The ministry has said that even one case of monkeypox is to be considered as an outbreak. The guidelines also give details on treating skin rash, genital ulcers, oral ulcers, conjunctivitis, dehydration, fever, itching, nausea, vomiting, headache, and malaise. During the period of isolation, the patients have to monitor for signs such as pain in eye and blurry vision, shortness of breath, chest pain, difficulty in breathing, altered consciousness, seizures, decreased urine output, poor food intake, and lethargy. The ministry has advised international passengers to refrain from eating or preparing meat from wild game (bushmeat) or using products such as creams, lotions and powders derived from wild animals in Africa, besides avoiding close contacts with sick people, including those with skin lesions or genital lesions. The “Guidelines on Management of Monkeypox Disease” issued to the states and Union territories include an annexure – advisory for international passengers – which recommends that these passengers should avoid contact with dead or live wild animals such as small mammals, including rodents (rats, squirrels) and non-human primates (monkeys, apes). The contacts of suspected infected cases will be monitored at least daily for the onset of signs or symptoms for a period of 21 days (as per case definition) from the last contact with a patient or their contaminated materials during the infectious period. The government had earlier ordered surveillance of all international entry points and also asked for samples of travellers from Africa, showing symptoms to be set to NIV, Pune. Who is at risk? WHO chief  Tedros Adhanom Ghebreyesus in June said he was particularly concerned about the risk the virus poses to vulnerable groups, including pregnant women, children and people with weakened immunity due to other health conditions. Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Also read: Explained: How the Centre is prepping for monkeypox as it spreads to 23 countries Since transmission via droplet respiratory particles usually requires prolonged face-to-face contact, health workers, household members and other close contacts of active cases are at greater risk. Transmission can also occur via the placenta from mother to fetus (which can lead to congenital monkeypox) or during close contact during and after birth. While close physical contact is a well-known risk factor for transmission, it is unclear at this time if monkeypox can be transmitted specifically through sexual transmission routes, WHO said. “The risk of exposure is not limited to any one particular group,” said Dr Rochelle Walensky, director, the Centers for Disease Control and Prevention (CDC). “Our priority is to help everyone make informed decisions to protect their health and the health of their community, and that starts with building awareness guided by science, not by stigma.” WHO to reconvene expert committee A surge in monkeypox infections has been reported since early May outside the West and Central African countries where the disease has long been endemic. On 23 June, the WHO convened an emergency committee of experts to decide if monkeypox constitutes a so-called Public Health Emergency of International Concern (PHEIC) – the highest alarm that the WHO can sound. But a majority advised the WHO’s chief Tedros Adhanom Ghebreyesus that the situation, at that point, had not met that threshold. Now a second meeting will be held, with case numbers rising. “The emergency committee will provide its views to the WHO director general on whether the event constitutes a PHEIC,” the UN health agency said in a statement. “If so, it will propose temporary recommendations on how to better prevent and reduce the spread of the disease and manage the global public health response.” A statement will be issued in the days following the meeting. ‘Tackle the stigma’ Most monkeypox infections so far have been observed in men who have sex with men, of young age and chiefly in urban areas, according to the WHO. The committee will look at trends, how effective the counter-measures are and make recommendations for what countries and communities should do to tackle the outbreak, Tedros told a press conference on Tuesday. He said the WHO was working closely with civil society and the LGBTQ community, “especially to tackle the stigma around the virus” and spread information to help people stay safe. “WHO continues to work with countries and vaccine manufacturers to coordinate the sharing of vaccines, which are currently scarce,” he added. The Geneva-based organisation is also working with countries and experts to drive forward research and development. “We must work to stop onward transmission and advise governments to implement contact tracing to help track and stem the virus as well as to assist people in isolation,” Tedros said. Snapshot profile A week ago, the WHO issued its first situation report on the spread of monkeypox, detailing the typical profile of those affected by the outbreak so far. According to available statistics, almost all patients affected thus far are male, with a median age of 37, with three-fifths identifying as men who have sex with men, the WHO said. The normal initial symptoms of monkeypox include a high fever, swollen lymph nodes and a blistery chickenpox-like rash. But the report said that in this outbreak, many cases were not presenting with the classically-described clinical picture. Among the cases who reported at least one symptom, 81 per cent presented with a widespread rash on the body, 50 per cent presented with fever and 41 percent presented with genital rash. The WHO’s 16-member emergency committee on monkeypox is chaired by Jean-Marie Okwo-Bele from the Democratic Republic of Congo, who is a former director of the WHO’s Vaccines and Immunisation Department. There have been six PHEIC declarations since 2009, the last being for COVID-19 in 2020,  though the sluggish global response to the alarm bell still rankles at the WHO’s headquarters. With inputs from agencies Read all the Latest News , Trending News ,  Cricket News , Bollywood News , India News and Entertainment News here. 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