Mpox in India: Health Ministry strengthens defence, asks states and UTs to intensify screening, contact tracing

The Centre on September 9 has issued a directive over the mpox outbreak and suggested screening, testing, and contact tracing of all suspected patients.  

The Union Health Ministry announced on Monday that a single case of the mpox virus has been detected in India, linked to international travel. Contact tracing is underway to assess any broader impact. The government clarified that this case is not connected to the global public health emergency declared by the World Health Organisation (WHO) regarding the mpox outbreak.

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What the advisory suggests 

Union Health Secretary Apurva Chandra issued a formal advisory to all states and union territories, urging them to enhance surveillance and testing measures. The ministry reassured the public that there is no cause for undue concern. India remains prepared to manage isolated cases, with robust measures in place to contain any potential risk. 

• States have been asked to identify hospitals to prep isolation facilities for treating suspected as well as confirmed cases. The government has also directed a review of public health preparedness by senior officials. 
• States and union territories have been urged to widely circulate the Ministry’s “Guidelines for Management of Monkeypox Disease” and act on the updated Communicable Disease Alert (CD-Alert) issued by the National Centre for Disease Control (NCDC).  

NCDC guidelines 

As per the surveillance strategy shared by NCDC early detection of mpox cases is a priority. The strategy includes guidelines for laboratory testing, clinical management protocols, and infection control measures. The key stakeholders in surveillance are NACO, IDSP, points of entries (PoEs), hospitals (derma OPDs, RTI/STI clinics, antenatal clinics & pediatric OPDs) and the designated lab network. 

• Even one case of Mpox is to be considered as an outbreak. A detailed investigation, including contact tracing, jointly by all the concerned stakeholders is urgently required. 
• Report any suspected case immediately to the District Surveillance Units (DSUs)/State Surveillance Units (SSUs) and CSU (Central Surveillance Unit), which shall report the same to Dte. GHS MoHFW. 
• Send the samples as per the guidelines to the designated laboratories. A record of all the samples sent for testing & their results is to be maintained by the IDSP SSUs. 
• All the clinical specimens should be transported to NCDC/NIV Pune/VRDLs routed through the IDSP network of the respective district/state. A network of testing laboratories is being enhanced for early diagnosis with 35 labs equipped for testing so far and 22 labs currently ready.
• Home quarantine & active follow up for contacts of confirmed cases and self-monitoring for contacts of probable cases are recommended.
• Contacts should be monitored at least daily for the onset of signs/symptoms for a period of 21 days (as per case definition above) from the last contact with a patient or their contaminated materials during the infectious period. 

Mass vaccination not needed 

According to the NCDC guidelines: Three vaccines are currently licensed for mpox:  

1) Modified vaccinia Ankara-BN (e.g., MVA-BN or JYNNEOS, Imvamune or Imvanex), a 2-dose 3rd generation smallpox vaccine that is a highly-attenuated replication-deficient vaccinia virus vaccine, approved in the USA, Canada and Europe; 

2) LC16-KMB (licensed in Japan)  

3) OrthopoxVac (licensed in the Russian Federation). 

• WHO advises vaccination for only individuals at high risk of exposure, such as those with certain occupations or circumstances, and travellers who may be at risk, as determined by a healthcare provider. 
• Based on currently assessed risks and benefits, mass vaccination is NOT recommended by WHO for Mpox at present. India has also not issued any advisory pertaining to Mpox vaccination at present.

 Contagious factor

Amid the global outbreak of mpox, a US CDC report shows that, unlike Covid-19, the virus (MPXV) does not easily spread through the air. The findings suggest that “travelling on a flight with a person with mpox does not appear to constitute an exposure risk or warrant routine contact tracing activities”. 

However, the CDC recommends that people with mpox infections must isolate and delay travel until they are no longer infectious. The CDC also pointed out that irrespective of variants, the findings apply to MPXV and both clade I and clade II mpox spread in the same ways.

Advisory from WHO 

The Union Health Ministry’s proactive steps come in the wake of the WHO’s decision to declare mpox a PHEIC. The WHO's September 3, 2024, report indicate that mpox cases have been reported in 121 member states with a total of 102,997 laboratory-confirmed cases and 186 probable cases as of July 31, 2024.