Monkeypox cases in India: All you need to know about how it spreads, its stages, mortality rate

Delhi reported its first case of monkeypox, taking the total number of cases in the country to four. The latest case is of a 31-year-old man who has no foreign travel history. However, the man had attended a party in Manali in Himachal Pradesh, an official said. 

“The first case of Monkeypox was detected in Delhi. The patient is stable and recovering. There's no need to panic. The situation is under control. We have made a separate isolation ward at LNJP. Our best team is on the case to prevent the spread and protect Delhiites,” said Delhi CM Arvind Kejriwal. 

Meanwhile, the WHO has declared monkeypox as a public health emergency of international concern.

Monkeypox origin

Monkeypox is not a novel disease. It was first isolated in the late 1950s from a colony of monkeys. It gets its name from a 1958 outbreak among a group of laboratory test monkeys inside a research facility in Denmark’s Copenhagen. 

The virus that causes the disease is in the same genus as variola, the causative agent of smallpox, and vaccinia, the virus used in one of the available smallpox vaccines. 

How monkeypox spreads

Dr Dhiren Gupta, Intensivist and Senior Consultant at Sir Gangaram Hospital said, “There is a significant role of animals in the spread of monkeypox. Man and monkeys both are accidental hosts and wild rodents are usually seen harbouring this virus. The strain isolated from West Africa appears to be less virulent than the one from Central Africa. It’s clad 2 ie west African strain is spreading all over the world.”

If an individual has prolonged contact with animals such as monkeys, squirrels, and wild rodents, consumes wild animal meat, or has close contact with an infected person, he is likely to contract monkeypox. It does not spread via air, but if someone is in close proximity to an infected person, then he or she can contract monkeypox via large droplets. Secondary attack rates are around 7 per cent and are less infectious than smallpox and chickenpox. 

Who is at risk?

Most cases of monkeypox have been seen in men. Men who have sex with men, and the LGBTQ community have been flagged by the WHO. 

Healthcare professionals who have prolonged and close exposure to a patient could be infected through large droplets or skin contact too. Moreover immunocompromised people or people with prolonged health complications are likely to contract monkeypox. 

Is it a sexually transmitted disease?

Health experts and epidemiologists do not agree that monkeypox is only a sexually transmitted disease (STD). Dr Sanjay Rai, Professor, Community Medicine AIIMS, said, “We have not generated evidence to say that it is only an STD, or spreads through the sexually transmitted disease modes of sexual contact only. It is not like HIV, we can’t categorise it explicitly as HIV only, but these men are in close contact with each other. There are other modes of spread, such as unsafe and unchecked blood transfusions also.”

“The categorisation of patients of high risk status has been given to men who have sex with men. But that is not the case. Anyone can get monkeypox if they come in contact with those who have these skin regions up until scabs are formed and a normal skin comes back,” said Dr Giridhar Babu, Professor and Head – Life Course Epidemiology at Public Health Foundation of India.

What are the stages of monkeypox?

Dr Dhiren Gupta from Sir Gangaram Hospital explains the stages as follows: 

Prodromal phase - It typically lasts up to five days, and is characterised by fever, intense headache, lymphadenopathy, back pain, myalgia, and severe fatigue. Swelling of the lymph nodes may also be experienced in many areas. 

Rash - The skin eruption usually begins within one to four days of appearance of fever and continues for a period of two to three weeks. However, rashes without a prodrome have also been reported. The rash is painful to start with but becomes itchy. The rash typically begins as 2 to 5 mm diameter macules, which subsequently evolve to papules, vesicles, and then pustules. 

Lesions are well circumscribed, deep seated, and often develop umbilication (a central depression on the top of the lesion). This could begin from the face, then go to the palm of the hands and soles of the feet. 

Multiple nonspecific laboratory findings can be seen in patients with monkeypox. These include abnormal aminotransferases, leukocytosis, thrombocytopenia, and hypoalbuminemia.

How to prevent the spread?

If infected, one must isolate himself for three weeks till all the lesions scab go away. The incubation period of monkeypox virus is usually 5-13 days but could also range from 4-21 days.

“Smallpox vaccination, if given within 4 days, can prevent the disease. Although vaccination can be considered for up to 14 days of an exposure, if given between days 4 and 14, vaccination is thought to reduce the symptoms of disease but not prevent the disease,” said Dr Gupta.

There are two available vaccines that can reduce the risk of developing monkeypox. The modified vaccinia Ankara (MVA) vaccine, and the ACAM2000 vaccine. 

Mortality rate

Dr Gupta said that the mortality rate in monkeypox is low. “Monkeypox is a self-limiting disease with low mortality. It doesn’t lead to scarring unless immunocompromised,” he said.

Dr Rai also points out over the years, the rate of mortality has been low, ranging from 0 to 10 per cent. 

Also read: Monkeypox case in India: How it is different from COVID-19, how it spreads

Also read: Govt advises strict health screening of foreign travellers after second monkeypox case