Monkeypox: Transmission, Symptoms & treatment update

Update on Monkeypox

Delhi reported its first case of the monkeypox virus,(July 24, 2022). Important to note that the patient does not have any history of travel abroad. It suggests local transmission of disease.

Ealier three cases of Kerala disease found in people —who arrived from the United Arab Emirates.

Delhi case
31-year-old patient, a resident of Delhi, currently admitted and recovering at isolation ward of Lok Nayak Hospital. He had attended a Stag party in Himachal Pradesh recently

How was the diagnosis confirmed?
The diagnosis has been done by the National Institute of Virology (NIV), Pune using PCR*

What is monkeypox?
Monkeypox is an illness caused by the monkeypox virus. It is a viral zoonotic infection which can spread from animals to humans. It can also spread from person to person.

Monkeypox virus is DNA Virus (unlike SarsCov-2 which is RNA Virus).

Is it primarily transmitted from Monkeys?
No. It was transmitted primarily from Rodents to Humans in Western African countries mainly Nigeria and Congo.

The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in 1958 in Zaire (now Congo). It was later detected in humans in 1970.

Worldwide Spread
Rodents got exported to US and there the virus jumped to piere dogs and then to humans. Current pandemic is witnessing human to human transmission primarily through sexual route.

Mode of transmission:
Close contact and Sexual route is the most important route. Most cases in world have been seen in Gay Men, MSM community is most at risk.
Other routes like mouth to mouth, Direct skin contact, fomites can be infective
Airborne droplets infections are being considered.
Skin lesions, vesicular fluid, scab scrapings are highly infective.

Disease burden:
Nearly 77 Countries more than 16000 cases
Primarily Western Europe

Major Symptoms:
Fever
Backache
Profound weakness
Rash

Signs:
Swollen lymph nodes. This is followed or accompanied by the development of a rash which can last for two to three weeks. *Vasicular Rash on Face, Palms and Soles.
Rash spares trunk.
Symptoms typically last two to three weeks

Incubation period:
6 to 13 days

Period of infectivity
2 days prior to symptoms till all the lesions have healed (count 3 weeks).

Treatment
Symptomatic

Any Effective Anti-viral drug?
👍Yes *Tecovirimat*
Drug is Available in India. It was developed by USA primarily to thwart any potential smallpox virus warfare.

Vaccine:
Smallpox vaccine provides cross immunity against monkeypox in 85% cases
People in age group of 50s and late 40s having two big small pox vaccination marks might be protected

Why the disease is surfacing now?
Because the immunity of population has gone down. Small pox vaccination was abandoned in late 70s. It cross protected against monkey pox.

How to protect?
Isolate the patient till all lesions heal
Give him cloths with long sleeves and long pants
Triple layer mask

Treatment:
Antipyretics, Supportive treatment, hydration good diet
On lesions calamine lotion
Anti Viral to be reserved for immunocompromised and malnourished likely to have complications.

Protection of HCWs
Mask PPE kit
hand washing
80%alcohol
Soap water repeated proper hand washing
Disinfection using 1% Sodium Hypochlorite
Proper disposal of clothing and linen.