Ministry health

Explained | What are the Ministry of Health guidelines on monkeypox?

Why is India on high alert? What are the origins, symptoms and likely modes of transmission?

Why is India on high alert? What are the origins, symptoms and likely modes of transmission?

The story so far: The Indian Ministry of Health has issued guidelines on the management of monkeypox. So far, no cases of the virus have been confirmed in India, but reports of the spread of the virus in non-endemic countries have led to guidelines being issued.

What do the guidelines say?

The 23-page document, available on the Ministry of Health website, is a fact sheet that lists the global prevalence of the disease as of May 31, its epidemiology or characteristics, including the type of virus that causes the disease, its likely origins, incubation period, how long before until the symptoms appear, etc. It also highlights the time it takes to abate, modes of transmission, symptoms, likely modes of exposure, testing to confirm presence of the virus, government surveillance strategy in place to identify cases and clusters of infection.

What are the most important recommendations?

The guidelines recommend that contacts be monitored daily for the onset of signs/symptoms for a period of 21 days (as per case definition) from the last contact with a patient or their contaminated material during the infectious period. Suspected cases of monkeypox include a person of any age who has traveled to affected countries within the past 21 days and presents with an unexplained acute skin rash and one or more symptoms including swollen lymph nodes, fever, headache / body and deep weakness. .

Other symptoms include eye pain or blurred vision, shortness of breath, chest pain, difficulty breathing, impaired consciousness, seizures, decreased urine output, poor oral absorption, and lethargy.

A case of monkeypox is laboratory confirmed by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing, much like a test for COVID-19. However, commercial tests for monkeypox are not yet available and all clinical specimens must be transported to the state-of-the-art laboratory at ICMR-NIV (Pune) routed through the Integrated Disease Surveillance Program (IDSP) network of the respective district/state.

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There is no specific treatment protocol or medication for monkeypox and a patient should be managed based on the symptoms they present with. For example, dehydration should be treated with oral fluids; fever with sponge and paracetamol, nausea and vomiting with antiemetics.

What is the prevalence of monkeypox worldwide?

The World Health Organization said cases of monkeypox have been reported in 12 member states that are not endemic for the monkeypox virus. Cases reported so far have not established travel links to endemic areas. Based on currently available information, the cases were primarily, but not exclusively, of men who have sex with men (MSM) seeking care at primary care and sexual health clinics.

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To date, all cases whose samples have been confirmed by PCR testing have been identified as being infected with the West African clade of the virus. The genome sequence of a swab sample from a confirmed case in Portugal indicated a close match between the monkeypox virus causing the current outbreak and cases exported from Nigeria to the UK. United, Israel and Singapore in 2018 and 2019. Countries where the virus was endemic are, according to WHO, Benin, Cameroon, Central African Republic, Democratic Republic of Congo, Gabon, Ghana (identified in animals only ), Côte d’Ivoire, Liberia, Nigeria, Republic of Congo, Sierra Leone and South Sudan.

Are there any vaccines?

Historically, smallpox vaccination has been shown to be protective against monkeypox. While a vaccine (MVA-BN) and specific treatment (tecovirimat) were approved for monkeypox, in 2019 and 2022 respectively, they are not widely available. A smallpox vaccination is said to protect against monkeypox, but this vaccine would relate to people over the age of 40 to 50, who have been inoculated with the smallpox vaccine and, here too, the duration of protection is not clear.

  • Ministry of Health guidelines recommend that contacts be monitored daily for the onset of symptoms for a period of 21 days from the last contact with a patient or their contaminated material during the infectious period.

  • Suspected cases of monkeypox include a person of any age who has traveled to affected countries within the past 21 days and presents with an unexplained acute skin rash and one or more symptoms including swollen lymph nodes, fever, headache / body and deep weakness. .

  • A case of monkeypox is laboratory confirmed by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing, much like a test for COVID-19. There is no specific treatment protocol or medication for monkeypox and a patient should be managed based on the symptoms they present with.