2022–2023 mpox outbreak in India

2022–2023 mpox outbreak in India
DiseaseMpox
Virus strainMonkeypox virus (West African clade)
LocationIndia
Index caseKollam, Kerala (First landed and hospitalized in Thiruvananthapuram, infected in the United Arab Emirates)
Date14 July 2022 – ongoing (1 year, 4 months and 6 days ago)
Confirmed cases23
Suspected cases‡0
Deaths
1 [1]
Territories
4 states and 1 union territory
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

The 2022–2023 mpox outbreak in India is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in India on 14 July 2022 when Kerala's State Health Minister Veena George announced a suspected imported case which was confirmed hours later by the NIV. India was the tenth country to report a mpox case in Asia and the first in South Asia. Currently, India has reported 23 cases of mpox.

On 24 July, the first locally transmitted case was reported in Delhi. The individual, a middle-aged male who had no recent history of travelling abroad, was isolated in the Lok Nayak Hospital, New Delhi.

Background

Mpox (formerly known as monkeypox)[2] is an infectious viral disease that can occur in humans and some other animals.[3] Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes.[3] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[4] The time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks.[5] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[6]

The disease is caused by the monkeypox virus,[lower-alpha 1] a zoonotic virus in the genus Orthopoxvirus. The variola virus, the causative agent of the disease smallpox, is also in this genus.[3] Human-to-human transmission can occur through direct contact with infected skin or body fluids, including sexual contact.[3] People remain infectious from the onset of symptoms until all the lesions have scabbed and healed.[6] It may spread from infected animals by handling infected meat or via bites or scratches.[6] Diagnosis can be confirmed by PCR testing a lesion for the virus' DNA.[3]

An outbreak of mpox, a viral disease then commonly known as "monkeypox", was confirmed in May 2022.[7] The initial cluster of cases was found in the United Kingdom,[8] where the first case was detected in London on 6 May 2022[9] in a patient with a recent travel history from Nigeria (where the disease is endemic).[10] On 16 May, the UK Health Security Agency (UKHSA) confirmed four new cases with no link to travel to a country where mpox is endemic. All four cases appeared to have been infected in London.[9] From 18 May 2022 until May 2023, cases were reported from several countries and regions, predominantly in Europe and the Americas but also in Asia, Africa, and Oceania.[17] The outbreak marked the first time mpox had spread widely outside Central and West Africa.

On 23 July 2022, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, declared the outbreak a public health emergency of international concern (PHEIC).[18] As of 18 March 2023, there had been a total of 86,516 confirmed cases in over 113 countries.[19][20] In May 2023, the World Health Organization declared an end to the global health emergency that was declared in response to the worldwide outbreak of the monkeypox virus.[21]

Transmission

Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where mpox is normally found, such as Nigeria, the Democratic Republic of the Congo as well as central and western Africa. It is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. The CDC has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in Africa.[22]

In addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. CDC has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[23]

History

Arrival

On 14 July, a suspected mpox case was reported in the South-Indian state of Kerala by the State health minister Veena George. The patient was reportedly in close contact with a person who tested positive for mpox abroad in the United Arab Emirates, and arrived in India from UAE four days prior to the announcement.[24][25][26]

Hours later, minister Veena George announced that the patient was confirmed to be infected with the mpox disease by the NIV of Pune.

Spread

No community transmission or locally transmitted cases were detected in India until on 24 July, Delhi reported their first case, and the patient had no history of travel from abroad. He recently attended a party in Himachal Pradesh. Although community transmission of the disease in India wasn’t confirmed by the government health officials.

Timeline

Mpox cases in India  ()
     Deaths        Confirmed cases
Date
Cases (rise)
Deaths (rise)
2022-07-14
1(n.a.)
2022-07-15
1(=)
2022-07-16
1(=)
2022-07-17
1(=)
2022-07-18
2(+1)
2022-07-19
2(=)
2022-07-20
2(=)
2022-07-21
2(=)
2022-07-22
3(+1)
2022-07-23
3(=)
2022-07-24
4(+1)

May 2022

June 2022

July 2022

14 July: A suspected mpox case was reported in Kerala. State health minister Veena George said that the patient was in close contact with a person who tested positive for mpox. The patient arrived in India from the United Arab Emirates four days earlier, according to the health minister, and was admitted to a hospital in the state after the patient showed symptoms, and samples were sent to the National Institute of Virology (NIV). It was also reported that tests in local hospitals confirmed that the individual was affected with disease, but still samples were sent to the NIV for confirmation, as per the guideline given by the central government.[24][25][26]

31 July: A 22-year-old man who had been in the United Arab Emirates came back to India. During his stay in the UAE, he had been in contact with another man who also tested positive for the virus. He then tested positive for mpox in the UAE but left the country following the test, he then arrived in his home-district in Thrissur, Kerala on 22 July. At first, he didn't have much symptoms with others in contact with him saying he was actively playing 'football' and other daily activities. On 26 July, he was admitted to a hospital with a fever and the authorities announced a suspected case. On 31 July, he died in the hospital of an unknown cause. It was then reported he died of mpox.[27]

Responses

Central government

After the outbreak was highlighted on mid-May, Union Health Minister Mansukh Mandaviya directed the National Centre for Disease Control (NCDC) and the Indian Council of Medical Research (ICMR) to keep a close watch and monitor the situation. The Union Health Ministry has also directed airport and other port health officers to be vigilant and have been instructed to isolate and send samples to the National Institute of Virology (NIV) in Pune of any sick passenger with a travel history to infected countries.[28]

State and Union territory governments

  • Karnataka: Following the directions of the Union Health Ministry, Karnataka state government directed officials to set up mpox surveilience and set up a two-bed isolation ward in every district hospital to isolate suspected or confirmed cases.[29]
  • Madhya Pradesh: The state health department issued an advisory about pox-related diseases (especially Smallpox and Mpox) on early June. Health Commissioner-and-Secretary Sudam Khade directed all district Chief Medical and Health Officers (CMHOs) to take necessary steps as per the advisory when needed.[30]
  • West Bengal: The West Bengal state government issued an advisory on June. In the advisory, the State Health Department asked hospitals in the state to set up separate facilities to accommodate patients coming from abroad with symptoms and collect and sent samples of suspected patients to the NIV.[31]
  • Uttar Pradesh: On June, Uttar Pradesh Chief Medical Officer issued an advisory for and District Magistrates and other higher health officials of the state to remain alert. The advisory directed that information on patients with fever and rashes to be shared with the office of the CMO.

Others

Cases and Statistics

State/Union Territory District Confirmed Cases Suspected Cases Total Cases References
Bihar Patna — 1 1 [32]
Nalanda — 1 1
State Total — 2 2
Delhi New Delhi — 1 1 [33]
West Delhi 1 — 1
UT Total 1 1 2
Kerala Kannur 1 — 1 [34]
Kollam 1 — 1
Malappuram 1 — 1
State Total 3 — 3
Telangana Khammam — 1 1 [35]
State Total — 1 10
Uttar Pradesh Auraiya — 1 1 [36][37]
Ghaziabad — 2 2
Gautam Buddha Nagar — 1 1
State Total — 4 4
 India 4 8 12 —

Total Cases Graph

See also

Notes

  1. ↑ The World Health Organization (the authority on disease names) announced the new name "mpox" in November 2022. But virus naming is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV), which is currently reviewing all orthopoxvirus species. As of March 2023, the official name of the virus remains "monkeypox virus".[2]

References

  1. ↑ "Kerala youth who died Saturday had tested positive for monkeypox". August 2022.
  2. 1 2 "WHO recommends new name for monkeypox disease" (Press release). World Health Organization (WHO). November 28, 2022. Retrieved November 29, 2022.
  3. 1 2 3 4 5 "WHO Factsheet – Mpox (Monkeypox)". World Health Organization (WHO). April 18, 2023. Archived from the original on April 21, 2022. Retrieved May 21, 2023.
  4. ↑ "Monkeypox". GOV.UK. May 24, 2022. Archived from the original on May 18, 2022. Retrieved May 28, 2022.
  5. ↑ "Mpox Symptoms". U.S. Centers for Disease Control and Prevention (CDC). February 2, 2023. Archived from the original on May 21, 2023. Retrieved May 21, 2023.
  6. 1 2 3 "Mpox (monkeypox)". World Health Organisation. May 12, 2023. Archived from the original on May 23, 2023. Retrieved May 24, 2023.
  7. ↑ "Multi-country monkeypox outbreak in non-endemic countries". World Health Organization. May 21, 2022. Archived from the original on May 22, 2022. Retrieved May 25, 2022.
  8. ↑ "So, Have You Heard About Monkeypox?". The Atlantic. May 19, 2022. Archived from the original on June 23, 2022. Retrieved June 2, 2022.
  9. 1 2 "Monkeypox cases confirmed in England – latest updates". GOV.UK. September 6, 2022. Retrieved September 25, 2022.
  10. ↑ "Monkeypox – United Kingdom of Great Britain and Northern Ireland". World Health Organization. May 16, 2022. Archived from the original on May 17, 2022. Retrieved May 17, 2022.
  11. ↑ "Viruela del mono: confirmaron el primer caso del virus en el país" (in Spanish). May 26, 2022. Archived from the original on June 24, 2022. Retrieved May 26, 2022.
  12. ↑ "UAE reports first case of monkeypox in the country". Al Arabiya. May 24, 2022. Archived from the original on May 24, 2022. Retrieved May 24, 2022.
  13. ↑ Efrati, Ido. "Israel Confirms First Case of Monkeypox Virus". Haaretz. Archived from the original on May 20, 2022. Retrieved May 21, 2022.
  14. ↑ "Monkeypox confirmed in Melbourne and Sydney". Australian Broadcasting Corporation. May 20, 2022. Archived from the original on May 20, 2022. Retrieved May 20, 2022.
  15. ↑ "Morocco Reports First Monkeypox Case". Morocco World News. Archived from the original on June 21, 2022. Retrieved June 2, 2022.
  16. ↑ "5 cases of monkeypox confirmed in Ghana". MyJoyOnline.com. Archived from the original on June 21, 2022. Retrieved June 8, 2022.
  17. ↑ [11][12][13][14][15][16]
  18. ↑ "WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern". World Health Organization (WHO). July 23, 2022. Retrieved August 4, 2022.
  19. ↑ "Monkeypox Data Explorer". OurWorldInData. Archived from the original on June 28, 2022. Retrieved May 27, 2022.
  20. ↑ Kozlov, Max (July 25, 2022). "Monkeypox declared a global emergency: will it help contain the outbreak?". Nature. doi:10.1038/d41586-022-02054-7. PMID 35879614. S2CID 251067503.
  21. ↑ Kimball, Spencer (May 11, 2023). "WHO says mpox outbreak, the largest in history, no longer global health emergency". CNBC. Retrieved May 11, 2023.
  22. ↑ Vargas, Ramon Antonio (June 7, 2022). "US raises monkeypox alert level but says risk to public remains low". the Guardian. Retrieved June 9, 2022.
  23. ↑ "Monkeypox update: Where the outbreak stands now".
  24. 1 2 "Suspected Monkeypox Case Found in Kerala, Samples Sent for Testing". News18. July 14, 2022. Retrieved July 18, 2022.
  25. 1 2 "Suspected Monkeypox Case In Kerala, Traveller From UAE Being Tested". NDTV. July 14, 2022. Retrieved July 18, 2022.
  26. 1 2 "Monkeypox Virus: Suspected monkeypox case found in Kerala, samples sent for testing | Thiruvananthapuram News - Times of India". Times of India. July 14, 2022. Retrieved July 18, 2022.
  27. ↑ "Youth who died in Kerala's Thrissur succumbed to monkeypox, says health dept after NIV confirms". The Indian Express. August 1, 2022. Retrieved August 1, 2022.
  28. ↑ "Monkeypox outbreak: India to screen arrival for virus signs, isolate sick patients; details here". Zee News. May 21, 2022. Retrieved July 17, 2022.
  29. ↑ "Monkeypox: Karnataka asks districts to step up surveillance". The Hindu. June 6, 2022. ISSN 0971-751X. Retrieved July 17, 2022.
  30. ↑ "Bhopal: It is necessary to isolate in chicken pox, monkeypox diseases, health department advisory to CMHOs". Free Press Journal. June 4, 2022. Retrieved July 17, 2022.
  31. ↑ "Monkeypox outbreak: West Bengal government on alert, issues advisory". Zee News. May 27, 2022. Retrieved July 17, 2022.
  32. ↑ "Bihar: After Patna Suspected Case of Monkeypox Detected in Nalanda, Sample Sent to Pune". India.com. July 27, 2022. Retrieved July 27, 2022.
  33. ↑ "Monkeypox suspect with foreign travel history admitted to Delhi's LNJP Hospital". The Economic Times. July 26, 2022. Retrieved July 27, 2022.
  34. ↑ "India reports third case of monkeypox in Kerala". The Hindu. July 22, 2022. ISSN 0971-751X. Retrieved July 27, 2022.
  35. ↑ "One more suspected case of monkeypox in Telangana". Telangana Today. July 26, 2022. Retrieved July 27, 2022.
  36. ↑ "Suspected monkeypox case reported in Noida; patient in home isolation". Hindustan Times. July 27, 2022. Retrieved July 27, 2022.
  37. ↑ "Ghaziabad On Alert After Suspected Case of Monkeypox". India.com. July 27, 2022. Retrieved July 27, 2022.
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