2022 monkeypox outbreak in India

The 2022 monkeypox outbreak in India is a part of the ongoing outbreak of human monkeypox 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 monkeypox case in Asia and the first in South Asia. Currently, India has reported ten confirmed cases of monkeypox, three of them in Kerala and five in Delhi, and eight suspected cases, one case each in Delhi and Telangana, four in Bihar and four in Uttar Pradesh.

2022 monkeypox outbreak in India
DiseaseMonkeypox
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 (3 months, 2 weeks and 6 days ago)
Confirmed cases4
Suspected cases‡13
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.

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
These paragraphs are an excerpt from Monkeypox and 2022 monkeypox outbreak.

Monkeypox is an infectious viral disease that can occur in humans and some other animals.[2] Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over.[2] The time from exposure to onset of symptoms ranges from five to twenty-one days.[3][4] The duration of symptoms is typically two to four weeks.[4] There may be mild symptoms, and it may occur without any symptoms being known.[3][5] The classic presentation of fever and muscle pains, followed by swollen glands, with lesions all at the same stage, has not been found to be common to all outbreaks.[2][6] Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.[7]

The disease is caused by the monkeypox virus, a zoonotic virus in the genus Orthopoxvirus.[8] The variola virus, the causative agent of smallpox, is also in this genus.[9] Of the two types in humans, clade II (formerly West African clade)[10] causes a less severe disease than the Central African (Congo basin) type.[11] It may spread from infected animals by handling infected meat or via bites or scratches.[12] Human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route.[2][12] People can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted.[11] Diagnosis can be confirmed by testing a lesion for the virus's DNA.[13]

There is no known cure.[14] A study in 1988 found that the smallpox vaccine was around 85% protective in preventing infection in close contacts and in lessening the severity of the disease.[15] A newer smallpox and monkeypox vaccine based on modified vaccinia Ankara has been approved, but with limited availability.[3] Other measures include regular hand washing and avoiding sick people and animals.[16] Antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin and the smallpox vaccine may be used during outbreaks.[17][18] The illness is usually mild and most of those infected will recover within a few weeks without treatment.[18] Estimates of the risk of death vary from 1% to 10%, although few deaths as a consequence of monkeypox have been recorded since 2017.[19]

An ongoing outbreak of monkeypox, a viral disease, was confirmed in May 2022.[20] The initial cluster of cases was found in the United Kingdom,[21] where the first case was detected in London on 6 May 2022[22] in a patient with a recent travel history from Nigeria (where the disease is endemic).[23] On 16 May, the UK Health Security Agency (UKHSA) confirmed 4 new cases with no link to travel to a country where monkeypox is endemic. All four cases appeared to have been infected in London.[24] From 18 May onwards, cases were reported from an increasing number of countries and regions, predominantly in Europe but also in North and South America, in Asia, in Africa, and in Oceania.[31] The outbreak marks the first time monkeypox has spread widely outside Central and West Africa.

On 23 July, the Director-General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, declared the outbreak a public health emergency of international concern (PHEIC).[32] As of 15 October, there had been a total of 73,087 confirmed cases in over 109 countries.[33][34]

Transmission
Stages of lesion development.

A large portion of those infected were believed to have not recently traveled to areas of Africa where monkeypox 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.[35]

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 monkeypox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes.[36]

History

Arrival

On 14 July, a suspected monkeypox 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 monkeypox abroad in the United Arab Emirates, and arrived in India from UAE four days prior to the announcement.[37][38][39]

Hours later, minister Veena George announced that the patient was confirmed to be infected with the monkeypox 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
Monkeypox 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)

July 2022

14 July: A suspected monkeypox 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 monkeypox. 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.[37][38][39]

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 monkeypox 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 monkeypox.[40]

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.[41]

State and Union territory governments
  • Karnataka: Following the directions of the Union Health Ministry, Karnataka state government directed officials to set up monkeypox surveilience and set up a two-bed isolation ward in every district hospital to isolate suspected or confirmed cases.[42]
  • Madhya Pradesh: The state health department issued an advisory about pox-related diseases (especially Smallpox and Monkeypox) 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.[43]
  • 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.[44]
  • 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.

Cases and Statistics
State/Union Territory District Confirmed Cases Suspected Cases Total Cases References
Bihar Patna — 1 1 [45]
Nalanda — 1 1
State Total — 2 2
Delhi New Delhi — 1 1 [46]
West Delhi 1 — 1
UT Total 1 1 2
Kerala Kannur 1 — 1 [47]
Kollam 1 — 1
Malappuram 1 — 1
State Total 3 — 3
Telangana Khammam — 1 1 [48]
State Total — 1 1
Uttar Pradesh Auraiya — 1 1 [49][50]
Ghaziabad — 2 2
Gautam Buddha Nagar — 1 1
State Total — 4 4
 India 4 8 12 —

Total Cases Graph

See also

References
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