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Mint Explainer: Can Covid lessons help fight monkeypox?

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“For the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” said WHO Director-General Tedros Adhanom Ghebreyesus on July 23, while declaring it a public health emergency. But the US has reported cases in children as well, triggering concerns it can spread beyond gays and bisexuals. There is an approved vaccine in the US and Europe now, but demand is expected to soar way beyond supply, as already seen in the US. Experts are talking about social distancing and masks again. India has reported a few cases as well and can’t be complacent.

With all the lessons it learnt from the Covid crisis, can the world stop monkeypox from snowballing?

What is monkeypox?

It’s an illness spread by the monkeypox virus. The name monkeypox comes from its early origins. It was first discovered in 1958 among a cohort of laboratory monkeys kept for research. The first case among humans surfaced over a decade later, in 1972. Monkeypox is a viral zoonotic infection, and can spread from animals to humans.

Monkeypox virus comes from the same family of viruses that causes smallpox. It’s the reason why smallpox vaccines are effective in combating monkeypox as well. However, monkeypox symptoms, while similar to smallpox, are milder and rarely cause fatalities. Monkeypox has no connection with chickenpox as some mistakenly believe.

Before the outbreak this year, monkeypox cases kept surfacing in central and western African countries. The spread of cases beyond Africa earlier was widely a consequence of international travel to and from countries where this virus was endemic.

Already this year, the cases have been more than 16,000 across 75 countries, forcing the WHO to label it a “public health emergency of international concern” (PHEIC). Under the International Health Regulations 2005, countries are legally bound to take notice of a PHEIC and it often leads to a concerted global movement against a disease, with pooling of financial and medical resources. This is the seventh PHEIC declaration by the WHO since 2009 after H1N1 (2009), poliomyelitis (2014), Zika (2015), Ebola (twice, 2013 and 2018) and Covid-19.

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India has come out with detailed guidelines for preventing the spread of monkeypox.

How monkeypox spreads? What are the symptoms?

Common symptoms of monkeypox are fever, headache, muscle aches, back pain, fatigue and swollen lymph nodes. This is accompanied by a rash on some parts of the body such as the face, eyes, mouth, throat, groin and genital and anal regions. The symptoms usually persist for two to three weeks and gradually disappear on their own though some medication may be required for fever or pain. People remain infectious until all the painful lesions drop off and get replaced with a new layer of skin.

Monkeypox spreads through close contact including face-to-face, skin-to-skin, mouth-to-mouth, mouth-to-skin and sexual, according to the WHO. An infected person can also contaminate just about everything in his surroundings with the monkeypox virus, from surfaces to objects to clothes to electronic equipment. The virus can spread through respiratory droplets and short-range aerosols, though scientists are still trying to understand how it transmits through air.

An overwhelming number of infections (90% plus) have been transmitted through sexual contact, reveals a study by the New England Journal of Medicine—about 98% of the infected people covered in this study were gay or bisexual men. But experts have warned against the stigmatisation of a certain section of people. Here’s what the WHO says: “The virus does not only spread through sexual contact, but also through any form of close contact with someone who is infectious. Persons living in the same household are at higher risk. Anyone who has symptoms that could be monkeypox should seek advice from a health worker immediately.” The virus can also spread from mother to the foetus during pregnancy, or from a parent with monkeypox to an infant or child during close contact. 

The WHO says pieces of DNA from the monkeypox virus have been found in semen, but it is not yet known whether infection can spread through semen, vaginal fluids, amniotic fluids, breastmilk or blood. Those at higher risk for severe disease or complications include people who are pregnant, children or immunocompromised, says the WHO.

Monkeypox can spread to people when they come into physical contact with an infected animal, as seen in West and Central Africa. Animal hosts predominantly have been rodents and primates.

How much effective are the vaccines?

New and safe smallpox vaccines have been found effective against monkeypox as well. In fact, one of them has been specifically approved for monkeypox—Jynneos in the US, manufactured by Bavarian Nordic. The EU on Monday also approved this vaccine, marketed there as Imvanex. But matching the soaring demand for the vaccine will be a big challenge. Already, there are long queues outside clinics in the US amid big shortages of the two-dose Jynneos.

Small-pox vaccination stopped globally in 1979 after the disease was eradicated. Vaccine production too was tapered off. It’s not known whether India has the ability to mass-manufacture smallpox vaccines in big numbers if required.

For now, not everybody can get vaccinated. The WHO says only people who are at risk (for example, someone who has been a close contact of someone who has monkeypox) should be considered for vaccination. It does not recommend mass vaccination.

The US Food and Drug Administration (FDA) has sounded a note of caution on vaccines. In the US, along with Jynneos, another vaccine —ACAM2000—is available but may have serious side effects. ACAM2000 can cause myocarditis and pericarditis, says the USFDA. Also, those recently vaccinated with ACAM000 can also infect the unvaccinated with the vaccine virus on close contact. The Jynneos vaccine too can have some side-effects such as muscle pain, headache, fatigue, nausea and chills.

Singapore has cautioned about the benefits of the vaccine. Singapore’s Ministry of Health (MOH) does not recommend mass vaccination against monkeypox. Health Minister Ong Ye Kung said on Monday, “As of now, given the self-limiting nature of the disease, MOH does not recommend the mass vaccination of the whole population against monkeypox, because the benefits do not outweigh the risk.”

How can you prevent getting infected?

The approach to preventing a monkeypox infection is in some ways similar to fighting Covid. Since it spreads by close people-to-people contact, social distancing and wearing masks in public places is already being advised by many experts. A surgical mask will work though obviously an N95 is the safest. The risk of catching monkeypox from animals can be reduced by avoiding unprotected contact with wild animals, especially those that are sick or dead (including their meat and blood). As another precaution, any food containing animal meat or parts should be cooked thoroughly before eating. Thermal scanners can also help monitor people at public places for early symptoms of the illness.

India has come out with detailed guidelines for preventing the spread of monkeypox. People with symptoms such as fever and skin rashes, in an area where monkeypox has been reported, have to immediately consult the nearest health facility.

The Kerala government too has issued detailed SOPs. Anyone with fever and red spots at international airports will be transferred to the nearest hospital with isolation facilities. Doctors have to wear PPE kits while the patients have to wear N95 masks. Also, international travelers have been advised against eating or preparing meat from wild game (bushmeat) or using products (creams, lotions, powders, etc.) derived from wild animals from Africa.

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