First confirmed monkeypox case in India

Context

India’s first confirmed monkeypox case has been reported in a 35-year-old male in Kerala, who reached the State capital three days ago from the UAE.

What is monkeypox?

• Monkeypox is caused by the monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.
• It is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe.
• With the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health.
• It primarily occurs in central and west Africa, often in proximity to tropical rainforests, and has been increasingly appearing in urban areas. 
• Animal hosts include a range of rodents and non-human primates.
  

Transmission

• Animal-to-human (zoonotic) transmission can occur from direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals.
• Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.
  

Symptoms

• The incubation period (interval from infection to onset of symptoms) is usually from 6 to 13 days but can range from 5 to 21 days.
• Monkeypox is usually a self-limited disease with symptoms lasting from 2 to 4 weeks. Severe cases can occur. The case-fatality ratio has been around 3–6% in recent times.
• The infection can be divided into two periods:
• The invasion period (which lasts between 0–5 days) is characterized by fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, muscle aches, and lack of energy. Lymphadenopathy is a distinctive feature of monkeypox compared to other diseases that may initially appear similar (chickenpox, measles, smallpox).
• The skin eruption usually begins within 1–3 days of the appearance of fever.
  
  

History of a monkeypox outbreak

• Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-month-old boy in a region where smallpox had been eliminated in 1968.
• Since 1970, human cases of monkeypox have been reported in 11 African countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.
• Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately 3%. Cases continue to be reported until today.
• In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs.
• Monkeypox has also been reported in travelers from Nigeria to Israel in 2018, to the United Kingdom in 2018, 2019, 2021, and 2022, to Singapore in 2019, and to the United States of America in 2021.
• In May 2022, multiple cases of monkeypox were identified in several non-endemic countries.