Monkeypox

           Monkeypox (MPX) / Clade 1&Clade ll

The first thing everyone should know about monkeypox is that it actually has very little to do with monkeys. It derived its name from the fact that it was first discovered in 1950, when two outbreaks of  a disorder resembling pox started to appear in groups of monkeys in a lab in Denmark.

An ongoing outbreak of monkeypox, a viral disease,  was confirmed in May 2022. The initial cluster of cases was found in the United Kingdom, where the first case was detected on 6 May 2022 in an individual with travel links to Nigeria  (where the disease is endemic). The outbreak marked the first time monkeypox has spread widely outside Central and West Africa. 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 Australia. On 23 July, the World Health Organization  (WHO) declared the outbreak a public health emergency of international concern (PHEIC), raising the status of the outbreak to a global health emergency.

First identified in monkeys, the virus is transmitted chiefly through close contact with an infected person. Until this year, the viral disease has rarely spread outside Africa where it is endemic. But reports of a handful of cases in the United Kingdom in early May signalled that the outbreak had moved into Europe.

The first suspected case of monkeypox reported in Telangana was of a person named Ibrahim with travel history from Kuwait on 6 July. He has been isolated at fever hospital. Mainly, travelers from Africa are being monitored 

India's first Monkeypox patient completely cured.

New York declares public health emergency as monkeypox infections spreads.

In Africa, the only continent where the virus has been endemic for decades, infections are mostly a result of household transmission, not sex between men. Women account for about 40% of cases there, because they're typically the ones who care for the sick,

Monkeypox

      "No need to panic as monkeypox disease self-limiting, fatality rate low, say experts".

Almost maximum  infections among men who have sex with men (MSM).

                                "Strain detected in India not linked to Europe outbreak".

India total cases 10

Death 1

• Kerala 5
• Delhi 5

Introduction

Updated on 19th Sept 2022

WORLD

Countries Affected 92 (Maximum cases from Europe and America)

Hong Kong

India 14

China 1

Total cases 35,000

Death  12

INDIA 13

Delhi 9

Kerala 5

The south Indian state has also reported one death due to the viral disease. The infection unlike Covid 19 is not easily airborne and transmit through direct contact with bodily fluids or the lesion of the infected person. It can also spread through indirect contact with leision material such as through contaminated clothing's or linen.

What is monkeypox?

Monkeypox Virus (DNA Virus)

Monkeypox is an illness caused by the monkeypox virus. It is a viral zoonotic infection which can spread from animals to humans. It can also spread from person to person.

Monkeypox virus is DNA Virus (unlike SarsCov-2 which is RNA Virus).

Renaming Monkeypox

While the clade formerly known as the Congo Basin or Central African clade will now be referred to as clade I, while the West African clade will be called clade II. 

Is it primarily transmitted from Monkeys?

No. It was transmitted primarily from Rodents to Humans in Western African countries mainly Nigeria and Congo. 

The term “bushmeat” refers to raw or minimally processed meat that comes from wild animals in certain regions of the world including Africa and may pose a communicable disease. Bushmeat comes from a variety of wild animals, including bats, nonhuman primates (monkeys), cane rats (grasscutters), and duiker (antelope)

The disease is called monkeypox because it was first identified in colonies of monkeys kept for research in 1958 in Zaire (now Congo). It was later detected in humans in 1970. 

Update on 17rd Sept 2022

A new strain of monkeypox have been identified in the UK . The strain whose preliminary genomic sequencing showed it is different from the current strain circulating in the UK. It was found on an individual who has recently returned from West Africa. The individual was admitted to the high consequence infectious disease (HCID) unit of  royal Liverpool University Hospital.

Case fatality Rate 

 3-6%

The incubation period is usually from six to 13 days and the case fatality rate of monkeypox has historically ranged up to 11 per cent in the general population and higher among children. In recent times, the case fatality rate has been around three to six per cent.

Worldwide Spread

Rodents got exported to US and there the virus jumped to Pierre dogs and then to humans. Current  pandemic is witnessing human to human transmission primarily through sexual route.

Prairie dogs (genus Cynomys) are herbivorous burrowing ground squirrels native to the grasslands of North America. Within the genus are five species: black-tailed, white-tailed, Gunnison's, Utah, and Mexican prairie dogs.

Pierre Dog (Ground Squirrels)

Mode of transmission: 

Close contact and Sexual route is the most important route. Most cases in world have been seen in Gay Men, MSM community is most at risk.

Other routes like mouth to mouth, Direct skin contact, fomites can be infective

Airborne droplets infections are being considered.

• Skin lesions, vesicular fluid, scab scrapings are highly infective. 

Disease burden: 

Nearly 78 Countries more than 18000 cases 

Primarily Western Europe 

Incubation period:

(The interval from the infection to onset of symptoms i. e  the incubation period of monkeypox.) It may take days or weeks to develop symptoms after exposure to the virus.

6 to 13 days 

Period of infectivity 

2 days prior to symptoms till all the lesions have healed (count 3 weeks).

Suspected Case

Any person having a history of travel to affected countries within the last 21 days presenting with an unexplained acute rash and symptoms like swollen lymph nodes, fever, headaches, body aches and profound weakness is to be considered to be a 'suspected case'.

Contacts

Contacts : The guidelines stated that a contact is defined as a person who, in the period beginning with the onset of the source case's first symptoms, and ending when all scabs have fallen off, has had one or more of the exposures-- face-to-face exposure, direct physical contact, including sexual contact, contact with contaminated materials such as clothing or bedding --- with a probable or confirmed case of monkey pox.

Cases can be prompted to identify contacts across household, workplace, school/nursery, sexual contacts, healthcare, houses of worship, transportation, sports, social gatherings, and any other recalled interactions.

Contacts should be monitored at least daily for the onset of signs/symptoms for a period of 21 days from the last contact with a patient or their contaminated material during the infection period. In case of occurrence of fever clinical/lab evaluation is warranted.

Asymptomatic contacts should not donate blood, cells, tissue, organs or semen while they are under surveillance.

Pre-school children may be excluded from day care, nursery, or other group settings.

The ministry guidelines state that human-to-human transmission occurs primarily through large respiratory droplets generally requiring prolonged close contact.

International passengers have been asked to avoid contact with dead or live wild animals such as small mammals including rodents like rats and squirrels and non-human primates like monkeys and apes.

Symptoms typically last two to three weeks

Major Symptoms:

Symptoms of monkeypox include lesions which usually begin within one to three days from the onset of fever, lasting for around two to four weeks and are often described as painful until the healing phase when they become itchy. A notable predilection for palm and soles is characteristic of monkeypox

MONKEYPOX : A vesicle is a small fluid-filled blister on the skin

Signs:

• High Fever 2-3 weeks
• Headache
• Bodyache
• Backache
• Swollen lymph nodes. 
• Fatigue, Profound weakness 
• Rash : A rash typically develops after a few days.
• Pus releasing blisters : Eventually they turn into pus releasing blisters. 
• It may take 2-4 weeks for the blisters to dry out and start to peel off.
• It's also possible to develop lesions in the mouth and genitals.
• The skin lesions in monkey pox could be all over the body. The blisters with fluid could be all over the body like the small pox virus. The small blisters are shown with redness around them. These vesicles will break, crust over, scab, and finally heal
• Vesicle
• Pustules
• Umblicated late lesions
• Ulcers
• Pain 2-3 weeks
• This is followed or accompanied by the development of a rash which can last for two to three weeks.  
• Respiratory symptoms
• Joint pain
• Single leision on mouth or on genital.

Lesions progress through the following stages before falling off:

• Macules

• Papules

• Vesicles

• Pustules

• Scabs

the skin eruption usually begins within 1–3 days of appearance of fever. The rash tends to be more concentrated on the face and extremities rather than on the trunk. It affects the face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of cases). Also affected are oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (20%), as well as the cornea. The rash evolves sequentially from macules (lesions with a flat base) to papules (slightly raised firm lesions), vesicles (lesions filled with clear fluid), pustules (lesions filled with yellowish fluid), and crusts which dry up and fall off. The number of lesions varies from a few to several thousand. In severe cases, lesions can coalesce until large sections of skin slough off.

Vascular Rash

Vascular Rash on hand

Transmissibility

The virus is not highly transmissible but one has to be cautious. Animal to human transmission occurs from direct contact with blood, body fluids or mucosal lesion of infected  animals.

Human to human transmission results from close contact with respiratory secretions, skin lesion of infected person or recently contaminated objects. The role of sexual transmission is also studied.

Risk Involved

Monkeypox is not usually fatal and has no long term detrimental health implications, unlike Covid 19. However patients with week immunity may get secondary infections of lungs and the central nervous system. In severe cases it may lead to Pneumonia and affect the brain.

Complications 

• Pain in eyes / blurred vision.
• Difficulty in breathing.
• Chest pain
• Seizures
• Decrease in urine output.

Can kids catch monkeypox virus?

Children can also get monkeypox if they have close contact with someone who has symptoms. There, however, have been a small number of kids with monkeypox in the current outbreak.

Monkeypox vs Chickenpox

The symptoms of many viral diseases are similar. People should seek medical care....Symptoms of Shingles, Hand foot and mouth disease. herpes Zoster, fungal infection is are also similar. The initial symptoms of viral disease are similar, so there could be some confusion. People should seek medical help. 

Due to genetic similarities between chickenpox and monkeypox viruses, there is often a confusion between the two diseases.. 

• Both chickenpox and Monkeypox are self limiting viral diseases
• The duration of infection in monkeypox is 3-4 weeks and in chickenpox it is 2 weeks.
• The chickenpox virus is highly contagious, while monkeypox virus has a low transmission ratio.
• In contrast to chickenpox, monkeypox is less severe.
• Monkeypox lesions are larger and Non-itchy whereas the chickenpox lesions are smaller and itchy. 
• In monkeypox, early symptoms include patterns of rashes that starts from the mouth and spread to the extremities involving palms and soles, and swollen lymph nodes.
• Monkeypox patients get skin eruptions that are bigger in size as compared to those in chickenpox.
• In case of Monkeypox the eruption may also manifest on the palms and soles of the feet. Which is not the case in chickenpox.

Monkeypox is a viral zoonosis ( a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients. However, according to the World Health Organization (WHO) it is clinically less severe than smallpox.

A virus originally from animals, now seen in humans. Infections spreading rapidly from one country to another, numbers rising and descriptions of unpleasant and dangerous symptoms abound. Genome sequencing reports from  two monkeypox patients from Kerala suggests they were infected with  the A2  strain of virus, different from the one causing the monkeypox outbreaks in Europe. Both the cases have travel history. They have travel links  to Middle East or West Africa. 

The A2 strain which has largely been found in the US and Thailand, has been linked to  major cluster or super spreader events, unlike the B1which has been found in large parts of Europe.

In the current outbreak, some patients experience only a single lesion in the mouth or on the genitals, making it more difficult to differentiate from other infections

All the viruses over the time  undergo slow evolution and as they evolve, they form into different evolutionary branches. There is no cause of panic or alarm. There are two outbreaks of monkeypox that are going on simultaneously A.2 and B.1

Perhaps the most important and the most misunderstood aspect of the circulating monkeypox (MPX) is that this is distinct from Sars CoV2 including in the type of virus whom it infects, the disease it causes and possibly the immune response. This is a disease caused by DNA Virus that has been in West and Central Africa for over 50 years with continuing cases reporting in more recent times. In 2022 there has been a sharp increase of detection and reporting across multiple countries outside Africa, mostly in the western world. In general DNA viruses do not evolve quickly, but the monkey pox circulating now appears to have  acquired a number of mutations, which have been proposed by some researchers to be responsible for the  potential sustains circulations in humans for the past five years. Not all researchers agree and the rapid increase in just the past few months has led to questions about why now ? The pattern of infections and how best to control the spread.

        "Monkeypox has been declared as a public health emergency of international concern."

This is the time when world needs to work together to establish mechanisms to share data, anticipate and prepare for detection and diagnosis of cases and implement measures for control and medical management.

This is a self limiting disease in healthy people. which can be managed at home with symptomatic treatment. While self limiting the leisions, particularly ulcers. The fever and the pain can be challenging for the two-three weeks needed for recovery. Children and people with underlying conditions particularly those who are immuno-comprimized can have more severe disease and could die. Although the case fatality rate with the currently circulating strain is estimated at 3-6% in Africa. There have been so far , no deaths outside Africa.

In the current global outbreak, the bulk of cases have been reported in men who have sex with men (MSM) , although there are a small number of cases in women, children and house hold contacts. While Monkeypox is not a sexually transmitted disease in the traditional sense, most but not all, transmission is believed to have taken place through skin to skin contact during sexual encounter.

We have incomplete knowledge about how this outbreak  has evolved, and what the future holds. But based on public health principles, we can and must decide on what should be done today., and adopt our strategies as new information emerges.. The first and most important principle is that, as with any infectious disease, we have shared responsiblity- the government and its policies, the health care providers and the community particularly and the groups that are particularly at highest risk.

Health care workers and the public should be  educated about the  symptoms  and about unusual presentations. While a fever, respiratory symptoms and a rash that progresses to vesicles, pustules and  umblicated late lesions are common ulcers, joint pains and fatigue. With few leisions may also be seen so clinical diagnosis must be  strengthen along with testing.

The government must support potentially affected individuals to get tested. This will require expanding the availability of testing at both public  and private facilities. Testing at a restricted number of "authorizes" facilities will lead to many people not reporting symptoms or getting tested. At least two Indian companies have already made PCR Teats and these should be made widely available in public and private laboratories. The government should focus on  ensuring the quality of testing, including sequencing and on collating and sharing data to inform and estimate the impact of isolation and other control measures.

Once an infection is identified the person must be encouraged to isolate, preferably at home, and only if very ill or if the domestic environment is not conductive to isolation than at a public or private health care facility. If India follows rest of the world in the communities that are most affected, then men who have sex with men must be educated about the disease and encouraged to test and isolate, as needed. This is less likely to happen if there is labeling and stigmatization. Isolation to prevent further transmission is essential, and whether at home , or in a facility. Infected individuals should be supported and not castigated.

Along with expanding clinical and diagnostic capacity, contact tracing must be strengthen. The acquisition of infection in a case without travel history is an indication that cases are going undetected. However, converting isolation and contact tracing into a law and order situation as was done during the early phase of  the Sars Cov2 pandemic, will have consequences with monkeypox, driving infected people to hide.

The government and media play an important role in describing both the potential threat and the strategy for control. For men who have sex with men and others who are not in monogamous relationship, it is important to provide information on disease and its mode of  transmission, as well as advice on restricting sexual partners at this time.

Monitoring and responding to cases require data systems that track information on individuals in a single integrated database. This was a hard lesson from the separation of the Sars Cov2 testing and vaccination information and not linking sequencing early and at scale. There is no need to repeat such mistakes.

The information from India should be shared globally, even as we design and conduct studies that inform strategies for control and build greater understanding of the virus and the infection. Linking to the world is important to establish early excess to drugs and vaccines even though the amounts that will be required will be relatively limited and can be further restricted through appropriate public health measures. Sufficient testing kits should be available.

Three cases of Kerala disease found in people who arrived from the United Arab Emirates.

It is not as contagious as Covid 19.  It requires close skin-to-skin or face-to-skin or face-to-face contact for transmission. And this can only occur in very close household contact or when health care personnel come in contact with the patients. The fatality so far has been very low. It is a self-limiting disease. "We just need to stay alert and vigilant. The focus should be on contact tracing and surveillance. If we keep the patient in isolation and do timely testing, then there is no need to worry. The situation will remain under control. 

 Animal-to-human transmission may occur by bite or scratch of infected animals or through bush meat preparation.

More than 70% of monkeypox cases have been reported from the European Region, and 25% from the Region of the Americas, the WHO said. So far, five deaths have been reported, and about 10% of cases are admitted to hospital to manage the pain caused by the disease,

                   "Preventive measures can help control the spread of Monkeypox."

Hong Kong reported its first case on sept 6 in an international traveler flying from the Philippines state run

In Delhi, the first case of monkeypox was reported on July 24. 2022.

Nigerian is 8th monkeypox patient, 30 year old Nigerian women living in Delhi has tested positive for Monkeypox. The women is undergoing treatment in Delhi's Lok Nayak Hospital, the nodal center for managing monkeypox cases in the city. All patients are stable 

A 30 year old women from Nigeria living in Delhi. The women who tested positive on Monday  19th sept is stable and recovering well. All other patients have been discharged. As most patients in capital do not have travel history. Expert studying the disease believe that there could be a possibility of more cases within the community.

China reports first monkeypox case.

Preventive measures that can control the spread of Monkeypox

• Home to home transmission can result from close contact with respiratory secretions or skin leisions of an infected person.
• Transmission via respiratory particles requires prolonged face to face contact.
• Transmission can also occur via the placenta from mother to fetus or during close contact during and after birth. While close physical contact is a risk factor, it is unclear if  monkeypox can be  transmitted specifically through sexual routes.
• The chief of the global health body said that monkeypox vaccines may also play an important part in controlling the outbreak, and in many countries there is high demand for vaccines from the affected communities. 

Do's

• Disinfection using 1% Sodium Hypochlorite
• Proper disposal of clothing and linen.
• Isolate the patient till all lesions heal 
• Give him cloths with long sleeves and long pants 
• Follow a vitamin C rich diet, which includes amla, lemons, guavas, grapes, oranges, and papayas, to promote the body's cellular processes and act as a immunity booster.
• Increase your intake of selenium, a potent anti-oxidant that safeguards the body from oxidative stress. It is found in eggs
• Cook all foods containing meat or other animal products well.
• Wash your hands with soap and water frequently.
• Wear a  triple layer mask  in public and crowded places.
• Maintain social distancing
• Follow hand hygiene
• If travelling from a country which has reported monkeypox, look out for symptoms such as fever and skin eruptions.
• Isolate if symptoms appear.
• Contact a health professional
• Practice safe sex.
• When providing medical care to those who have the virus, put on personal protective equipment (PPE) kit.
• Protect health care workers.
• Sanitizer 80% alcohol.

Don'ts

• Do not use contaminated items, such as beddings.
• Travellers should be extremally vigilant and look for symptoms.
• Avoid contact with animals that are afflicted with the virus, specially sick or dead animals.
• Do not panic.
• Do not ignore symptoms
• Do not pick on leisions.
• Do not stigmatize people who have been infected.
• Do not start home treatment.

How dangerous is monkeypox disease?

Monkeypox is a virus that typically causes mild symptoms including fever, aches, and pus-filled skin lesions. People tend to recover within two to four weeks, according to the WHO.
Anyone can spread the virus, but the current outbreak outside of Africa is concentrated almost exclusively among men who have sex with men.
Monkeypox spreads primarily via intimate skin-to-skin contact, usually with someone who has an active rash, as well as via contact with contaminated clothes or bedding. It is not as easily transmitted as the SARS-CoV-2 virus that spurred the COVID-19 pandemic.
"COVID is spread by the respiratory route and is highly infectious. This doesn`t appear to be the case with the monkeypox," said Dr Martin Hirsch of Massachusetts General Hospital.
The risk of monkeypox is moderate globally, except in Europe, where the WHO has deemed the risk as high.

The fatality rate in preceding monkeypox outbreaks in Africa of the strain currently spreading has been around 1%, but so far this outbreak appears to be less lethal in the non-endemic countries, many of which have stronger healthcare infrastructure.

 

Monkeypox vesicles

          "INDIA REPORTS FIRST MONKEYPOX DEATH FROM KERALA."                

Social Stigma

In countries where homophobia and life-threatening discrimination is rife, many people may not seek help, World Health Organization Director General Tedros Adhanom Ghebreyesus has warned, "making the outbreak much harder to track, and to stop." 

In India, stigma remains a pervasive social barrier. The country decriminalized homosexuality in 2018. The same year, a survey of 290 students attending Calcutta National Medical College in Kolkata found that, although overall attitudes toward homosexuality were positive, 16% believed that homosexuality was an illness and 27% saw it as an "acquired behavior." 

That may have been a consideration for a 22-year-old man who tested positive for monkeypox in the United Arab Emirates in mid-July, days before returning home to India where he experienced fever and swollen lymph glands. He was hospitalized in Thrissur, a city in the south Indian state of Kerala, and developed brain-swelling and required breathing support before he died. He was already in critical condition when the patient's relatives told hospital staff about his monkeypox diagnosis.

In the context of monkeypox, where infections are currently occurring mostly via sexual networks, identifying contacts is a sensitive issue, especially if it forces people to disclose their sexual orientation, . "They're contact tracing every 'Tom, Dick and Harry' they have come in touch with," he said. "You are identifying people indirectly."

Genetic sequencing of virus specimens from other patients in Kerala indicated that monkeypox might have been circulating in the state for some time before it was reported.

                                "Strain detected in India not linked to Europe outbreak".

How was the diagnosis confirmed?

A case is considered laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing.

The diagnosis has been done by the National Institute of Virology (NIV), Pune using PCR Test

Monkeypox (Orthopoxviral), DNA PCR TEST. 

The PCR test which is done from skin lesions and throat swabs.

 Polymerase chain reaction (PCR) is the preferred laboratory test given its accuracy and sensitivity. For this, optimal diagnostic samples for monkeypox are from skin lesions – the roof or fluid from vesicles and pustules, and dry crusts. Where feasible, biopsy is an option. Lesion samples must be stored in a dry, sterile tube (no viral transport media) and kept cold. PCR blood tests are usually inconclusive because of the short duration of viremia relative to the timing of specimen collection after symptoms begin and should not be routinely collected from patients.

Roche develops Monkey PCR Test

• Detected: A non-variola orthopoxvirus was detected. In addition to monkeypox, there are several viral species in the genus orthopoxvirus. But since there are no current epidemiological concerns about those other viruses, a positive result is presumptive positive for monkeypox. Variola is the virus that causes smallpox. This test will not detect smallpox.
• Not Detected: This means that an orthopoxvirus was not detected, and the patient is therefore negative for monkeypox.
• Equivocal: This result can occur when the virus is detected at levels close to the limit of detection of the assay, and a definitive result cannot be determined. For any equivocal result, the CDC recommends that a new patient sample is collected and tested.
• Inconclusive: This result can occur when the assay control criteria are not met and no virus is detected. The concern here is a poorly collected sample, and the CDC recommends that a new patient sample should be collected and tested.

Test details

• Turnaround time: 2-3 days
• Sample collection: Vigorously swab or brush the base of the lesion with a sterile dry polyester, rayon or Dacron swab. Insert the swab into the tube containing UTM or VTM. Carefully break the swab at the scoreline and tightly close the sample. Some UTM kits may contain two swabs; however, only one swab needs to be collected and submitted for testing. If multiple lesions with differing appearances are present, consider submitting an additional UTM/VTM collection, as described above, for each lesion.
• The test sample must be collected by a clinician at the site where the patient is being seen. Labcorp cannot collect this sample at a patient service center.

Treatment: 

Monkeypox symptoms often resolve on their own within weeks. Patients may receive extra fluids and additional treatment for secondary bacterial infections.

Symptomatic 

• Antipyretics, 
• Supportive treatment,
• Hydration 
• good diet 
• Calamine lotion on leision
• Anti Viral to be reserved for immunocompromised and malnourished likely to have complications.

Recovery Period

Approximately 2-4 weeks.

Any Effective Anti-viral drug?

Yes Tecovirimat : It is an anti viral drug medication licensed for treatment of smallpox has been given license of monkeypox

Drug is Available in India. It was developed by USA  primarily to thwart any potential  smallpox virus warfare.

Immunization :

Vaccine: 

Smallpox vaccine provides cross immunity against monkeypox in 85% cases.

Vaccination against smallpox is 85% effective in preventing monkeypox.

People in age group of  50s and late 40s having two big small pox vaccination marks might be protected 

But we know there are two vaccines approved by the USA Food and Drug Administration (FDA)

Why the disease is surfacing now? 

Because the immunity of population has gone down. Small pox vaccination was abandoned in late 70s. It cross protected against monkey pox.

How India can tackle the outbreak

Educate health care workers and the public about disease symptoms. Support individuals to get tested and work against prejudice. Strengthen contact tracing and  and sharing of data and craft a clear strategy for developing drugs and vaccines.

Kerala

First case was reported from Kerala Kollam on July 14 2022. Man's samples were sent to the  National Institute of Virology (NIV( in Alappuzha on July 30, but he has tested positive for  the disease in the UAE on July 19 2022. 

The man 22 years old who hailed from Chavakkad Kuranjiyur in Thrissur district, who recently returned from high risk United Arab Emirates  (UAE)  on July 21 2022. On evening of 26th he developed abnormal jerking.  He was admitted to a hospital in Thrissur on July 27 for severe fatigue and brain fever. He died on July 30. His samples were sent for testing to the National Institute of Virology (NIV) in Pune. The results came out positive on Monday  (1st August 2022) .His family members told authorities on the day he died that he was tested for monkeypox in the UAE on July 19, the result of which was positive. Kerala Confirms India’s First Monkeypox Death; 22-yr-Old Youth Who Died in Thrissur Tested Positive.

“His monkeypox test done in a foreign country was positive, but his relatives gave the report to hospital authorities on Saturday,". The health department will also examine the reasons behind the delay in his hospitalization after he arrived from the UAE on July 21.

Monkeypox death: Centre contacts UAE to know how patient took flight to Kerala? despite having declared positive for the infection. The man, as per sources, boarded a flight to Kerala on July 22 after even as he was positive in the UAE itself. The patient did not immediately report to a health facility even after reaching Kerala. The person was out and about for five days before seeking care at a health facility when his symptoms worsened. A sample was sent to the National Institute of Virology, Pune, by the hospital where the 22-year-old was admitted. He tested positive for monkeypox again.

 A high-level probe will be conducted to determine the cause of death.

    Lok Nayak Jai Prakash Hospital.(LNJP)  which is Delhi's nodal hospital for people diagnosed with the Monkey infection. 

Jawahar Lal Nehru Marg, Central, Delhi - 110002 · Hospital Address · Contact / Help Desk of Hospital (For Public Domain) . It is centrally located and very near to both old and New Delhi railway stations 

Delhi 

Delhi :  1 confirmed and 2 suspected cases of Monkeypox  in Delhi. 35 year old man admitted at the city's Lok Nayak Hospital tested positive for the infection. Patient had not travel outside  Delhi recently.

Delhi's first Monkeypox patient tested positive on July 24 2022.  A 34 year old resident of West Delhi too had no history of foreign travel,, but travel to Himachal Pradesh, after which he started developing fever and skin eruptions. He was admitted to Lok Nayak Hospital  on July 22 and his samples returned positive two days later from NIV Pune. The west Delhi Patient is stable and recovering well

On July 15th second suspected case from Ghaziabad was admitted to Lok Nayak hospital with skin eruptions and fever. His report s, however, returned negative for monkeypox and he was later diagnosed with chickenpox.

A Nigerian national living in Delhi  has tested positive for Monkeypox in Delhi. He was admitted to hospital on 30 July 2022 Saturday with symptoms of fever and rashes that pointed towards Monkeypox; He does not have history of international travel for last 21 days.

Two others are isolated in the facility and being treated as  suspected monkeypox patients. Their reports are awaited. To be sure, the suspected cases and confirmed cases are not in each other's contact. 

None of the three (the confirmed patient and the other two suspected)patient had travel history.

The latest to test positive in the capital is a  31 year old Nigerian women, who is undergoing treatment in Lok Nayak Hospital. Two other Monkeypox patients are also Nigerian are being treated at the  facility which is Delhi's nodal hospital for people diagnosed with  the infection. 

The first patient was discharged after treatment on Monday.

• Delhi on Saturday reported its fifth monkeypox patient. The African woman had travelled to Nigeria a month ago.

Prevention

The best way to do that is to reduce the risk of exposure. That means making safe choices for yourself and others. For men who have sex with men, this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed

How stay safe from monkeypox virus?

Health officials say that people should avoid close personal contact with someone who has an illness presenting with a distinctive rash or who is otherwise unwell. People who suspect they have monkeypox should isolate and seek medical care. Health officials have also been offering monkeypox vaccines to high-risk individuals and those that have recently been in close contact with an infected person.

5 Monkeypox myths debunked

Myth : Monkeypox is a new strain of Corona 19

Monkeypox belongs to the Smallpox family of viruses. Monkeypox and Corona virus has no connection. It has an absolutely different transmission and life cycle. It is not air born like Covid 19. Even though the number of Monkeypox cases is rising, its not showing the fatalities that we  experienced in the early stages of Covid 19 pandemic. This indicates that Monkeypox will not have the same devastation effect as Covid 19. However , the signs and symptoms of the virus are unpleasant and severe.

Myth : There is no treatment for Monkeypox.

In most cases, the virus is self limiting as most of the infection resolves in 2-4 weeks. For symptomatic care, isolation, hydration, electrolyte maintenance and antipyretics are enough.. Paracetamol, anti viral, or other NSAIDs, nutritional support, skin care, eye care, and respiratory support are used as treatment for fever and pain.

Myth : Monkey pox is a new virus.

It was first discovered in 1950's in the research of monkeys (hence name) . The first human case was recorded in 1970 in Africa, The virus has been studied in detail, and medical literature has all information regarding its spread and prevention. Although it typically affects animals, it can also infect people. Fever, chills, headache, muscle aches and weakness are a few of its sign. In more severe cases, a rash may develop on the face and genitalia. 

                                                     

Myth :  Monkeypox affects only gay and bisexual me.

A big no. Although this outbreak symptoms differ from previous outbreaks, it is not limited to individuals of these sexual orientations, Andy Seal, A WHO expert, states, "As some users on social media have attempted to claim, this is not a gay sickness. Simply said that is untrue. Any body can contract Monkeypox through close contact. The viral disease is also seen in heterosexual individuals. But men who have sex with men and who don't use protection during sexual intercourse are more prone to this infection.

Myth :  Only Monkeypox spread Monkeypox

Monkeys have nothing to do with the transmission of this disease. It gets its name from the research conducted on monkeys in Denmark, in whom this virus was first isolated, In fact monkey can also catch the infection like other primates.  Transmission and spread can happen through rodent bites like squirrel.

Squirrel

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