Monkeypox Scare: Can India's Experience With Smallpox Prove To Be A Boon?

Even as the world continues to recover from the impact of the Covid-19 pandemic, a new disease seems to be ringing alarm bells in many countries, including India. Monkeypox cases have been reported from Britain, Italy, Portugal, Spain, Canada and the US, among others, marking the first time the pathogen has travelled outside of central African nations where it usually circulates. As of May 25, the World Health Organisation recorded 131 cases of monkeypox around the world.

With several countries reporting cases, the Union Health Ministry in India has advised all states and union territories to direct hospitals to watch out for symptomatic patients who have travelled to these countries recently and isolate them at designated healthcare facilities.

What is monkeypox and how does it transmit?

Monkeypox is a pathogen belonging to the Orthopoxvirus family of viruses. It gets its name from an 1958 outbreak of the same among a group of laboratory test monkeys inside a research facility in Copenhagen. 

While the virus has been around since the late 50s, it was only in 1970 that the first case of a Monkeypox infection in a human being was detected, at a time when the World Health Organisation and other health institutions were focusing on eradicating smallpox from the Democratic Republic of Congo. While Monkeypox outbreaks have been reported in several countries in central Africa, Congo continues to be a hot-spot for the virus. 

How does monkeypox spread?

Monkeypox can transmit through contaminated bodily fluids and/or intimate contact with infected animals or humans. 

While the name suggests monkeys to be primary source of the virus, however, the pathogen can spread through other animals as well. In fact, bushmeat animals like African squirrels and dormice have been noted as more popular carriers of the disease. 

According to an advisory issued by the Indian health ministry to states and union territories, monkeypox can be transmitted from animal to humans as well as human to human. The virus enters the body through broken skin (even if not visible to the naked eye), respiratory tract, or mucous membranes (eyes, nose, or mouth).

Human-to-human transmission is thought to occur primarily through large respiratory droplets generally requiring a prolonged close contact.

It can also be transmitted through direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens of an infected person. 

According to the WHO, monkeypox can spread through sexual contact but it is not a sexually transmitted disease. According to Dr David Heymann, who formerly headed WHO's emergencies department, the current outbreak of Monkeypox might be “a random event” but that the leading theory to explain the spread of the disease in countries outside of Africa was sexual transmission among gay and bisexual men at two raves. 

This marks a significant departure from the disease's typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates and outbreaks have not spilled across borders.

How is Monkeypox related to Smallpox

Monkeypox is a close relative of smallpox, in that it's clinical presentation resembles that of smallpox. While both are related orthopoxvirus infections, smallpox was declared eradicated worldwide in 1980. Due to its 'self-limiting' tendencies, however, Monkeypox is less contagious than smallpox and causes less severe symptoms and illness. 

With regard to symptoms, monkeypox shows to have similar effects on the infected body. Those infected with it experience fever, sore throat and body ache, accompanied with bumpy rashes, much like in smallpox. However, the primary difference between smallpox and monkeypox symptoms is that the latter causes enlargement of the liver, an effect that is missing. insmallpox patients.

Can smallpox vaccines prevent monkeyvirus?

The Covid-19 pandemic has taught us the importance of vaccines. And since Monkeypox is close to the Smallpox virus family, researchers have hopes that that vaccines developed for preventing smallpox can also prevent monkeyvirus. Previous data collected from African nations suggest that 85 percent smallpox cases could be prevented with the use of Smallpox vaccines. In 2019, the US Food and Drug Administration approved Jyenneos, a smallpox vaccine manufactured by Danish pharmaceutical firm Bavarian Nordic, as effective for prevention of both smallpox and monkeyvirus.

The European Centre for Disease Prevention and Control recommended all suspected cases be isolated and that high-risk contacts be offered a smallpox vaccine. The U.K. is offering high-risk contacts the smallpox vaccine and recommending anyone who might be infected to isolate until they recover. 

The US has 1,000 doses of a vaccine approved for the prevention of monkeypox and smallpox, plus more than 100 million doses of an older-generation smallpox vaccine in a government stockpile, Associated Press reported.

Can smallpox medication be used to treat monkeypox? 

According to reports, a drug developed for treating smallpox in case it returned post its eradication in 1980 was used by doctors to successfully treat a monkeyvirus patient in the UK in 2021. The analysis was made in a study which examined seven people who had caught monkeypox in the UK since 2018. It was noted that a patient, who was given smallpox medication, recovered quicker than others. However, a definitive analysis of the effects on smallpox medication on treating monkeyvirus would need more case studies. Siga Technologies, a US-based pharmaceutical firm is currently conducting an observational study to analyse the impact of use of the smallpox medication on monkeyvirus patients in the Central African Republic. However, observational studies were seen to give insubstantial results during the study of the Covid-19 pandemic. 

Do Indians have an edge over monkeypox due to smallpox?

In 1974, Indian experienced one of the worst smallpox epidemics in the world with the virus reportedly killing at least 15,000 people within a span of months. That year, India recorded over 86 per cent of the total smallpox cases in the world with 61,482 cases. By the end of 1975, the disease had been eradicated from India, thanks to the arrival of the smallpox vaccine. 

With the smallpox vaccine being touted by reserachers as an effective tool to prevent monkeypox, Indians might be at advantage, thanks to its successful experience with smallpox immunisation and eradication process earlier. 

Monkeypox cases in India

As of now, reports claim only one traveller from Canada has been recorded with symptoms of monkeypox infection had been isolated. However, samples collected from the passenger turned out negative for the infection following test conducted at the National Institute of Virology (NIV) in Pune. Officials have refrained from divulging the name of the airport where the passenger had landed.

The ministry recently had asked health officials at airports and ports to step up surveillance and isolate symptomatic travellers from monkeypox-affected countries and send their samples to the NIV for investigation. This is because the incubation period for monkeypox infection is typically 7-14 days. However, it can range from 5-21 days as well. In this period, patients may not show any symptoms at all. The aim of surveillance is to detect those persons who were missed during the screening at the airport due to lack of symptoms at health facilities after they manifest the symptoms.

How India is dealing with monkeypox

The Health Ministry, in collaboration with the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC), is framing comprehensive guidelines for the treatment and prevention of monkeypox.

In the interim advisory to all states and union territories recently, the ministry said that health facilities should keep heightened suspicion on people who "present with an otherwise unexplained rash and who have travelled, in the last 21 days, to a country that has recently had confirmed or suspected cases of monkeypox or report contact with a person or people with confirmed or suspected monkeypox."

All suspected cases should be reported to the District Surveillance Officer of the Integrated Disease Surveillance Programme.

The advisory recommends sending laboratory samples consisting of fluid from vesicles, blood, sputum, etc. to the NIV in Pune for monkeypox testing in case of suspicion.

In case a positive case is detected, contact tracing has to be initiated immediately to identify the contacts of the patient in the last 21 days, the advisory stated.

(With inputs from Agencies)