Lt Col Nazmul Huda Khan :
As of May 25, the World Health Organization (WHO) received reports of more than 100 laboratory-confirmed monkeypox from 18 countries where the disease is not endemic. Britain, Spain, Portugal, Italy, US, Sweden, France, Germany, Belgium, Australia and Canada all have reported infections. However, no monkeypox cases have been identified in any Asian country yet. In this situation, WHO has held an emergency meeting to discuss the recent outbreak of monkeypox.
Monkeypox is not a new emerging infectious disease. It was first identified in 1958 among laboratory monkeys in Denmark. The first cases in humans were found in 1970 in the Democratic Republic of the Congo (DRC). Almost 50 cases were reported between 1970 and 1979. WHO surveillance between 1981 and 1986 in DRC recorded 338 confirmed cases and 33 deaths (CFR 9.8%). The other cases originated from Liberia, Nigeria, Ivory Coast and Sierra Leone. A second outbreak was identified in DRC in 1996-1999, 511 cases were reported between 1991 and 1999. A total 71 cases of monkeypox were reported through 2003 in USA was traced to a pet store of rodents imported from Ghana. About 2000 cases per year were detected in DRC between 2011 and 2014. It has been reportedly spread around southeast and south Nigeria between 2017 and 2019 which reports about 3,000 cases, where people have close contact with infected rats and squirrels. In 2018, first case was recorded in the United Kingdom. Country’s first case of monkeypox in Singapore was confirmed in 2019 in a 38-year-old man who travelled from Nigeria. In the UK, three cases from a single household were identified in 2021. In the same year, an American returning from a trip in Nigeria was diagnosed with monkeypox in US. The 2022 monkeypox outbreak represents the first incidence of widespread community transmission outside of Africa, mostly in young men who hadn’t previously traveled to Africa.
According to the WHO, symptoms of monkeypox include headache, muscle pain, fever and fatigue. The manifestations of this disease are similar to chickenpox, measles and smallpox, less presence of swollen glands those appear near the ear and jaw, in the neck or in the groin before the onset of the rash. Within a few days of the fever, small flat lesions with clear fluid appear on the face, palms of the hands and soles of the feet, genitals and the eyes which subsequently burst and scab over. They can last for two to four weeks, with severe cases occurring more commonly among children. Though the incubation period is 10-14 days, symptoms may typically appear in six to 13 days but can take as long as three weeks after exposure. Reports of the risk of death, if untreated, are as high as 10% to 11% in the Congo Basin (Central African) clade of monkeypox. About the West African clade, the case fatality rate of 1% according to the World Health Organization.
The primary route of infection is thought to be contact with the infected animals or their bodily fluids by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material or indirect contact with lesion material, such as through contaminated bedding. The virus can also spread from human to human, by respiratory contact or by contact with an infected person’s bodily fluids. The virus enters the body primarily through broken skin (even if not visible) or the mucous membranes (eyes, nose or mouth). Transmission may occur through sharing a bed or room or using the same utensils as an infected person. The European CDC rates likelihood of transmission due to close contact, including sexual contact as “high”, but without close contact, considers the risk to the wider public “low”. Prior to the 2022 outbreak, monkeypox was not considered to be a sexually transmitted infection (STI). The rapid spread of the virus between sexual partners in the initial stages of the outbreak has prompted discussion that sexual intercourse may be a further route of transmission. Evaluating the recent outbreak, the scientists and public health experts guess that, this is not the kind of spread in West Africa beforehand, so there may be something new happening in the West. A notable proportion of the most recent infections in the UK and Europe have been in young men with no history of travel to Africa who were gay, bisexual, or had sex with men. In Germany, the virus was being sequenced to see if there were any genetic changes that might have made it more infectious. Again in Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, it really needs to understand why.
Diagnosis can be verified by testing for the virus. Polymerase chain reaction (PCR) testing of samples from skin lesions is the preferred laboratory test. The CDC says, there is no proven, safe treatment for monkeypox, but the Food and Drug Administration has approved the use of smallpox vaccines and antiviral treatments to control outbreaks. In the European Union and the United States, tecovirimat is approved for the treatment of several poxviruses, including monkeypox. BMJ Best Practice recommends tecovirimat or the smallpox treatment brincidofovir as the first line antiviral treatment if required, alongside supportive care including antipyretic, fluid balance and oxygenation. The CDC recommends that healthcare providers should do a full set of personal protective equipment (PPE) before caring for an infected person. This includes a gown, mask, goggles, and a filtering disposable respirator such as an N95. An infected person should be isolated.
As no monkeypox case has been identified in any Asian countries including Bangladesh, the health experts of Bangladesh have focused on generating public awareness about the monkeypox virus. They have also advised to report to the hospital if any similar symptoms are present. Hospitals have been asked to collect patient samples if any and send to the IEDCR. People coming to Bangladesh have been advised to have health checkups at the airport particularly those from the country of exposure, must be cautious in order to prevent the virus from spreading. To protect from the virus, concerned need to wear a mask and wash hands frequently, the same rules apply for both corona virus and monkeypox. At airports, anyone showing signs of this disease should be quarantined for at least 14 days. Monkeypox is still being studied. As a result, nothing can be said elaborately. Everyone, however, should be aware. There’s no need to be worried, but we must remain vigilant and cautious.
(Lt Col Nazmul Huda Khan, MBBS, MPhil, MPH is Public Health expert and Assistant Director, Kurmitola General Hospital).
