Monkeypox, a virus originating in Africa, is spreading rapidly and has reached Pakistan. Recently, the World Health Organization (WHO) declared monkeypox or Mpox a public health emergency of international concern. This decision came amid a rapid increase in the spread of the disease in eastern Democratic Republic of Congo (DRC) and its detection in neighbouring countries. The arrival of the virus in Pakistan has caused serious concerns in India. Dr. Baset Hakim, MD Medicine, Apollo Clinic Viman Nagar, shares how the virus can spread, its symptoms and how India can stay safe.
Monkeypox: Mode of transmission
Dr. Baset Hakim says the natural reservoir of the virus is still unknown. As for transmission, Dr. Hakim says, “It is known that human-to-human transmission occurs primarily through large respiratory droplets that usually require prolonged close contact. It can also be transmitted through direct contact with bodily fluids or wound material, and by indirect contact with wound material, such as through contaminated clothing or bed linens of an infected person.”
The doctor adds that transmission from animal to human can occur through bites or scratches from infected animals such as small mammals including rodents and non-human primates or through the preparation of wild animal meat.
Clinical features of monkeypox and mortality rate
Monkeypox is usually a self-limiting disease with symptoms lasting two to four weeks. “Severe cases occur most often in children and are related to the degree of exposure to the virus, the patient’s health status and the nature of the complications. The case fatality rate for monkeypox has historically ranged from 0 to 11% in the general population and has been highest among young children. Recently, the case fatality rate has been around 3-6%,” says Dr. Hakim.
Symptoms of monkeypox
Dr. Hakim lists common symptoms and signs of the virus:
Prodrome (0-5 days)
a. Fever
b. Lymphadenopathy
c. Headache, muscle aches, exhaustion.
d. Chills and/or sweats
e. Sore throat and cough.
Skin involvement (rash)
a. It usually begins 1 to 3 days after the onset of fever and lasts about 2 to 4 weeks.
b. Deep, well-defined and frequently develop umbilication.
c. Lesions are usually described as painful until the healing phase, when they begin to itch (at the scab stage).
d. Stages of rash (slow evolution)
– Enanthema – first lesions on tongue and mouth
The macules begin on the face and spread to the arms, legs, palms, and soles of the feet (centrifugal distribution) within 24 hours. The rash progresses through macular, papular, vesicular, and pustular phases.
– The classic lesion is vesiculopapular.
– On the third day the lesions progress to papules.
– By the fourth or fifth day the lesions transform into vesicles (raised and filled with fluid).
– Between the sixth and seventh day, the lesions become pustular, very raised, filled with opaque fluid, firm and deep. They may become umbilicated or confluent.
– At the end of the second week, they dry out.
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Key Ways India Can Stay Safe From Mpox
Dr. Hakim stresses the importance of surveillance, early diagnosis and rapid action to combat monkeypox. He mentions the following points:
– Diagnosis by PCR analysis from samples collected from blood, urine, skin lesions and oral or nasopharyngeal swabs.
– Monitoring and treatment of complications: The patient should closely monitor the appearance of any of the following symptoms during the isolation period:
– Eye pain or blurred vision
– Shortness of breath, chest pain, difficulty breathing.
– Altered consciousness, convulsions. Decreased urine output.
– Poor oral intake
– Lethargy
Dr. Hakim says that if any of the above symptoms appear, the patient should immediately contact a nearby healthcare facility or specialist.
Patient isolation:
– Isolation of the patient in a hospital isolation room/at home in a separate room with independent ventilation
– The patient must wear a triple-layer mask.
– Skin lesions should be covered as best as possible (e.g. long sleeves, long pants) to minimize the risk of contact with other people.
– Isolation should continue until all lesions have resolved and scabs have completely fallen off.
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