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Homœopathic Links 2022; 35(03): 162-163
DOI: 10.1055/s-0042-1756470
Guest Editorial

Yet Another Threat Looming Large!

S.R. Sharma
1   Former Scientist-3, Central Council for Research in Homoeopathy, under Ministry of AYUSH, Govt. of India, New Delhi, India
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Having considered the complexities and uncertainties associated with a recent viral multi-country outbreak of monkeypox, the World Health Organization (WHO) on 23rd July 2022 declared it a public health emergency of international concern (PHEIC), a ‘call to action’, necessitating immediate international measures. PHEIC is one step below that of a ‘pandemic’. The prompt response to this ‘knock at the door’ by yet another virus, the human monkeypox virus (hMPXV), reflects seriousness and concern of WHO about this outbreak. A welcome step!

Monkeypox is a zoonotic disease caused by the orthopoxvirus genus, a close relative of variola virus (smallpox), which also includes cowpox virus and vaccinia virus. The monkeypox virus (MPXV) is an enveloped, double-stranded DNA virus unlike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus which is a single-stranded RNA virus. MPXV is endemic in tropical rainforest regions of Central and West Africa. It was first discovered in 1958 in monkeys kept for research in the Democratic Republic of the Congo, whereas the first human case of monkeypox was also reported in Congo in 1970. Despite its name, monkeys are not the harbourers of MPXV, rather the virus is believed to mainly reside in rodents like squirrels and rats. Transmission to humans occurs when a person comes in contact with an infected animal, or a person.

Prolonged and intimate contact with infected person is the most significant risk factor for the transmission of this infection. Therefore, household members and healthcare workers who are more likely to come in contact with the patients are at a greater risk of getting infected. Apart from physical contact, contact with body fluids, exude from skin lesions, scabs, respiratory droplets and other contaminated materials such as soiled linen, towel or laundry of infected patients pose a potential threat in spreading the infection.

Monkeypox is a self-limiting disease that typically resolves within 2 to 4 weeks. The incubation period varies between 5 and 21 days. The patients usually experience systemic symptoms like fever, myalgia, headache, swollen lymph nodes, prostration, lack of energy and symptoms related to throat. After a few days (usually 1–3 days of appearance of fever), rashes begin to form on face, hands and feet, including palms and soles. The rash starts as a macule, progressing to papule, vesicle, pustule and ending in a scab. The lesion fluid and scabs are highly contagious. Monkeypox symptoms are quite similar to those of smallpox but are less severe and most people recover without an issue.[1] Sometimes severe cases can occur. In recent times, the case fatality ratio has been around 3 to 6%.[2] Regarding vaccination against monkeypox there is no specific vaccine available globally. But smallpox vaccines are known to be effective against monkeypox and so the WHO is in the process of seeking data from countries, said WHO officials during a technical briefing to member states at the UN health agency's annual assembly on 27 May 2022.[3] Previous data from Africa suggests that previous vaccines against smallpox may be up to 85% effective in preventing monkeypox infection. In recognition of this protection, there is extant policy which recommends that smallpox vaccination should be considered.[4]

Complications of monkeypox can include secondary infections, broncho-pneumonia, sepsis, encephalitis and infection to the cornea resulting in loss of vision. Higher risk populations include neonates, children and those with immunodeficiency. For this DNA virus, real-time/quantitative polymerase chain reaction (PCR) is the preferred laboratory test unlike SARS-CoV-2 (RNA virus) where reverse-transcription PCR is done. Samples for this test are taken from skin lesion, fluid from blisters or scab.[5]

In a descriptive case series of 197 PCR confirmed monkeypox patients, the clinical features in current outbreak of monkeypox infection in humans were characterised, at a regional high consequences infectious disease (HCID) network in south London, between May and July 2022. Surprisingly, all patients in this case series were men and 196 were identified as gay, bisexual or other men who have sex with men (MSM). The most common systemic symptoms were fever, myalgia, lymphadenopathy. Thirty-six per cent reported rectal pain, 15.7% penile oedema, 16.85 sore throat and 13.7% had oral lesions. Astonishingly, 35.9% were human immunodeficiency virus positive.[5] With 07 deaths confirmed and around 34,399 cases in non-endemic countries, the monkeypox virus has spread to 94 countries in the recent outbreak which has triggered international consternation in a world that is yet to recover from coronavirus disease 2019 pandemic. As per real-time monkeypox tracker, top 5 countries where maximum number of cases have been reported include United Kingdom, Spain, United States, Germany and France.[6]

Disclaimer

This article summarises available information as on date on monkeypox infection and MPXV which are of general nature, and are not in any manner meant for specific diagnosis or targeted therapeutic intervention. These are presented for the purpose of generating awareness about the disease in public at large and healthcare professionals in particular. New information and updates will keep on pouring in future which may even be contrary to the current knowledge.




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Artikel online veröffentlicht:
30. September 2022

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