Monkeypox: Causes, symptoms, prevention and treatment

Just as our country is dealing with multiplying Covid cases, there has been an increase in the number of cases of Monkeypox, a disease that has taken over parts of the world. While there are over 18,000 cases reported around the world, India currently has four known cases. The first case was reported in the country on July 14 in Kerala. The patient, a Kollam native, has now recovered from the disease, according to state Health Minister Veena George.

The World Health Organization (WHO) has declared the viral disease a global emergency. The United Nations health agency says Monkeypox is a viral zoonosis (a virus transmitted to humans from animals). It has symptoms similar to those seen in past smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. Last week, WHO Director-General Tedros Adhanom Ghebreyesus advised men, who are considered more at risk of getting monkeypox, to consider reducing the number of sexual partners for the moment.

In India, the Centre released guidelines stating that patients should isolate for 21 days and keep lesions covered. In Mumbai, Brihanmumbai Municipal Corporation (BMC) has kept a 28-bed ward ready in Kasturba Hospital for patients.

Amid a growing concern about the disease, Mid-day Online spoke to Dr Aniket Mule, consultant internal medicine, Wockhardt Hospital Mira Road and Dr Umang Agarwal, infectious diseases consultant, PD Hinduja Hospital and Medical Research Centre, Mahim, to understand more about the disease. Since the disease sounds similar to Monkey fever for which Maharashtra reported nine cases recently, we also asked them about the difference between the two to clear any cause of worry and misinformation among people.

What is monkeypox?

Mule: Monkeypox is a viral infection commonly seen in the West and Central Africa and is a relative of smallpox. It was discovered in 1958 when two outbreaks of a pox-like disease were seen in lab monkeys for the study purpose and the name was also derived from them. The Monkeypox virus belongs to the Orthopoxvirus genus in the family Poxviridae and is not that fatal.

What are the causes of Monkeypox?

Mule: Human-to-human transmission of this virus is possible owing to the respiratory droplets. One can also catch the virus because of the bite of an infected animal, coming in contact with an individual infected with it, or even touching contaminated bedding or clothing.

Agrawal: The traditional mode of transmission was through the bite or by petting an infected animal. In the present outbreak, it has been observed predominantly in men who have sex with men, the route of transmission has generally been close physical contact with infected lesions. Other modes of transmission might include respiratory transmission by large droplets.

What are the symptoms of Monkeypox that people should look out for?

Mule: Rash on the face or other body parts, fever, headaches, muscle aches, backache, chills, exhaustion, and swollen lymph nodes are some of the worrisome signs of monkeypox. You need to consult the doctor, once you showcase these signs.

Agrawal: The initial stage that is the incubation period is when the patient is harbouring the virus but not really manifesting any symptoms. This period is generally between 5 to 13 days. Thereafter, the patient develops a prodromal phase wherein the patient will complain of fever, intense headache myalgia along with extreme fatigue.

In addition to that, you might also notice swelling over multiple parts of your body. These swellings indicate swollen lymph nodes. Around a day to four days after the appearance of fever, the patient will start complaining of blisters all over the body. These are fluid filled lesions which may involve the palms and soles, and the lesions look very similar to smallpox or chicken pox. Eventually these lesions crust over the next couple of weeks, scab and eventually fall off.

What is the age group most affected by Monkeypox? Is it seen more in males or females?

Mule: It is commonly seen in people of all age groups right from children to older adults. It is not just limited to any age group or gender. One will have to take utmost care of himself/herself if he/her is detected with monkeypox. Ones with cancer or organ transplant are at a greater risk of getting infected with monkeypox.

Agrawal: There is no real gender or age predilection for this disease. However, in the present outbreak, it has been seen more in men who have sex with men and the proposed mechanism of transmission has been close contact with the infected lesion.

What are the effects of Monkeypox?

Mule: Usually, it is milder. But, sometimes, one can face serious consequences and even death due to it. One has to be proactive when it comes to his/her health and take all the precautions to keep monkeypox at bay.

Agrawal: Most of the patients with monkey pox (around 95 per cent) have a self-limited illness. A few individuals who have risk factors for progression to severe disease like immunosuppressed individuals who are on cancer therapy, diabetes, blood pressure, hypertension, etc may need hospitalisation and very few amongst these might need ICU care.

How can Monkeypox be prevented?

Mule: Do not come in contact with infected animals or humans. Try to maintain personal hygiene and wash hands with soap and water. Wear masks and disinfect frequently touched surfaces.

Agrawal: So, the most important measure is please do not panic. As soon as you suspect that either you or your family member has monkeypox, the suspected person needs to be kept in isolation and the health authorities need to be informed immediately. Presently in Mumbai, Kasturba Medical College is the nodal Centre for monkeypox. They have a separate ward for these patients. Use of masks and social distancing would definitely help. Post exposure prophylaxis with smallpox vaccine can also help curb the spread, but is not yet available in India.

Why should Monkeypox be a cause of concern?

Mule: It spreads quickly from one person to another. In some instances, it can be life-threatening too. So, it can become a matter of concern. This virus tends to enter the body through skin lesions, the respiratory tract, or mucous membranes (the eyes, nose, or mouth). Try to follow all the instructions given by the doctor. Do not ignore any signs of it.

Agrawal: Given the recent outbreak of monkey pox all over Europe, and the recent declaration by WHO that is a public health emergency, it does have the potential to eventually become a pandemic. Thus, this particular disease should not be taken lightly. Appropriate masking, social distancing, isolation and most importantly, not panicking would go a long way in curbing the emergence of this disease.

How can Monkeypox be treated?

Mule: There is no treatment available for monkeypox. Getting vaccinated against smallpox can prevent monkeypox.

Agrawal: It is a self-limiting disease. In a small subset of patients who will require ICU admission because of complications may be treated with certain drugs such as brincidofovir and tecovirimat.

What is monkey fever?

Mule: Monkey fever (Kyasanur forest disease) is a viral fever occurring due to a virus belonging to the family Flaviviridae and is carried by ticks, birds, etc. It is a vector-borne disease. It tends to impact monkeys and human beings. It was first seen in Kyasanur forest in Karnataka, in March 1957 where lots of monkeys died, and later humans were infected.

Agrawal: Monkey fever is transmitted by a group of viruses called flaviviruses. It is a viral hemorrhagic fever very different from the virus which causes monkeypox. Monkey fever is also known as the Kyasanur forest disease. A few years back there was a small outbreak near Goa, and around three or four months back there was a case reported from Kerala as well.

How is monkeypox different from monkey fever?

Mule: Monkeypox is a viral zoonosis (a virus transmitted to humans from animals) and the symptoms are similar to those of smallpox, although monkeypox is less severe. Monkeypox was discovered in the colony of monkeys that were kept for research. Kyasanur Forest disease (KFD) (Monkey Fever) is a vector-borne disease spread by rodents, shrews, and monkeys are the common hosts and ticks are the vector. The tick transfers infection to humans through a bite.

Agrawal: The typical symptoms of monkey fever include high grade fever, chills, rigors, lots of weakness, intense headache, but more importantly, it can cause hemorrhagic manifestations such as bleeding from the nose, mouth and other parts of the body. It can also cause confusion and agitation, etc. It is more aggressive compared to monkey pox.

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(Disclaimer: This article is not intended as a substitute for professional medical advice, diagnosis or treatment. Mid-day Online does not in any way endorse the accuracy, completeness, efficacy or timeliness of any advice or line of treatment mentioned in this article. Readers must always seek the advice of a certified medical practitioner and/or a mental health professional before deciding on or starting any course of treatment.)