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Table of Contents
SPECIAL FEATURE: COMMENTARY
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 271-273

2022 monkeypox outbreak: Global risk assessment and areas to strengthen


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission04-Jun-2022
Date of Decision24-Jun-2022
Date of Acceptance27-Jun-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE), Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcsr.jcsr_109_22

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How to cite this article:
Shrivastava SR, Shrivastava PS. 2022 monkeypox outbreak: Global risk assessment and areas to strengthen. J Clin Sci Res 2022;11:271-3

How to cite this URL:
Shrivastava SR, Shrivastava PS. 2022 monkeypox outbreak: Global risk assessment and areas to strengthen. J Clin Sci Res [serial online] 2022 [cited 2022 Dec 7];11:271-3. Available from: https://www.jcsr.co.in/text.asp?2022/11/4/271/359808




  Introduction Top


Monkeypox is a viral infectious disease that has a primary zoonotic origin, but cases of the spread between human-to-humans have also been reported since 1970.[1] The disease was predominantly endemic in the areas of central and west Africa with reports of the detection of cases in other non-endemic nations through travellers visiting the endemic regions.[2] Outbreaks of the disease have been quite common in endemic nations, as evidenced by the very fact that since December 2021, multiple outbreaks have been reported in different African nations.[1] The available estimates suggest that the infection resolves on its own within 2–4 weeks of the onset of the symptoms, while the case fatality rate attributed to the infection is between 3% and 6%.[3] Children and people with immune deficiency or co-existing chronic morbidities have been identified as susceptible to developing complications.[1],[2],[3],[4]


  Clinical Manifestation of Smallpox, Chicken Pox and Monkeypox Top


It is essential to differentiate the clinical presentation of patients presenting with smallpox, chicken pox and monkeypox. The basic difference between the symptoms of smallpox and monkeypox is that monkeypox infection accounts for lymphadenopathy while this trait is missing among patients of smallpox.[5] Even though, both smallpox and monkeypox results in the development of pus-filled boils, it is important to note that patients of monkeypox tend to have mild and self-limiting illness.[1] Monkeypox rash starts on the face and subsequently spreads to the different parts of the body, including the soles and palms, while the Chickenpox rash first comes on the trunk and then spread over full body, except the palms and soles. Finally, smallpox rash begins in the form of small red spots on the tongue and mouth, and then on the face, arms and legs (palms and soles are also involved).[5]


  Transmission of Infection and People at Risk Top


The infection spreads from one person to another through close physical contact (viz. rash, body fluids and the scabs are infectious), trans-placental, from post-natal mother to infant during breastfeeding via skin contact, or through unprotected contact with the infected animals and/or their products like meat or blood.[1],[3] In addition, clothing, bedding or other things that have been contaminated with the virus, owing to contact with an infected person also have the potential to infect others. The health-care personnel or the caregivers or family members who are in close contact with the infectious cases are at the maximum risk to acquire the infection.[1],[3]


  Monkeypox Outbreak in Non-Endemic Nations Top


A new outbreak of monkeypox has been reported in May 2022, and the most striking aspect is that cases have been reported in non-endemic nations.[6] The first case of the outbreak was reported in the United Kingdom, and since then, confirmed cases have been reported in another 36 nations spread across different parts of the world.[1],[7],[8] As of 15 June 2022, a cumulative total of 2103 cases has been reported.[8] On epidemiological analysis, it has been reported that most of the confirmed cases did not have a history of travel to the endemic nations.[8],[9],[10] This kind of epidemiological distribution is not a usual one and suggests that we have not been up to the mark to prevent the transmission of infection from endemic nations to other nations.[2],[9],[10]

There is a definite possibility that the number of cases of the disease is under-reported mainly because people with mild symptoms or local rash might not seek health-care services at all.[11] Further, as the disease is not quite common in different parts of the world, the health-care personnel might miss the diagnosis of the disease.[8] In addition, lacunae have also been identified in terms of gaps in surveillance mechanisms, and shortage of diagnostic tools and other logistics.[1],[3] It has also revealed that a major proportion of the initially reported cases were among men who have sex with men, but we must realise that none of the population groups are immune to the infection.[7],[11],[12]


  Risk Assessment Top


The overall risk of a monkeypox outbreak at the global level has been found to be moderate, and this has been predominantly due to the detection of cases in four different regions, which did not have any evident link to the endemic regions or nations.[8] Moreover, the detection of cases within a short period across different geographical regions is an indicator that even before the occurrence of the May 2022 outbreak, there has been widespread person-to-person transmission for multiple weeks or months.[8],[13] Further, the moderate risk will become high-risk, if the causative virus starts infecting young children and immunosuppressed individuals, which are quite vulnerable to the infection.[9]

Further, we cannot rule out the fact that the majority of us are having any kind of immunity against the infection, as the smallpox vaccine (which tends to provide some cross-immunity against monkeypox has been discontinued since 1980), and thus, we are all vulnerable.[1],[3] As this is just the beginning of the outbreak and many nations have reported cases, it will not be wrong to anticipate that many more cases might become detected in the days to come across different nations, and that too in other population groups as well.[11],[13] This calls for the urgent need that prompt actions and strategies to be implemented to contain the further spread of the infection among high-risk population groups.[9]


  Potential Strategies to Minimise the Caseload Top


Monkeypox is a disease that is new in many parts of the world and thus both health care personnel and the general population are not aware of the infection.[1] This essentially requires that the program managers should strategically plan for a special campaign to create awareness about the disease (viz. do's and don'ts, modes of transmission, symptoms, etc.), including activities on different platforms of social media.[6],[8] Further, there is a significant need to ensure that no population groups are stigmatised for acquiring the infection, as they will become reluctant to come forward to seek health care, and eventually, we will have a major outbreak.[1],[3],[6] Such scenario has to be avoided in all circumstances and thus, we have to strengthen advocacy, communication and social mobilisation activities in the general population.[1],[6]

As the infection is transmitted by close physical contact, all people who are involved in extending care to the cases should use personal protective equipment (viz. medical mask and gloves), regularly practice handwashing and disinfect the contaminated surfaces.[3] The disease is a self-limited one, but we do have vaccines and drugs for the prevention and management of the infection (in severe cases).[1] The need of the hour is to increase their production and establish supply-chain management to enable the availability of vaccines and drugs in all nations. In addition, we cannot forget the zoonotic link of the disease, and thus, all animal handlers should be extremely careful while dealing with sick and dead animals and thoroughly adopt and practice safety measures.[3],[6] In domestic settings, it becomes a vital practice to thoroughly cook meat products before consumption to minimise the risk of acquisition of infection.[2],[3]

To conclude, the overall public health risk of monkeypox disease has been identified as moderate due to the detection of cases in non-endemic nations. As the disease continues to advance in the days to come, it is our responsibility to take urgent actions and strengthen preventive strategies to interrupt the chain of transmission and minimise the risk to the general population.



 
  References Top

1.
World Health Organization. Monkeypox – Key Facts; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/monkeypox. [Last accessed on 2022 Jun 04].  Back to cited text no. 1
    
2.
Mauldin MR, McCollum AM, Nakazawa YJ, Mandra A, Whitehouse ER, Davidson W, et al. Exportation of monkeypox virus from the African continent. J Infect Dis 2022;225:1367-76.  Back to cited text no. 2
    
3.
World Health Organization. Monkeypox – Q&A; 2022. Available from: https://www.who.int/news-room/questions-and-answers/item/monkeypox. [Last accessed on 2022 Jun 04].  Back to cited text no. 3
    
4.
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis 2022;16:e0010141.  Back to cited text no. 4
    
5.
Insider. How Monkeypox Symptoms Compare to Smallpox and Chickenpox; 2022. Available from: https://www.insider.com /monkeypox-smallpox-chickenpox-rash-symptoms-chart-virus -outbreak-2022-5#:~:text=The%20main%20difference%20between%20the,those%20of%20chickenpox%20and%20smallpox. [Last accessed on 2022 Jun 24].  Back to cited text no. 5
    
6.
Nakoune E, Olliaro P. Waking up to monkeypox. BMJ 2022;377:o1321.  Back to cited text no. 6
    
7.
Mahase E. Seven monkeypox cases are confirmed in England. BMJ 2022;377:o1239.  Back to cited text no. 7
    
8.
World Health Organization. Multi-Country Monkeypox Outbreak: Situation Update – 17 June 2022; 2022. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON388. [Last accessed on 2022 Jun 24].  Back to cited text no. 8
    
9.
Kozlov M. Monkeypox goes global: Why scientists are on alert. Nature 2022;606:15-6.  Back to cited text no. 9
    
10.
Saxena SK, Ansari S, Maurya VK, Kumar S, Jain A, Paweska JT, et al. Re-emerging human monkeypox: A major public-health debacle. J Med Virol 2022. doi: 10.1002/jmv.27902.  Back to cited text no. 10
    
11.
Mahase E. Monkeypox: What do we know about the outbreaks in Europe and North America? BMJ 2022;377:o1274.  Back to cited text no. 11
    
12.
Dye C, Kraemer MU. Investigating the monkeypox outbreak. BMJ 2022;377:o1314.  Back to cited text no. 12
    
13.
Cohen J. Monkeypox outbreak questions intensify as cases soar. Science 2022;376:902-3.  Back to cited text no. 13
    




 

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Introduction
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