“Monkeypox has a lower transmission rate than Covid-19”

New Delhi: India has so far reported nine cases of monkeypox, including one death. As cases slowly increased, the Center convened a high-level meeting with top health experts to review monkeypox management guidelines. In an interview with The Sunday Guardian, Dr. Giridhara R. Babu, Professor and Head of Life Course Epidemiology at the Public Health Foundation of India, said the declaration of a public health emergency of international concern ( USPPI) helps raise awareness of monkeypox, as well as improving surveillance. Excerpts:
Q: How effective are smallpox vaccines against monkeypox since the Union Health Agency lacks vaccine efficacy data?
A: Evidence available in Africa in the 1980s suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. The efficacy of the JYNNEOSTM (also known as Imvamune or Imvanex) vaccine is available from a clinical immunogenicity study and efficacy data from animal studies. Not everyone needs a vaccine. Prevention, early detection and isolation will control the spread.
Q: What are the differences between Covid and monkeypox modes of transmission? Is monkeypox transmission rate more severe than Covid?
A: Monkeypox is spread by staying in close proximity and/or having prolonged contact with someone who has symptoms, which includes maintaining close contact and contact with contaminated materials such as towels and clothing. , is also spread by respiratory droplets spread by prolonged and close contact. face-to-face interaction. Human-to-human transmission can result from close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects. On the other hand, Covid is spread through tiny droplets in the air by breathing, talking, sneezing or coughing and it is highly contagious and can be spread even if an individual is infected with Covid but has no not the symptoms. Although declared a Public Health Emergency of International Concern (USPPI) for its spread to new geographies, monkeypox has a low rate of transmission compared to Covid-19.
Q: If monkeypox cases increase, will India face another lockdown? Anything to worry about in the days to come?
A: There is no need for containment as the mode and speed of transmission are different and outbreaks can be contained with public health measures. There is uncertainty regarding the spread of monkeypox and co-infection with Covid. Spread to new geographic areas in a short period of time, the implications of potential interactions with other infectious agents may impact infectivity patterns, severity, management, and response to vaccination.
Q: Two people with no international travel history have tested positive for monkeypox in Delhi. Is this a sign that the virus has started to spread locally? Can asymptomatic cases of monkeypox be expected in Delhi?
A: This is due to the long incubation period and lack of awareness in identifying symptoms. Close contact with infected people is also responsible for its spread. People remain contagious as long as the skin lesions are present. The extent to which asymptomatic infection may occur is unknown.
Q: Some experts have claimed that monkeypox has existed in India for longer and currently the country is witnessing a distinct cluster of human-to-human transmission which may not have been recognized for years. To what extent do you agree with this?
A: It is possible that low levels of sustained transmission preceded the 2022 epidemic in Europe. As researchers, we can only be informed by evidence. I salute the tenacity and research leading to publication by Bani Jolly and VinodScaria. Their paper suggests that there is a possibility of sustained human-to-human transmission spread across multiple countries, not just India. However, it is unclear why the disease has spread to more than 70 countries in a short time and whether it could be linked to genetic changes in the virus. Their study highlights the increased need to use genomic surveillance to uncover unknowns and complement epidemiological investigations. Further studies can establish the details of the chain of transmission and the reasons for its wider spread. Declaring PHIEC is useful for increasing awareness, improving surveillance and leading to greater availability of vaccines and diagnostics.
Q: India is already facing a shortage of medical professionals. Is India ready enough to fight the slow outbreak of the virus as no test kits are available so far?
A: There will be pressure on the health system if the burden is heavier, but India can definitely fight epidemics. At this point, we don’t really know if this is a limited, slow-spreading epidemic or if there could be a high number of cases. Improving public health surveillance and response will give us the data and the confidence to manage this. The government has accelerated the process of developing vaccines and diagnostics for the disease. Given the success of rapid development and scaling of Covid, there is no need to worry about test kits.
Q: Monkeypox has a very low mortality rate, is the A.2 strain more serious than the B.1 lineage? What is the most vulnerable group?
A: There is limited information regarding the clinical characteristics and mortality associated with the different lineages due to the lack of sequencing data for MPXV reservoir isolates from previous orthopoxvirus outbreaks. In a study published in the Democratic Republic of Congo, researchers document the clinical characteristics and severity of four lineages circulating in the reservoir population after introduction into the human population. Lines A and B produced mostly moderate disease. Furthermore, they found the deletion of MPV-Z-N2R/OMCP in lineage B and was significantly associated with human-to-human transmission. Lines C and D were associated with severe/serious disease. The results show that the pattern of gene loss with secondary transmission could indicate that monkeypox rapidly adapts for efficient replication in humans.
The risk is high in case of close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects. Healthcare workers, household members and other close contacts of active cases are at higher risk. Transmission can also occur via the placenta from mother to fetus or through close contact during and after birth. Although close physical contact is a well-known risk factor for transmission, it is currently unclear whether monkeypox can be sexually transmitted.
Eating undercooked meat and other products from infected animals and living in or near forested areas is a low risk.
Transmission can occur through direct contact with the blood, body fluids, or skin or mucous membrane lesions of infected animals. Many animals such as rope squirrels, tree squirrels, pouch rats, dormice, several species of monkeys and others can also be infected.
Q: As the Center has set up a task force to monitor the situation, do we expect serious cases of monkeypox in the future?
A: A task force is an essential governance mechanism to monitor and respond to the evolving epidemic. Collaborative efforts to scale up epidemiological and genomic surveillance, improve diagnostics, and vaccine/drug production and manufacturing capacity are essential for many zoonotic diseases in the future.