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Monkeypox follows in Covid-19’s wake

26 May 2022

  • Experts warn symptoms deceptively similar to dengue, as world prepares for an outbreak 
BY Sumudu Chamara Although a year ago, the Covid-19 pandemic was considered the most pressing health challenge facing humanity, the pandemic is slowly being forgotten as the world seems to have adapted to deal with the disease. The same situation can be seen in Sri Lanka, and Covid-19 is not a pressing concern as before. However, local experts last week expressed concerns about monkeypox, a health threat that has been observed in various countries recently, although it is yet to reach Sri Lanka. It was also noted that while Sri Lanka has all the necessary facilities to test for this disease, more preparations are underway. Monkeypox scare Concerns about this little-known disease called monkeypox, which has not been detected in Sri Lanka thus far, were raised by the Sri Jayewardenepura University’s Department of Immunology and Molecular Biology Head Dr. Chandima Jeewandara, who is well known for his involvement in Covid-19 related research. Speaking at a press conference over the weekend, Dr. Jeewandara noted that from 13 to 21 May, a total of 92 Monkeypox cases had been reported from various parts of the world, mainly from Western countries, including the UK, Europe, Canada, Australia, and the US, which he said is an unusual situation. He further told the media: “The World Health Organisation (WHO) is concerned because new cases have been found without travel links to the endemic regions of the monkeypox virus, which is endemic to African countries. Symptoms of the virus such as fever, headache, muscle aches, and exhaustion are similar to those of dengue and other illnesses.” Adding that this virus has not afflicted any patients in Sri Lanka at present, Dr. Jeewandara noted that the transmission of the virus is mainly through very close contact with an infected person, or direct contact with contaminated objects used by an infected person. With regard to the severity of the virus, he said that at times, groups such as children, pregnant females, and people with weakened immune systems may experience severe symptoms of the disease, while adding that it could happen very rarely. According to Dr. Jeewandara, even though the recent spread of the virus is a concerning situation, the situation is not as dire as that of the Covid-19 pandemic, as this is not an unknown virus and has existed for many decades. He noted that there are effective treatments available to treat monkeypox, and in addition, there is also a licensed vaccine specific to this virus. Adding that Sri Lanka has the necessary means to test for and diagnose monkeypox, he said that it is detected by a polymerase chain reaction (PCR) test, and that genetic sequencing can also be carried out. According to him, laboratories in Sri Lanka have all the necessary infrastructure to diagnose the disease, and the relevant reagents have already been ordered. What is monkeypox? According to the US national public health agency, the Centres for Disease Control and Prevention (CDC), monkeypox is a rare disease that is caused by infection with the monkeypox virus.  Although the disease was first discovered in 1958, the first human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo (DRC). Even though the majority of infections were reported from the DRC, a number of African countries including Cameroon, the Central African Republic, Côte d’Ivoire, Gabon, Liberia, Nigeria, and Sierra Leone, have reported cases of monkeypox. CDC notes that in humans, the symptoms of monkeypox are similar to, but milder than, the symptoms of smallpox, and that monkeypox begins with fever, headache, muscle aches, and exhaustion. The main difference between the symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy), while smallpox does not. Other symptoms of monkeypox include backache, swollen lymph nodes, and chills. Usually within one to three days (sometimes longer) after fever appears, the infected person develops a rash, often beginning on the face which then spreads to other parts of the body. The disease typically lasts for two to four weeks, and in Africa, monkeypox has been shown to cause death in as many as one in 10 persons who contract the disease. Some experts identify two types of the virus, one which has a fatality rate of 1% and another with a fatality rate of 10%. However, despite the fatality rate, experts have expressed fears that the disease could cause more deaths now that it has started spreading in countries that did not report monkeypox cases before, and Europe, which reported monkeypox cases recently, having a large number of international airports is also a concern.  The transmission of the monkeypox virus usually happens when a person comes into contact with an infected animal or person, or materials contaminated with the virus. The virus enters the body through broken skin, the respiratory tract, eyes, nose, or mouth. The CDC recommends several measures to prevent the monkeypox infection. Among them are, avoiding contact with animals that could harbour the virus (including animals that are sick or that have been found dead in areas where monkeypox occurs), avoiding contact with any materials such as bedding that have been in contact with a sick animal, isolating infected patients from others who could be at risk for infection, practicing good hand hygiene after contact with infected animals or humans, and using personal protective equipment when caring for patients. It also says that currently, there is no proven, safe treatment for the monkeypox virus infection, while for purposes of controlling a monkeypox outbreak in the US, the smallpox vaccine, antivirals, and vaccinia immune globulin (made from the pooled blood of individuals who have been inoculated with the smallpox vaccine) can be used. It was reported that an antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox. Recent spread of monkeypox  The main reason the recent outbreak of monkeypox has been identified by health experts as an alarming situation is because of the disease’s geographical spread. According to experts, during the past five decades, i.e. since the disease’s emergence in the 1970s, there have been very few monkeypox cases outside Central and West Africa. They note that monkeypox cases being reported from several continents throughout the world within a short period of time, including in places that have never reported a case before, is thus an alarming situation.  Researchers are currently looking into how unrelated monkeypox cases were reported from a number of different places, and some reports claim that the origin of the current outbreak may be a September 2018 incident, where a person who travelled to the UK from Nigeria tested positive for monkeypox. It is in this context that the WHO has raised concerns about the prevailing situation and has commenced emergency meetings to discuss the matter with the health experts. Amidst reports of the unexpected spread of monkeypox, on 22 May, US President Joe Biden had stated that the monkeypox outbreak is something everybody should be concerned about, and that the US health officials are looking into possible treatments. In a context where several European countries – UK, Portugal, Sweden, Italy, Spain, France, Belgium, and Germany – have reported monkeypox cases, last week, Belgium became the first country to introduce a 21-day compulsory quarantine for monkeypox patients. This was after the country reported several monkeypox cases last week.   Meanwhile, Israel’s health authorities have reported that the country detected the country’s first monkeypox case in a man who had returned from abroad, and that this is considered the first confirmed monkeypox case reported from the Middle East. Even though India has not reported a single monkeypox case, it has taken a number of precautions to keep its health sector ready to deal with the disease in the event of a monkeypox outbreak. While that country’s Health Ministry has directed the National Centre for Disease Control and the Indian Council of Medical Research to keep a close watch on the outbreak, Indian media reported that if cases continue to increase, the Indian Government might start random screening of people who arrive from countries that have reported monkeypox cases. This is in a context where Indian health experts have also stressed that the chances of monkeypox entering India cannot be ruled out. Moreover, Indian media reported that Tamil Nadu, the state closest to Sri Lanka, has also taken steps to manage and prevent a monkeypox outbreak. The Tamil Nadu Government has put all its district collectors and medical officers on high alert, and the officers have been instructed to conduct proper tests on those who have travelled to countries where monkeypox has been detected. In addition, they have been instructed to be vigilant about unexplained rashes (one of the indicators of the monkeypox infection) on people, and to report all suspected monkeypox cases. Even though vaccination, i.e. the smallpox vaccine, is believed to be effective against monkeypox, experts say that these vaccines may cause severe side effects in some people, especially in children and people living with various diseases. Therefore, they advise against mass vaccination, and recommend contact tracing and selective vaccination, in which case the general public too have a role to play. This may include being vigilant about those coming from abroad, especially from African countries, being vigilant about symptoms including inexplicable rashes, and being cautious when dealing with animals, especially imported animals, although only several types of animals are believed to transmit monkeypox.  


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