Explained What are the guidelines of the Ministry of Health regarding monkeypox?

The story so far: The Ministry of Health of India has issued guidelines for the management of monkeypox disease. No cases of the virus have been confirmed in India so far, but reports of the virus spreading to non-endemic countries have led to guidelines.

What do the guidelines say?

The 23-page document, available on the Ministry of Health’s website, is an information sheet listing the global spread of the disease as of 31 May, its epidemiology or disease characteristics, including the type of virus that causes the disease, its likely origin, incubation period, how long before the symptoms appear, etc. It also highlights how long it takes to go away, ways of transmission, symptoms, possible ways of exposure, a test to confirm the presence of the virus, the government’s monitoring strategy to identify cases and groups of infection.

What are the most important recommendations?

The guidelines recommend that contacts be monitored daily for signs / symptoms for a period of 21 days (as defined by the case) of the last contact with a patient or his contaminated materials during the infectious period. Suspected cases of monkeypox include a person of any age with a history of travel to the affected countries in the past 21 days and presentation of unexplained acute rash and one or more symptoms, including swollen lymph nodes, fever, headache and profound weakness.

Other symptoms include eye pain or blurred vision, shortness of breath, chest pain, difficulty breathing, altered consciousness, seizures, decreased urine output, poor oral intake and lethargy.

A case of monkeypox has been confirmed in a laboratory by detecting unique sequences of viral DNA by polymerase chain reaction (PCR) and / or sequencing, similar to the COVID-19 test. However, there are still no commercial tests for monkeypox and all clinical samples must be transported to the ICMR-NIV Laboratory (Pune), directed through the Integrated Disease Surveillance Program (IDSP) network of the area / state.

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There is no treatment protocol or medication specific for monkeypox and the patient should be managed based on the symptoms that occur. For example, dehydration should be treated with oral fluids; fever with sponge and paracetamol, nausea and vomiting with antiemetics.

How common is monkeypox worldwide?

The World Health Organization reports that cases of monkeypox have been reported by 12 Member States that are not endemic to the monkeypox virus. The cases reported so far have no established links to travel to endemic areas. Based on currently available information, the cases are predominant, but not limited to men who have sex with men (MSM) seeking care in primary care and sexual health clinics.

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To date, all cases whose samples have been confirmed by PCR have been identified as infected with West African virus. The genome sequence of a swab sample from a confirmed case in Portugal shows a close coincidence of the monkeypox virus causing the current epidemic with the cases exported from Nigeria to the United Kingdom, Israel and Singapore in 2018 and 2019. Countries where the virus was endemic according to the WHO, Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified only in animals), Côte d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan.

Are there any vaccines?

It has historically been shown that smallpox vaccination protects against monkeypox. While one vaccine (MVA-BN) and one specific treatment (tecovirimate) were approved for monkeypox in 2019 and 2022, respectively, they are not widely available. The smallpox vaccine is said to be protective against monkeypox, but this vaccine will be given to people over the age of 40-50 who have been inoculated with the smallpox vaccine, and it is not clear how long the protection lasts.

• The guidelines of the Ministry of Health recommend that contact persons be monitored daily for symptoms for a period of 21 days from the last contact with a patient or contaminated material during the infectious period.

• Suspected cases of smallpox include a person of all ages with a history of travel to affected countries in the past 21 days and presentation of unexplained acute rash and one or more symptoms, including swollen lymph nodes, fever, headache and profound weakness.

• A case of monkeypox has been confirmed in a laboratory by detecting unique sequences of viral DNA by polymerase chain reaction (PCR) and / or sequencing, similar to the COVID-19 test. There is no treatment protocol or medication specific for monkeypox and the patient should be managed based on the symptoms that occur.