Monkeypox - Emerging Pandemic: Epidemiology & Problem Statement for India

CME
Monkeypox -An emerging Pandemic:
Epidemiology & Problem Statement for India
Prof Dr. Sanjev Dave
HOD Department of Community Medicine
Soban Singh Jeena Govt Institute of Medical sciences &
Research,
Almora (Uttarakhand)
11/26/2022 1

Outline
• History
• Past Journey to Current Scenario Across the World
• Epidemiology & Problem Statement -India
• Prevention
• Surveillance
• Contact tracing
• Way forward
11/26/2022 2

Introduction
• Monkeypox is an emerging zoonotic infection caused by monkeypox
virus (MPXV) of the Poxviridae family
• The incubation period of Monkeypox can be up to 21 day ( usually 5-21
days )
• Period of communicability: 1-2 days before the rash to until all the
scabs fall off
• Severity: Rare, sometimes life-threatening
• Endemic in West and Central Africa
• Can spread from infected animals to humans and person-to-person
• Respiratory secretions
• Skin-to-skin contact with infected body fluids
• (e.g., fluid from vesicles and pustules)
• Fomites (e.g., shared towels, contaminated bedding)
11/26/2022 3

History of Monkeypox
Past Journey to Current Scenario
PROBLEM STATEMENT
11/26/2022 4

Monkey Pox Outbreaks-History
• Human monkeypox first identified in humans in
1970 in the Democratic Republic of the Congo
• In a 9-month-old boy in a region where smallpox
had been eliminated in 1968.
• Most cases reported --- Rural, rainforest regions
of the Congo Basin(Democratic Republic of the
Congo)
• Human cases increasingly reported ----central
and west Africa.
11/26/2022 7

Monkeypox Endemicity in Africa
• Since 1970, human cases of monkeypox---
reported in 11 African countries:
• Benin, Cameroon, the Central African Republic,
the Democratic Republic of the Congo, Gabon,
Cote d’Ivoire, Liberia, Nigeria, the Republic of the
Congo, Sierra Leone and South Sudan.
• The true burden of monkeypox was not known.
• In 1996–97, an outbreak reported in the
Democratic Republic of the Congo -------
• a lower case fatality ratio and
• a higher attack rate than usual.
11/26/2022 8

• A concurrent outbreak of chickenpox (caused by
the varicella virus, which is not an orthopoxvirus)
and monkeypox ----found, which could explain
real or apparent changes in transmission
dynamics in this case.
• Since 2017, Nigeria -a large outbreak,
• ---over 500 suspected cases and
• ----over 200 confirmed cases and
• Case fatality ratio --3%.
• Cases continue to be reported until today.
Concurrent Outbreak of
Chicken Pox & Monkeypox
11/26/2022 9

• In 2003, the first monkeypox outbreak outside of
Africa was in the United States of America ----linked
to contact with infected pet prairie dogs.
• Pets housed with Gambian pouched rats and
dormice ----imported into the country from Ghana.
• This outbreak led to over 70 cases of monkeypox in
the U.S.
Outbreak of Monkeypox( United States)
11/26/2022 10

• Monkeypox has also been reported in travellers:
• --Nigeria to Israel in September 2018,
--to the United Kingdom in September 2018,
December 2019,
May 2021 and May 2022,
--to Singapore in May 2019, and to the
--United States of America in July and November
2021.
• In May 2022, multiple cases of monkeypox ---
identified in several non-endemic countries.
Monkeypox Spread in Travellers
11/26/2022 11

Geographical Spread of Monkeypox
• Since early May 2022,
---cases of monkeypox have been reported from countries
-----where the disease is not endemic, and
-----continue to be reported in several endemic countries.
• Most confirmed cases with travel history reported
travel to countries in Europe and North America,
rather than West or Central Africa where the
monkeypox virus is endemic.
• This is the first time that many monkeypox cases and
clusters have been reported concurrently in non-
endemic and endemic countries in widely disparate
geographical areas.
11/26/2022 12

• Between 1 January and 7 July 2022, a total of 7,892 confirmed cases,
including three deaths, were reported from 63 Member States in five
World Health Organization (WHO) Regions.
• The 3 fatal cases were reported from Nigeria (1) and the Central
African Republic (2).
• As of 7 July 2022,
• 82% (6,496 cases in 34 countries) of the confirmed cases were
reported in the WHO European Region;
• 15% (1,184 cases in 14 countries) in the WHO Region of the Americas,
• 2% (173 cases in 8 countries) in the WHO African Region,
• <1% (24 cases in 4 countries) in the WHO Western Pacific Region, and
• <1% (15 cases in 3 countries) in the WHO Eastern Mediterranean
Region.
• In 1st half- there was an increase of 41.6% in reported cases globally.
Global Journey in 1st half of 2022:-
11/26/2022 16

WHO – Monkeypox Data till July 2022
• World Health Organization (WHO) confirmed -
---global outbreak of monkeypox has grown
to more than 6,000 cases, with 80% in
European countries.
• WHO Director-General Tedros Adhanom
Ghebreyesus, PhD, said –infections detected
in 58 countries.
• WHO Data listed 7,075 confirmed cases
worldwide on 06th Jul-2022.
11/26/2022 17

Spain 3,125
United States of
America
2,316
Germany 2,268
The United Kingdom 2,137
France 1,453
Netherlands 712
Canada 615
Brazil 592
Portugal 588
Italy 374
• Together, these
10 countries
account
for 88.5% of the
cases reported
globally.
THE 10 MOST AFFECTED COUNTRIES
11/26/2022 18

Multi-country outbreak with cumulative cases
(19,188 as on 26th July,2022)
11/26/2022 19

Monkeypox - a PHEIC
• WHO Director-General Tedros Adhanom
Ghebreyesus, PhD, said today that infections was
detected in 58 countries.
• WHO World in Data lists 7,075 confirmed cases
worldwide in July 2022.
• Over 19,188 cases and 5 deaths (all in Africa)
across 76 countries this year since 4th May,2022
till 26th July.
• WHO declared the Monkeypox outbreak as Public
Health Emergency of International Concern
(PHEIC) on 23 July 2022.
11/26/2022 20

MonkeyPox- Entery in India?
• Though no Monkeypox case was reported
from India till mid-June 2022,
• considering the rate of its spread in non-
endemic countries,
• So urgent planning of better understanding of
the disease epidemiology to help clinicians,
public health specialists and policymakers for
any eventuality was done.
11/26/2022 21

Kerala reported Monkeypox
Index case
• A person who had recently returned from abroad has been admitted to a
hospital in Kerala after he showed symptoms of monkeypox, news agency
Press Trust of India reported, citing Health Minister Veena George. The
samples was sent to the National Institute of Virology for testing.The
Kerala minister said the person showed symptoms of monkeypox and he
was in close contact with a monkeypox patient abroad.
• So India Strengthened all the measures to rapidly detect and take
appropriate measures to prevent spread of Monkeypox.
• The first case of Monkeypox in WHO South-East Asia Region
was reported from India on 14th July,2022, in a 35-year old
man who arrived from the Middle East.
• In July 2022, 8 cases diagnosed in India (3 in Kerala and 1 in
Delhi) Including 1 Death.
11/26/2022 23

11/26/2022 25
Declining Trend of MonkeyPox ?

11/26/2022 26
US Centers for Disease Control and Prevention (CDC) report-- 13 September 2022
than 57,995 confirmed cases had been documented in
100 countries/territories

Current cases of Monkeypox ??
How many confirmed
cases of monkeypox in
World in Oct 2022?
20 455
confirmed cases
Since the start of the monkeypox
outbreak and as of 11 October
2022, 20 455 confirmed cases of
monkeypox (MPX) have been
reported from 29 EU/EEA
countries.
In total, 63 cases have been
reported from three Western
Balkan countries and Turkey
How many confirmed cases
of monkeypox in India?
Currently, India has reported
10 confirmed cases of
monkeypox,
--three of them in Kerala and
---five in Delhi, and
--eight suspected cases,
one case each in Delhi and
Telangana,
---four in Bihar and
--- four in Uttar Pradesh.
11/26/2022 27

Indian Scenario:
The total number of monkeypox cases in the
country have climbed to 19 after a Nigerial
tested positive for the virus in Delhi. Oct 25,
2022 .
Developed Countries( US) :
The latest data available on the US
Centres for Disease Control and
Prevention website is over 28, 000
Monkeypox cases have been confirmed
in the US, with six deaths and 75,568
global cases.
Rising Cases of Monkeypox- An issue?
During the week of 10 October to 16
October 2022, the number of
monkeypox cases reported in the
Regions of Europe and the Americas
continue to decline, driving the overall
downward trend observed since August
2022.
11/26/2022 28
Since the start of the monkeypox (MPX) outbreak and as of 25
October 2022, 20 675 confirmed cases of MPX have been reported
from 29 EU/EEA countries. In total, 51 cases have been reported
from three Western Balkan countries and Türkiye.
The five countries reporting most cases since the start of the
outbreak are: Spain (7 317), France (4 084), Germany (3 662),
Netherlands (1 235) and Portugal (932).
Deaths have been reported from: Spain (2), Belgium (1) and Czechia
(1).
The highest cumulative notification rates have been reported in
Spain, Portugal and Luxembourg

Epidemiology of Monkeypox
11/26/2022 29

Case profiles, As of July 25 2022
(Figures are not mutually exclusive)
Reported cases
MSM 3589 (98.0%)
HIV-Positive 1119 (41.4%)
Travel History 603 (36.8%)
Hospitalised2
380 (9.9%)
ICU 1 (0.1%)
Died 5
• Among cases with
known data on
sexual
orientation, 98.0%
(3591/3664) identifi
ed as MSM.
• Among those with
known HIV
status 41.4%
• Note that
information on
HIV status is not
WORLD WIDE CASES PROFILE
11/26/2022 30

11/26/2022 31
Cases Outcomes in Monkeypox

Case fatality ratio of Monkeypox
• Historically ranged : 0 to 11 % in the general
population
• Higher among young children.
• Currently case fatality ratio : 3–6%.
11/26/2022 33

Regional Profile:
Increase of 82% in the Africa Region,
60% in the Western Pacific Region,
57% in the Region of the Americas and 38% in the European
Region.
Age Profile:
Globally, 78% of confirmed cases are males aged 18 to 44 years
old (7 cases among children under 18 years of age in countries
in the African and European Regions).
Sexual history:
Overall, 98% of cases were identified as men who have sex with
men (MSM) and of these, 41% are HIV-positive.
Prior Exposure:
Among the cases, 47% indicated that they had prior exposure to
the disease during social events with sexual contact.
Epidemiological Profile of Monkeypox Cases
11/26/2022 34

• 1,110 cases with available information----
• 113 (healthcare workers).
• Infection in above cases ---caused by
occupational exposure??.
Monkeypox Cases in Health workers
11/26/2022 35

Monkeypox Clads
• Two clades of monkeypox viruses, the West
African and Congo Basin viruses have been
identified.
• The Congo Basin viruses are more virulent.
11/26/2022 37

Clade West african clade Congo basin clade
Severity Less severe More severe
Case fatality rate 3.6% 10.6%
Transmissibility Less More
Features of CLADES OF MONKEYPOX VIRUS
(The present PHEIC belongs to West African Clade)
11/26/2022 39

MODES OF TRANSMISSION
◾Virus enters body through broken skin, respiratory
tract, or mucous membranes [eye, nose, mouth].
Direct contact
Close contact
with lesions, body
fluids, respiratory
droplets
Indirect contact
Contaminate
d
materials such as
bedding.
Human to
Human
Animal to
Human
Bites
Scratches
Bush meat
preparation
11/26/2022 41

Modes of Transmission
• Most reported cases identified ----
• sexual health or other health services in
primary or secondary health-care facilities
and
• have involved mainly, but not exclusively, men
who have sex with men.
11/26/2022 45

Transmission Dynamics
• Animal-to-human (zoonotic) transmission can occur from direct
contact with the blood, bodily fluids, or cutaneous or mucosal
lesions of infected animals.
• In Africa, evidence of monkeypox virus infection has been found in
many animals including rope squirrels, tree squirrels, Gambian
pouched rats, dormice, different species of monkeys and others.
• The natural reservoir of monkeypox has not yet been identified,
though rodents are the most likely.
• Eating inadequately cooked meat and other animal products of
infected animals is a possible risk factor.
• People living in or near forested areas may have indirect or low-
level exposure to infected animals.
11/26/2022 48

Modes of transmiss
• 98% cases have
been reported
in MSM (not
mutually
exclusive) due
to intimate
contact during
sex with
infectious skin
lesions
• Oral Sex is a
cause too
• Modes of
transmission
yet to be fully
understood &
evolving
11/26/2022 49

Human Transmission
• Human-to-human transmission can result from close contact with respiratory
secretions, skin lesions of an infected person or recently contaminated
objects.
• Transmission via droplet respiratory particles usually requires prolonged
face-to-face contact, which puts health workers, household members and
other close contacts of active cases at greater risk.
• However, the longest documented chain of transmission in a community has
risen in recent years from 6 to 9 successive person-to-person infections.
• This may reflect declining immunity in all communities due to cessation of
smallpox vaccination.
• Transmission can also occur via the placenta from mother to fetus (which can
lead to congenital monkeypox) or during close contact during and after birth.
• While close physical contact is a well-known risk factor for transmission, it is
unclear at this time if monkeypox can be transmitted specifically through
sexual transmission routes.
• Studies are needed to better understand this risk.
11/26/2022 50

Case Definitions
11/26/2022 53

Case Definitions
Suspected case:
– A person of any age having
history of travel to affected
countries within last 21 days
presenting with an
unexplained acute rash AND
one or more of the
following signs or symptoms
• Swollen lymph nodes
• Fever
• Headache
• Body aches
• profound weakness
Probable case:
A person meeting the case
definition for a suspected case,
clinically compatible illness and
has an epidemiological link
Confirmed case:
A case which is laboratory
confirmed for Monkeypox virus
(by detection of unique
sequences of viral DNA either by
polymerase chain reaction (PCR)
and/or sequencing by WGS)
11/26/2022 55

Suspected case:
A person of any age having history of travel to
affected countries within last 21 days presenting
with an unexplained acute rash AND
one or more of the following signs or symptoms
Swollen lymph nodes
Fever
Headache
Body aches
profound weakness
11/26/2022 56

Probable case:
A person meeting the case definition for a
suspected case,
-clinically compatible illness and
--has an epidemiological link (face-to-face
exposure, including health care workers without
appropriate PPE;
-direct physical contact with skin or skin lesions,
including sexual contact; or
--contact with contaminated materials such as
clothing, bedding or utensils is suggestive of a
strong epidemiological link.
11/26/2022 57

Confirmed case:
• A case which is laboratory confirmed for
monkeypox virus (by detection of unique
sequences of viral DNA either by
• Polymerase Chain Reaction (PCR) And/Or
Sequencing).
11/26/2022 58

Smallpox vs Monkeypox
• The clinical presentation of monkeypox
resembles that of smallpox, a related
orthopoxvirus infection which was declared
eradicated worldwide in 1980.
• Monkeypox is less contagious than smallpox
and causes less severe illness.
• Monkeypox typically presents clinically with
fever, rash and swollen lymph nodes and may
lead to a range of medical complications.
11/26/2022 59

Prevention
• Raising awareness of risk factors and educating
people about the measures they can take to
reduce exposure to the virus is the main
prevention strategy for monkeypox.
• Scientific studies are now underway to assess the
feasibility and appropriateness of vaccination for
the prevention and control of monkeypox.
• Some countries have, or are developing, policies
to offer vaccine to persons who may be at risk
such as laboratory personnel, rapid response
teams and health workers.
11/26/2022 64

PREVENTION
• Prevention includes activities mainly screening and vaccination
against the disease (India has started discussion with the
vaccine manufacturers)
• But now, we have to work on raising awareness of risk factors
and educating people about the measures they can take to
reduce exposure to the virus is the main prevention strategy for
Monkeypox.
• Scientific studies are now underway to assess the feasibility and
appropriateness of vaccination for the prevention and control
of Monkeypox.
11/26/2022 65

INFECTION CONTROL
 Isolation of Patient
 Persons with extensive lesions should be isolated in a separate room.
 Household members should limit contact with the infected person.
 Infected people should also avoid contact with animals, including pets.
 Use of Personal Protective Equipment (PPE)
 Persons with Monkeypox should wear a surgical mask,
 Disposable gloves should be worn for direct contact with lesions and
disposed of after use.
 Skin lesions should be covered to the best extent possible (Long
sleeves, long pants) to minimize risk of contact with others.
 Contain and dispose of contaminated waste (such as dressings and
bandages) should be done according to biomedical waste disposal.
11/26/2022 66

Proper hand hygiene and cleaning procedures
 Hand hygiene- Hand washing with soap and water
or use of an alcohol-based hand rub should be done.
 Hand hygiene is to be performed after touching
lesion material, clothing, linens, or environmental
surfaces.
Household disinfection
 Laundry: To be washed separately to avoid direct
contact with contaminated material.
 Soiled dishes and utensils should be with warm
water and soap.
 Contaminated surfaces should be cleaned and
disinfected. Standard household
cleaning/disinfectants may be used.
11/26/2022 67

INFECTION CONTROL PRECAUTIONS
By health workers-
 To implement standard, contact and droplet precautions
Recommended Personal Protective Equipment (PPE)
includes gloves, gown, medical mask and eye
protection – goggles or face shield
Aerosol generating procedures should be done by
taking proper precautions.
Continue until all lesions have resolved and a fresh
layer of skin has formed.
11/26/2022 68

SURVEILLANCE STRATEGIES
• The aims of the proposed surveillance strategy
are to rapidly identify cases and clusters of
infections and the sources of infections (Index
Case) as soon as possible in order to:
1. Isolate cases to prevent further transmission
2. Provide optimal clinical care
3. Identify and manage contacts
4. Protect frontline health workers
5. Effective control and preventive measures based on
the identified routes of transmission
11/26/2022 69

Role of APHOs/PHOs/LPHOs
• Remain in a state of alert, particularly for the passengers arriving
from countries reporting monkey pox outbreaks,
• Familiarize yourself with clinical presentation of monkey pox,
• Undertake strict thermal screening and history of travel to affected
countries in last 21 days,
• Establish/strengthen referral arrangements from airport/Sea-
port/Land-port to identified link hospital.
• Also, familiarize Bureau of Immigration personnel, Airline
personnel, Customs officials, Airport/Sea-port/Land-port officials,
State health officials and other stakeholders about the disease,
• Inform concerned airlines about detection of a suspect case for the
purpose of disinfection procedure to be followed as per standard
guidelines.
11/26/2022 70

PUBLIC HEALTH ACTION
1. Health units to keep heightened suspicion in people who;
a. Present with otherwise unexplained rash and
b. Who have travelled in the last 21 days to a country that
has recently confirmed or suspected cases of Monkeypox
or
c. Report contact with a person or people with confirmed or
suspected Monkeypox.
2. Refer suspected travelers to the designated isolation
facilities for further investigation and treatment
11/26/2022 71

2. All suspected cases to be isolated at designated healthcare facilities
until all lesions have resolved and a fresh layer of skin has formed OR
until the treating physician decides to end isolation.
3. All such patients to be reported to the district surveillance officer of
IDSP.
4. All infection control practices to be followed while treating such
patients.
5. Laboratory samples consisting of fluid from vesicle ,blood, sputum etc
to be sent to NIV Pune and other 15 ICMR labs for testing in case of
suspicion
6. In case a positive case is detected, contact tracing has to be initiated
immediately to identify the contacts of the patient in the last 21 days.
11/26/2022 72

Reducing the risk of human-to-human
transmission
• Surveillance and rapid identification of new cases is critical
for outbreak containment.
• During human monkeypox outbreaks, close contact with
infected persons is the most significant risk factor for
monkeypox virus infection.
• Health workers and household members are at a greater
risk of infection.
• Health workers caring for patients with suspected or
confirmed monkeypox virus infection, or handling
specimens from them, should implement standard
infection control precautions.
• If possible, persons previously vaccinated against smallpox
should be selected to care for the patient.
11/26/2022 73

Reducing the risk of human-to-human
transmission
• Samples taken from people and animals with suspected
monkeypox virus infection should be handled by trained
staff working in suitably equipped laboratories.
• Patient specimens must be safely prepared for transport
with triple packaging in accordance with WHO guidance for
transport of infectious substances.
• The identification in May 2022 of clusters of monkeypox
cases in several non-endemic countries with no direct
travel links to an endemic area is atypical.
• Further investigations are underway to determine the
likely source of infection and limit further onward spread.
• As the source of this outbreak is being investigated, it is
important to look at all possible modes of transmission in
order to safeguard public health.
11/26/2022 74

Reducing the risk of zoonotic transmission
Over time, most human infections have resulted from a
primary, animal-to-human transmission. Unprotected contact
with wild animals, especially those that are sick or dead,
including their meat, blood and other parts must be avoided.
Additionally, all foods containing animal meat or parts must be
thoroughly cooked before eating.
Preventing monkeypox through restrictions on animal trade
Some countries have put in place regulations restricting
importation of rodents and non-human primates. Captive
animals that are potentially infected with monkeypox should be
isolated from other animals and placed into immediate
quarantine. Any animals that might have come into contact
with an infected animal should be quarantined, handled with
standard precautions and observed for monkeypox symptoms
for 30 days.
11/26/2022 75

Surveillance Strategies
The aims of the proposed surveillance strategy are
to rapidly identify cases and clusters of
infections and the sources of infections as soon
as possible in order to:
a) isolate cases to prevent further transmission
b) provide optimal clinical care
c) identify and manage contacts
d) protect frontline health workers
e) effective control and preventive measures
based on the identified routes of transmission.
11/26/2022 76

Surveillance outline
a) Use Standard Case Definitions by all District Surveillance Units (DSUs) under
Integrated Disease Surveillance Programme (IDSP) and at Points of Entry (PoEs).
b) Even one case of monkeypox is to be considered as an outbreak. A detailed
investigation by the Rapid Response Teams need to be initiated through IDSP.
c) Report any suspected case immediately to the DSU/State Surveillance Units (SSUs)
and CSU (Central Surveillance Unit), which shall report the same to Dte. GHS
MoHFW.
d) Send the samples as per the guidelines to the designated laboratories.
11/26/2022 77

Features of Surveillance
The salient features include:
a) Targeted surveillance for probable case or
clusters.
b) Initiate contact tracing and testing of the
symptomatic after the detection of the
probable/confirmed case.
11/26/2022 78

Core Surveillance Strategy
a) Hospital based Surveillance: - Health facility-
based surveillance & testing – in
Dermatology clinics, STD clinics, medicine,
paediatrics OPDs etc.
b) Targeted Surveillance: This can be achieved
by:
i) Measles surveillance by Immunization division
ii) Targeted intervention sites identified by
NACO for MSM, FSW population
11/26/2022 79

Contact tracing
Definition of a contact
• A contact is defined as a person who, in the period
beginning with the onset of the source case’s
• first symptoms, and ending when all scabs have fallen off,
has had one or more of the following
• exposures with a probable or confirmed case of monkey
pox:
• face-to-face exposure (including health care workers
without appropriate PPE)
• direct physical contact, including sexual contact
• contact with contaminated materials such as clothing or
bedding
11/26/2022 80

Contact identification
Cases can be prompted to identify contacts
across household, workplace, school/nursery,
sexual contacts, healthcare, houses of worship,
transportation, sports, social gatherings, and
any other recalled interactions.
11/26/2022 81

Contact monitoring
a) Contacts should be monitored at least daily for the onset of
signs/symptoms for a periodof 21 days (as per case definition above)
from the last contact with a patient or their contaminated materials
during the infectious period. In case of occurrence of fever clinical/lab
evaluation is warranted.
b) Asymptomatic contacts should not donate blood, cells, tissue, organs or
semen while they are under surveillance.
c) Pre-school children may be excluded from day care, nursery, or other group
settings.
d) Health workers who have unprotected exposures to patients with
monkeypox or possibly contaminated materials do not need to be
excluded from work duty if asymptomatic, but hould undergo active
surveillance for symptoms for 21 days.
Advisory for International Passengers and surveillance at Airports and Role of
APHOs/PHOs
11/26/2022 82

One Health Approach
Therefore, appropriate measures should be taken, such as:
1. physical distancing between people infected with
monkeypox and domestic pets
2. proper waste management to prevent the disease from
being transmitted from infected humans to susceptible
animals at home (including pets), in zoos and wildlife
reserves, and to peri-domestic animals, especially rodents.
3.Residents and travellers to countries that have previously
reported monkeypox should avoid contact with sick
mammals such as rodents, marsupials, non-human
primates (dead or alive) that could harbor monkeypox virus
and should refrain from eating or handling wild game (bush
meat).
11/26/2022 84

Vaccination
• Vaccination against smallpox was demonstrated through several
observational studies to be about 85% effective in preventing monkeypox.
• Thus, prior smallpox vaccination may result in milder illness. Evidence of
prior vaccination against smallpox can usually be found as a scar on the
upper arm.
• At the present time, the original (first-generation) smallpox vaccines are
no longer available to the general public.
• Some laboratory personnel or health workers may have received a more
recent smallpox vaccine to protect them in the event of exposure to
orthopoxviruses in the workplace.
• A still newer vaccine based on a modified attenuated vaccinia virus
(Ankara strain) was approved for the prevention of monkeypox in 2019.
• This is a two-dose vaccine for which availability remains limited. Smallpox
and monkeypox vaccines are developed in formulations based on the
vaccinia virus due to cross-protection afforded for the immune response
to orthopoxviruses.
11/26/2022 86

Ring Vaccination Strategy for Monkeypox
11/26/2022 87

Prognosis
• At this time, there are no specific treatments available for Monkeypox infection,
but Monkeypox outbreaks can be controlled.
• Many individuals infected with Monkeypox virus have a mild, self-limiting
disease course in the absence of specific therapy
• The prognosis for Monkeypox depends on multiple factors such as previous
vaccination status, initial health status, and concurrent illnesses or
comorbidities
11/26/2022 88

Take Home Message
11/26/2022 89
Monkeypox is a viral zoonotic infection that results in a rash similar to that of
smallpox.
However, historically, person-to-person spread outside the household and
mortality from a monkeypox infection are significantly less than for smallpox.
Globally, there have been more than 68,000 monkeypox cases and 25 confirmed
deaths in the current outbreak, according to the World Health Organization.
According to the CDC, 71,096 monkeypox cases have been reported globally in
107 countries since January 1, 2022.
The U.S. has reported the highest number of monkeypox cases, followed by
Brazil with 8,207 and Spain with 7,209.
In the U.S., two vaccines (JYNNEOS and ACAM2000) may be used to prevent the
spread of monkeypox.

Monkeypox - Emerging Pandemic: Epidemiology & Problem Statement for India

Recomendados

Recomendados

Mais conteúdo relacionado

Semelhante a Monkeypox - Emerging Pandemic: Epidemiology & Problem Statement for India

Semelhante a Monkeypox - Emerging Pandemic: Epidemiology & Problem Statement for India (20)

Mais de CommunityMedicine46

Mais de CommunityMedicine46 (15)

Último

Último (20)

Monkeypox - Emerging Pandemic: Epidemiology & Problem Statement for India

Notas do Editor