Mbnnnnnnnnpox_Review_DGHS_18_Aug_2024.pptx

Medical College and hospital (monkey pox management) can be used

1. 1 Mpox (Monkeypox) 18th August 2024

2. Introduction Mpox is a viral zoonotic disease caused by DNA Monkeypox virus (MPXV) belongs to Orthopoxvirus genus. Mpox was first discovered in 1958 in colonies of monkeys kept for research, hence the name ‘monkeypox.’ It was first identified in humans in 1970 in the Democratic Republic of the Congo. Two clades - Congo Basin Clade (more virulent and transmissible) or Clade I (Responsible for 2024 epidemic) and the West African Clade or Clade II (responsible for 2022 upsurge) . Monkeypox has been declared as PHEIC by WHO on 23rd July 2022 which was revoked on 10 th May 2023. The 2024 upsurge has led to WHO declaring mpox as a PHEIC once again on the 14 th August 2024 2

3. Transmission (1) A. Person to Person: Mpox spreads from person-to-person through close contact with someone who is infected with the monkeypox virus. ⁠Close contact includes being face-to-face (such as talking or breathing close to one another which can generate droplets or short-range aerosols); skin-to-skin (such as touching or vaginal/anal sex); mouth-to-mouth (such as kissing); or mouth-to-skin contact (such as oral sex or kissing the skin). It is also possible for the monkeypox virus to persist for some time on clothing, bedding, towels, objects, electronics and surfaces that have been touched by a person with mpox . The virus can also spread during pregnancy to the fetus, during or after birth through skin-to-skin contact, or from a parent with mpox to an infant or child during close contact. ⁠Although live monkeypox virus has been isolated from semen, we do not yet know whether infection can spread through semen, vaginal fluids, amniotic fluids, breastmilk or blood . 3

4. Transmission (2) B. From animals to humans: Mpox can spread to people when they come into physical contact with an infected animal such as some species of monkeys, terrestrial rodent (such as the tree squirrel). Physical contact can mean through bites or scratches, or during activities such as hunting, skinning, trapping, or cooking. ⁠The virus can also be caught through eating infected animals if the meat is not cooked thoroughly. C. From humans to animals: There have been a few reports of the monkeypox virus being identified in pet dogs. However, it is not confirmed whether these were true infections, or whether the detection of virus was related to surface contamination. 4

5. Prodrome (0 – 5 days): Fever Headache, muscle aches, Body ache, Malaise Lymphadenopathy (key sign that differentiates monkeypox from chickenpox) chills and/or sweats Sore throat & Cough Rash: 1 – 3 days of fever onset, lasting 2 – 4 weeks Lesions, often painful, predominate on the face but may develop on the palms, soles and dorsal hand & feet Genital & Perigenital lesions have been conspicuous in recent 2022 outbreak. rash begins as 2 – 5mm diameter maculopapules , which evolve into vesicles, pustules & then crust over. 5 Signs & Symptoms

6. Blister fluid, blood & urine samples required for testing 32 labs equipped to conduct tests; 20 currently in state of readiness Orientation of IDSP SSUs, DSUs and RRTs on sample processing and transportation Logistic a arrangements for sample processing and transportation Functional linkages between health facilities, IDSP and lab network 6 Diagnosis

7. Vaccination There are two vaccines that have been approved by WHO- listed national regulatory authorities, and which are recommended by the WHO Strategic Advisory Group of Experts on Immunization: MVA-BN, manufactured by Bavaria Nordic LC16, manufactured by KM Biologics In addition, there is a third vaccine, ACAM2000 , that may be considered if the other two vaccines are not available. Vaccine can help prevent infection. Mass vaccination is neither required nor recommended for monkeypox at this time; Primary preventive (pre-exposure) vaccination (PPV) is recommended for individuals at high-risk of exposure : gay, bisexual, or other men who have sex with men (MSM) with multiple sexual partners. Others at risk may include individuals with multiple casual sexual partners; sex workers; health workers at risk of repeated exposure, laboratory personnel working with orthopoxviruses ; clinical laboratory and health care personnel performing diagnostic testing for monkeypox; and outbreak response team members; Decisions on use of smallpox or monkeypox vaccines should be based on a full assessment of risks and benefits on a case-by-case basis. 7

8. Management Only symptomatic treatment , Patient isolation , Protection of compromised skin and mucous membranes. Rehydration therapy and Nutritional support. Monitoring and treatment of complications . Contact tracing: Daily for 21 days from the last contact. Identification of dedicated I solation Facilities for patient management. Timely referral and end to end patient management including ambulance transfer. Treatment for smallpox may be used to prevent and treat monkey pox virus infections. Drugs: Tecovirimat Vaccinia Immune Globulin Intravenous (VIGIV) Cidofovir & Brincidofovir - effective against orthopoxviruses in  in vitro  and animal studies.  8 *Source: https://www.cdc.gov/poxvirus/mpox/clinicians/treatment.html

9. Timeline of Important events 9 May,2022 MoHFW released guidelines on management of Monkey pox disease 14 th July, 2022 25 th July, 2022 2 nd August,2022 01 st June, 2022 1 st case reported in Kerala, India NCDC PHEOC activated First case reported from a non-endemic country 23 rd July, 2022 WHO declared PHEIC NCDC issued CD Alert on Monkey pox 28 th Nov., 2022 WHO recommended using the word mpox 10 th May ,2023 WHO revoked the PHEIC status 14 th Aug, 2024 WHO declares mpox as a PHEIC once again.

10. G lob al dis t ribu t io n o f confirm ed mp o x c a s es 01 J a n 2022 – 30 June 2024 African CDC data : In 2024 - More than 16600 suspected cases, 2863 confirmed cases and 537 deaths reported Imported cases reported : Sweden, Pakistan China will monitor individuals and goods entering the country for M pox over the next six months 10

11. The Epicentre (Source: African and US CDC) 11 There are several outbreaks happening at the same time in DRC , with cases reported throughout the country, in the capital city of Kinshasa, and in some other large cities. In some provinces, patients have acquired infection through contact with infected dead or live wild animals, household transmission, or patient care (transmitted when appropriate PPE wasn’t used or available) A high proportion of cases have been reported in children younger than 15 years of age. In other provinces, the cases are associated with sexual contact among men who have sex with men and female sex workers and their contacts. These are first reported cases of sexual transmission with clade I mpox.

12. Mpox in India The first case of Mpox was reported in Kollam, Kerala on 14 th July 2022 . On 27 th March 2024 , the last case was reported from Kerala. Total 30 laboratory confirmed cases were reported from Kerala (15 cases) and Delhi (15 cases). The cases belonged to age range 22-48 years, affecting 18 males and 12 females. Nationality- 18 Indians and 12 African countries. International Travel History- 12 cases . Deaths- 1 case in Kerala Self reporting has been the primary modality for case detection in India (Passive surveillance) 12 Source: IDSP, NCDC

13. Steps taken in view of recent surge of cases 12 th August 2024  - Technical meeting of experts, chaired by Principal Adviser, NCDC, Delhi with a view to assess the risk for India : The risk of a large outbreak with sustained transmission is presently low for India.   The possibility of a few imported cases being detected in the coming weeks is not entirely ruled out. The following actions undertaken : The CD Alert on Mpox issued by NCDC in July 2022 is being updated to capture the newer developments A sensitization of the health teams at International Airports ( PoEs ) was undertaken 16 th August 2024 – Meeting of the Joint Monitoring Group (JMG) 17 th August 2024 – Situation and preparedness reviewed by Hon. HFM 18 th August 2024 –More than 200 participants from the States (IDSP Units), PoEs , RoHFWs & NCDC branches sensitized in a VC chaired by DGHS. 13

14. Risk Assessment (Global) WHO conducted the latest global mpox risk assessment in August 2024 . Mpox long-term risk was assessed as follows: Eastern Democratic Republic of the Congo and neighbouring countries, affecting mostly adults and spreading predominantly through sexual contact (linked to clade Ib ): HIGH. Areas of the Democratic Republic of the Congo where mpox is endemic, affecting mostly children and spreading through multiple modes of transmission (linked to clade Ia ): HIGH. Nigeria and countries of West, Central and East Africa where mpox is endemic, affecting children and adults and spreading through multiple modes of transmission (linked to clades I and II): MODERATE . All countries in Africa and around the world, where outbreaks affect mainly men who have sex with men and spread predominantly through sexual contact (linked to clade IIb ): MODERATE 14

15. 15 Thank You