MonkeyPox - Prevention & Control.pdf

MONKEY POX
PREVENTION AND CONTROL

1. MONKEYPOX:
PREVENTION & CONTROL
Dr. Robin T Vavachan
Junior Resident
1

2. Dr. BijayaNaik
Assistant Professor
Dr. Manisha Verma
Senior Resident
MODERATORS
2

3. 01 Introduction
02 Timeline
03
Virology & Transmission04
05
Global Burden
06 Investigation & Diagnosis
07
Risk Communication &
Prevention
08 Control Measures
Case Definition
3

4. INTRODUCTION
MPX –not a novel disease
It was endemic to western & central Africa earlier
First identified in lab monkeys in Denmark
Hence called the MPX virus (1958)
Inequity of global attention
Not just an “African Disease”
MPX –A zoonotic disease
Infection by the MPX virus causes constitutional
symptoms & skin manifestations.
MPX outbreak of 2022
Declared global health emergency by WHO (July 23
rd
of 2022)
4

5. 1970 1975-2003 2003 2017 2022
•FirstoutbreakinZaire
•2otheroutbreaksin
Liberia&SierraLeone
AMajoroutbreakin
Nigeriawith>200
cases
GlobalHealth
Emergency
Similaroutbreaksin
Nigeria,IvoryCost,
Cameroon,Gabon,
DRC
Firstoutbreak
outsideAfrica
TIMELINE
5

6. 94
Total
Green marketing Green marketing
87
Non-historical Locations
7
Historical Locations
41,358
Total Cases
Green marketing Green marketing
40,971
Non-historical Locations
387
Historical Locations
Confirmed Cases
Locations With Cases
GLOBAL BURDEN
*As on 22
nd
of August 2022
6

7. 7

8. TRANSMISSION
1)ANIMAL TO HUMAN
2)HUMAN TO HUMAN
3)HUMAN TO ANIMAL ?
PAGE VIEWS CLICKS
INCUBATION
PERIOD
3 -20
days
PERIOD OF
INFECTIVITY
2 -4
Weeks
MORTALITY
CLADE I 10%
CLADE II 1%
26%
IN 2003 USA
HOSPITALISATION
RATE
SECONDARY
ATTACK RATE
9% IN
HOUSEHOLDS
CASE FATALITY
RATE
3-6 %
R
0?
MPX VIRUS
8

9. CASE DEFINITIONS
WHO
•Definition of Contact
•Suspected Case
•Probable Case
•Confirmed Case
•Discarded Case
•Suspected Case
•Probable Case
•Confirmed Case
•Epidemiological
Criteria
CDC
MOHFW
•Suspected Case
•Probable Case
•Confirmed Case 9

10. •SHARE net group (Sexual health and HIV
All East research)–A London-based
collaborative
•Data collection by contacting peers
in various countries
•Observational descriptive study
10

11. Not always disseminated
arossthe body
Deep-seated, Often
umbilicated
Genital/Ano-Rectal/
Mouth
Well circumscribed
Firm, rubbery
Bacterial Conjunctivitis
Corneal opacity
Muco-Cutaneous
Complications
Do not always appear on
palms & soles
4 Stages
MPX LESION
-Current Global Outbreak
11

12. INVESTIGATION & DIAGNOSIS
Sample
Collection
Sample Transport
Sample Handling
Nodal Labs by
ICMR
ICMR Testing
Algorithm
12

13. Clinical Specimens (Lesion, EDTA, Serum, Urine, OPS/NPS)
PCR for Orthopoxvirusgenus [Cowpox, Buffalopox, Camelpox,
Monkeypox]
If negative
To be investigated for other causes
If positive*
Real time PCR
Monkeypox DNA
PCR specific for
Monkeypox
OR
Report Positive for Monkeypox
* Virus isolation and the Next Generation Sequencing of clinical samples (Miniseand Nexseq) will be used for characterization of the
positive clinical specimens
ICMR TESTING ALGORITHM
13

14. 14

15. MPX VIRUS: CURRENT LINEAGE
Two known clades of monkeypox virus based on
genetic Sequencing
•1 –Central African (Congo Basin; higher CFR)
•2 -West African (lower CFR, due to absence of a viral
complement control protein)
MPXV 2022 (Lineage B.1 ) clusters with 2018-2019
cases from West Africa.
Host APOBE3 activity-induced hypermutation is
seen in the current strain (VIRUS adapted to the
human host)
15

16. RISK COMMUNICATION & PREVENTION
Health Promotion Specific Protection
(PrEP)
Health Education to
remove stigma
Life Style & Behavioural
Changes
MVA Vaccine ACAM 2000
Role of Media
Role of
Researchers
Personal Protection Precautionary MeasuresSafe Sexual PracticesCleaning & Disinfection
16

17. HEALTH EDUCATION TO REMOVE STIGMA
Role of researchers & media
•To use non –stigmatizing & scientific language
•To use vocabulary & tone that is inclusive, empowering
MPX mandates a sophisticated response
Challenge for HCW
Anti –Gay Stigma in India
MPX cases are driven underground
Role of Public
To follow & abide government guidelines
17

18. SAFE SEXUAL PRACTICES
Communicate with your partner
about new symptoms
And beware of any new or unexplained symptoms
Reducing behaviors that risk
of MPX exposure
Reduce skin-to-skin & face-to-face contact
Exchanging contact info with
any new sexual partner
To facilitate contact tracing & follow up
Avoid spaces where intimate/anonymous
contacts might occur
Saunas, Sex clubs, private/public sex parties
18

19. PRECAUTIONARY MEASURES
In social gatherings
When MPX outbreak occurs in a
congregate living facility
Clean & Disinfect the affected areas
Ensure access to hand washing
Communicate with staff, volunteers & residents
About prevention & potential transmission possibilities
Response to cases in the facility
Medically evaluate, test, identify, isolate, consult IDSP
Provide appropriate PPE
When entering isolation, laundry areas & during cleaning-disinfection
19

20. PRE-EXPOSURE PROPHYLAXIS
MVA Vaccine ACAM 2000 Vaccine
No FDA approval yet
Only as an alternative for MVA vaccine under FDA’s
expanded access Investigational Drug (IND)
Mechanism
NY City Board of Health Vaccinia Strain
Replication competent smallpox vaccine
Low safety profile than MVA Vaccine
C/I in immuno-compromised & pregnant women
Maximum Seropositivity
4 Weeks after dosage
APPROVAL
•FDA approval –Sep 2019
•Emergency Use Authorization –Aug 2022
Modified Vaccinia Ankara Strain
Highly attenuated non-replicating vaccinia virus
Excellent safety profile
Safe even in immuno-compromised
Maximum Seropositivity
After 14 days of the second dose
20

21. CONTROL MEASURES
Frame work to identify,
isolate & inform
Infection Control in a
healthcare setting
Surveillance Strategy
Contact Tracing PEP
Surveillance Outline Salient Features Core Surveillance Strategy Case Reporting
21

22. INFECTION CONTROL IN A HEALTHCARE SETTING
Precautions to be taken
Clinicians, lab personnel, vets, forensic –autopsy
Among HCW
Standard infection control precautions, Ring Immunization
Sample Handling
Well-trained staff with suitably equipped labs &
ensure safe packaging + transporting
Patient Handling
Patient placement & transport
BMW
Category A infectious agent
Among HCW
Standard infection control precautions, Ring Immunization
22

23. SURVEILLANCE STRATEGY
Salient Features
•Targeted Surveillance for probable case or clusters
•Contact tracing initiated after detection of probable/confirmed case
Surveillance outline
•Use standard case definition
•Even one case will be considered as outbreak F/B detailed Ix
by Rapid Response Team
•Report case immediately
•Send samples as per guidelines
Core Surveillance strategy
•Hospital-based surveillance
•Targeted intervention sites by NACO for MSM, FSW
23

24. 24

25. CONTACT TRACING
Contact Monitoring
•Should be monitored at least once daily for signs & symptoms
for a period of 21 days from the last contact
•Asymptomatic Contacts should not donate blood/organ/semen
Definition of Contact
Contact Identification
Contacts across workplace, schools, sexual contacts, HCW contacts,
houses of worship, social gatherings
25

26. MPX CONTROL IN VARIOUS COUNTRIES
USA
•Failuretorecognizethevirus
wasspreadingdifferentlyand
farmoreaggressively
•Notdoingenoughtocontain
MPXcases
•Vaccinechallenges
•Gaymenfacingthethreatof
anagonizingillness
UK
•Newlyreleaseddatasuggest
transmissionisplateauing–
thatmeanspublichealth
measuresareworking
•Theyexpandedthepoolof
eligiblevaccinerecipients
•Encouraginganyoneeligible
togetinoculated.
26

27. Risk of interspecies transmission &
risk of virus remaining
in reservoir species
Not a “GAY /MONKEY /
AFRICAN DISEASE”
Only a matter of time before
this happens again
Role of governments in
developing countries
Lack of evidence based
clinical Mx guidelines
Vaccine & global health inequality
kills everywhere
LESSONS FROM MPX & COVID -19
27
“One Health Strategy” to reduce the
Poverty-related MPX outbreaks

28. Scale up the diagnostic testing + surveillance
+ contact tracing + Antivirals & supportive care
Boosting information updates & strict
quarantine measures for mass gatherings
Reliable & secured information sources +
Decentralized health care
Regional & Global collaboration +Coordination
of epidemiological surveillance
Enhanced poverty alleviation
Strategies + Early & effective
risk communication
ONE HEALTH STRATEGY
29
Strengthening international
health regulations

29. REFERENCES
30
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human-to-dogtransmissionofmonkeypoxvirus.TheLancet.2022
Aug;400(10353):658–9.
2.ThornhillJP,BarkatiS,WalmsleyS,RockstrohJ,AntinoriA,HarrisonLB,etal.
MonkeypoxVirusInfectioninHumansacross16Countries—April–June2022.New
EnglandJournalofMedicine.2022Aug25;387(8):679–91.
3.Guidelinesofvariousgovernment&NGOs(WHOetc).
4.IsidroJ,BorgesV,PintoM,SobralD,SantosJD,NunesA,etal.Phylogenomic
characterizationandsignsofmicroevolutioninthe2022multi-countryoutbreakof
monkeypoxvirus.NatMed.2022Aug;28(8):1569–72.

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