India's 1st monkeypox case reported in Kerala; Centre sends high-level team

The Centre on Thursday rushed a high-level, multi-disciplinary team to Kerala to collaborate with the state health authorities and institute public health measures after one case of monkeypox was confirmed in Kollam district of this southern state. A person who returned to Kerala from abroad and was hospitalised after showing signs of monkeypox tested positive for the same, state Health Minister Veena George said on Thursday.

The central team to Kerala comprises experts drawn from National Centre for Disease Control (NCDC), Dr RML Hospital, New Delhi and senior officials from MoHFW, along with experts from Regional Office of Health and Family Welfare, Kerala.

Earlier in the day, the health ministry had written to states, asking them to proactively work on public health response against the disease. “The team shall work closely with state health departments and take stock of on-ground situations and recommend necessary public health interventions. Govt of India is taking proactive steps by monitoring the situation carefully and coordinating with states in case of any such possibility of outbreak occurs,” the health ministry said in the evening.

The Centre had already issued guidelines for monkeypox disease management on May 31 amid rising cases across the globe.

A person who returned from overseas has been admitted to hospital after he showed signs of monkeypox. The samples sent to the National Institute of Virology for testing, came back positive. The person concerned was in close contact with a monkeypox patient abroad. Already eleven people who came in contact with the monkeypox patient have been quarantined.

The health ministry has urged states to start working on their public health infrastructure to handle the disease. The ministry has asked states to start screening at points of entries, contact-tracing, and undertake surveillance activities following detection of a case. Testing and treatment protocols should be set and doctors working in hospitals, along with disease surveillance teams, should be alert about common signs and symptoms.

Patients have to be isolated until all lesions have resolved and the scabs have completely fallen off, the letter from Union health secretary Rajesh Bhushan said. Hospitals must be identified and adequate human resource and logistic support should be ensured at identified hospitals equipped to manage suspected or confirmed cases, Bhushan said.

Intensive risk communication should be shared with health care workers, sites like skin and paediatric OPDs, immunisation clinics, etc. People should also be encouraged to report the symptoms promptly, the letter added.

The World Health Organization (WHO) has reported 3,413 laboratory confirmed cases of monkeypox since January 1, and one death.

“Majority of these cases have been reported from the European Region (86 per cent) and the Americas (11 per cent). This points to a slow but sustained increase in the spread of cases globally. Considering this is the first time that cases and clusters are being reported concurrently in five WHO Regions, WHO has assessed the overall risk of spread of cases as “moderate” at global level,” the health ministry letter read.

Monkeypox typically begins with a fever, headache, muscle aches, back-aches and exhaustion. The US Centers for Disease Control and Prevention (CDC) notes that it also causes lymph nodes to swell which is unlike smallpox. WHO has said it was important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.

The symptoms usually last for two to four weeks. It is usually a self-limiting disease.

After the initial fever phase, skin eruptions show up. Rashes are usually concentrated on the face, palms and soles of feet. It can also affect the cornea and the genital areas. These eruptions can last for two to four weeks; they harden, become painful, and get filled up with fluid and eventually with pus. Finally, the scabs form and they fall off.

The health ministry has asked to isolate patients till the time scabs fall off. It has also asked to watch out for any blurring of vision and decreased urine output.

STEPPING UP VIGIL

• Hospitals must be identified where these patients will be treated, the Centre has said
• MoHFW asks states to follow May 31 guidelines 
• Samples of first case were sent for testing at NIV, Pune
• Patient came from overseas, was in contact with monkeypox patient