The Union Ministry of Health and Family Welfare has issued guidelines on the management of monkeypox disease in India. There are no reported cases of the monkeypox virus in the country as of today, according to the Ministry. However, it said the country needs to be prepared given the rise in cases in non-endemic countries. The Ministry continues to maintain a close watch over the evolving situation.
According to the guidelines, a confirmed case is laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by polymerase chain reaction (PCR) and/or sequencing.
“All the clinical specimens should be transported to the apex laboratory of ICMR-NIV (Pune) routed through the Integrated Disease Surveillance Programme (IDSP) network of the respective district or state,” the release by the Ministry said.
It has proposed surveillance strategy to identify cases, clusters of infections and sources of infections to isolate and prevent further transmission. It also aims to provide optimal clinical care, identify and manage contacts and protect frontline health workers.
Disease transmission
As per the Ministry, human-to-human transmission occurs primarily through large respiratory droplets generally requiring prolonged close contact. It can also be transmitted through direct contact with body fluids or lesion material and indirect contact. An animal-to-human transmission may occur by bite or scratch of infected animals and non-human primates.
“The incubation period of monkeypox is usually from 6 to 13 days but can range from 5 to 21 days,” the Health Ministry report said.
The case fatality ratio of monkeypox has historically ranged from 0 to 11 per cent in the general population and has been higher among young children. In recent times, the case fatality ratio has been around 3-6 per cent, the document stated.
Monkeypox disease symptoms
A person having a travel history to the affected countries within the last 21 days presenting an acute rash and symptoms, including swollen lymph nodes, fever, headaches, body aches and profound weakness is to be considered to be a 'suspected case'. The disease symptoms include lesions which begin within 1-3 days of fever onset and last around 2-4 weeks.
"Report any suspected case immediately to the DSU/State Surveillance Units (SSUs) and CSU (Central Surveillance Unit), which shall report the same to the Directorate General of Health Services and send the samples as per the guidelines to the designated laboratories," Ministry said.
The salient features include targeted surveillance for probable cases or clusters, initiating contact tracing and testing of the symptomatic after the detection of the probable/confirmed case.
Surveillance and treatment
The guidelines direct hospital-based surveillance and testing in Dermatology clinics, STD clinics, medicine, paediatrics OPDs, and targeted surveillance achieved by measles surveillance by Immunization division and targeted intervention sites identified by NACO for MSM, FSW population.
The patient should be isolated in a separate room with ventilation, wear a triple layer mask and cover skin lesions to reduce the risk of contact with others. Patients should wear a surgical mask, especially those who have respiratory symptoms.
IT recommends supportive management of Monkeypox, including Paracetamol for fever, applying topical Calamine lotion or taking antihistaminics for itching and a nutritious diet. For skin rash, the guidelines advise cleaning with simple antiseptic and applying Mupirocin Acid/Fucidin.