Ignorance is sin - box the pox !
Globalization and air connectivity have brought the world closer than ever before. However, it has had the unintended consequence of increased likelihood of pandemics. Practically, any country in the world can be visited in less than 24 hours, which is less than the incubation period for many of the infectious diseases. Covid-19 is a perfect example of how improved air connectivity would contribute to the rapid spread of the disease across the globe. While many countries are trying to cope with the ongoing pandemic, the news of monkeypox outbreak has set off the alarms again. What is more alarming at this time is that the monkeypox cases have been reported in more than 20 countries where the disease is not endemic. While it is encouraging that no cases have been reported in India thus far, it is critical to remain vigilant and keep an eye on the disease's epidemiological situation. Though our recent experience in handling the covid-19 pandemic could be translated into immediate actionable plans in case of an untoward monkeypox incidence in India, we should be vigilant of the key issues that may lower the output of the pandemic response.
Despite the fact that acute unexplained skin rashes along with travel history are sufficient to identify the suspected cases, it is important to note the commonalities and differences between covid-19 and pre-symptomatic phase of monkeypox. The upper limit of the incubation period for monkeypox is 21 days compared to 14 days in case of covid-19, which amounts to increased quarantine period for travellers from at-risk countries. Secondly, monkeypox infection has a prodromal period during which infected patients exhibit symptoms similar to covid-19 and other upper respiratory tract infections. Therefore, extreme caution should be exercised while handling such cases. These subjects are to be screened for both covid-19 and monkeypox. The extent and possibility of mixed infections should also be considered in case the subject turns out to be positive for SARS-CoV-2. Third, the profile of the at-risk population is different between the two diseases. In case of monkeypox, elderly population is less vulnerable due to the protection offered by smallpox vaccination. With more than 65 percent of the population under the age of 35, the at-risk population in India is significant. The risk of disease spread is exacerbated further by high population density, and poor environmental sanitation. This emphasizes the need for a pre-emptive pandemic response in our country.
Waste water genome sequencing offers a sensitive method of detecting monkeypox infections in any given area. This method of surveillance could serve as a checkpoint for the success of the pre-emptive pandemic response. Additionally, the disease prevention ring vaccination technique can help immunise those who are at high risk of becoming ill. This procedure is used to vaccinate contacts of confirmed cases as well as people living nearby. In this way, everyone who has been or could have been exposed to a patient receives the vaccination, resulting in a "ring" of protection ‘box’ that can aid in disease prevention. Ring vaccination necessitates close monitoring and rapid epidemiologic case evaluation. This "ring" strategy was used with great success by the Intensified Smallpox Eradication Program to eradicate smallpox in the second half of the twentieth century, and it can be used again this time.
Written by
Dr Naveen Kumar Bhatraju and Dr Jitendra Narayan CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mall Road, Delhi
The authors are researchers at the CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB). All opinions expressed are personal.