Enhance surveillance: World Health Organisation as India reports 4th monkeypox case

New Delhi, July 24

As India reported its fourth monkeypox virus case on Sunday, a 34-year-old male with no travel history, the World Health Organisation (WHO) urged countries in Southeast Asia, including India, to urgently enhance surveillance and public health measures to detect the infection and mount responses.

The Health Ministry said NIV Pune had confirmed the fourth case, the other three being from Kerala, and said a 34-year-old male resident of Delhi isolated at Lok Nayak Hospital.

“The case is presently recovering at the designated isolation centre at Lok Nayak Hospital. The close contacts of the case have been identified and are under quarantine as per the ministry guidelines. Further public health interventions like identification of the source of infection, enhanced contact tracing, testing sensitisation of private practitioners are being carried out. A high-level review of the situation will be done today,” the ministry said.

Delhi Chief Minister Arvind Kejriwal said there was no need to panic. “The patient is stable and recovering. The situation is under control. We have made a separate isolation ward at LNJP. Our best team is on the case to prevent the spread and protect Delhi residents,” he said.

Meanwhile, WHO South East Asia Regional Director Poonam Khetarpal today said “countries should strengthen surveillance and public health measures for monkeypox, with the disease being declared a public health emergency of international concern yesterday.”

She said monkeypox has been spreading rapidly and to many countries that have not seen it before, which is a matter of great concern.

“However, with cases concentrated among men who have sex with men, it is possible to curtail further spread of the disease with focused efforts among at-risk population,” Singh added.

Globally, over 16,000 cases of monkeypox have been reported from 75 countries. In the WHO South-East Asia Region, four cases of monkeypox have been reported, three from India and one from Thailand.

The cases in India, WHO said, are among nationals who returned home from the Middle East, while in Thailand an international living in the country has been confirmed positive for monkeypox.

Singh said focused efforts and measures should be sensitive, devoid of stigma or discrimination.

The decision to term monkeypox as a public health emergency of international concern (PHEIC) was announced by Dr Tedros, Director-General WHO, yesterday, a day after he convened yet another meeting of the International Health Regulations emergency committee to review the multi-country outbreak.

Monkeypox virus is transmitted from infected animals to humans via indirect or direct contact. Human-to-human transmission can occur through direct contact with infectious skin or lesions, including face-to-face, skin-to-skin, and respiratory droplets. In the current outbreak countries and amongst the reported monkeypox cases, transmission appears to be occurring primarily through close physical contact, including sexual contact. Transmission can also occur from contaminated materials such as linens, bedding, electronics, clothing, that have infectious skin particles.

WHO advice for nations

• Stop human-to-human transmission with priority focus on communities at high risk of exposure, which may differ according to context and include gay, bisexual and other men who have sex with men (MSM).
• Targeted risk communication and community engagement, case detection, isolation and treatment, contact tracing, targeted immunization for persons at high risk of exposure for monkeypox.
• Targeted use of vaccines for pre-exposure prophylaxis in persons at risk of exposure and  convene the National Immunization Technical Advisory Group (NITAG) for any decision about immunisation policy and the use of vaccines.
• WHO said since smallpox (now eradicated) and monkeypox viruses are closely related, vaccines for the former might help prevent the current global outbreak but it advised that vaccination programmes be backed by thorough surveillance and contact-tracing and be accompanied by a strong information campaign.
• 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