India reported its first laboratory-confirmed, imported case of monkeypox virus when a 35-year-old man in Kerala’s capital tested positive. The diagnosis was easy as the individual informed health-care workers of his contact with an infected person in the United Arab Emirates. To cut the transmission chain, people who have come in contact with him in Kerala have been isolated. The first case of the virus outside Africa was first reported in the U.K. on May 6, 2022. Since then, the virus has spread to over 63 countries — Europe has reported 8,238 cases from 35 countries as of July 12, and the U.S., 1,470 cases as of July 14. Never before has the virus spread to more than a hundred people a year during any outbreak in endemic countries except Congo. In fact, sustained transmission beyond a few generations has been rare in Africa. In contrast, the rapid increase in cases and geographical spread have primarily been due to human-to-human transmission largely during sexual contact, especially among men who have sex with men (MSM). While a few rave parties in Spain and Belgium have turned out to be super-spreader events, WHO suspects that “undetected transmission for some unknown duration of time followed by recent amplifier events” to be responsible for cases being detected simultaneously in several countries outside Africa. With cases crossing the 10,000-mark in non-endemic countries, and a large number of cases in Spain (2,034), the U.K. (1,735), Germany (1,556) and the U.S. (1,470), the risk of the virus becoming established in some of these countries is becoming increasingly real.
While the first human case was reported in 1970 in the Democratic Republic of Congo, and the virus became endemic in 11 countries in Africa causing small outbreaks, no attempts were made to study it all these years. With the virus having a free run in non-endemic countries, scientists have now unveiled many discomforting facts: the virus appears to mutate at a much higher rate than what was assumed. And, based on genome sequences from the current outbreak, they have found the emergence of a novel clade of the virus in early March. A recent study has found monkeypox virus DNA in samples of semen, saliva, urine, rectal swabs and faeces, and at high viral loads; the infectious and disease potential of these body fluids was not studied. Whether the new clade by itself has a higher potential for human spread is not known. But surely, close sexual contact is providing the virus much opportunity to spread within the MSM community. With the sustained spread and a few cases already detected in women, the possibility of spread into the general community cannot be totally dismissed. Increased testing, contact tracing and building awareness, and not stigmatising the infected people can stop the spread.
