India has not registered any case of monkeypox as of now, but the pox spread around the world is being tracked closely, officials said on Saturday.
The country is also monitoring the alert by the World Health Organization (WHO) on the rise in reported cases of acute hepatitis of unknown aetiology in children from some parts of the world, a Union Health Ministry official said.
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Stating that the absence of monkeypox cases in India should not lead to lack of preparedness or lowering of guard against the virus, Pragya Yadav, scientist and group leader at the maximum containment laboratory at the Indian Council of Medical Research-National Institute of Virology, Pune, said, “We must understand that the danger is imminent with this pathogen registering its presence in previously non-endemic countries, scientists seeing no established travel links to the spread and also community spread indicated in some regions.”
The WHO said that nearly 200 cases of monkeypox have been reported in more than 20 countries not usually known to have such outbreaks.
Terming the situation as “containable”, the WHO, during its public briefing early on Friday, said there were still many unanswered questions regarding what triggered the unprecedented outbreak of monkeypox outside Africa. The agency added that there was no evidence that any genetic changes in the virus was responsible.
“The first sequencing of the virus shows that the strain is not different from the strains we can find in endemic countries and (this outbreak) is probably due more to a change in human behaviour,” Sylvie Briand, WHO’s director of pandemic and epidemic diseases, said.
“India has reported cases of cow and buffalo pox in humans indicating an animal-to-human transmission. Monkeypox is an exotic pathogen for us as we haven’t been exposed to it,’’ Dr. Yadav cautioned.
The NIV said it was fully prepared to take up sample testing and help with standardising guidelines for sample collection, transport and how to work with the pathogen.
Countries including Britain, Germany, Canada and the U.S. have now started evaluating how smallpox vaccines might be used to stem the outbreak. The WHO said its expert group was assessing the evidence and would provide guidance soon.
Rosamund Lewis, head of WHO’s smallpox department, said that “there is no need for mass vaccination”. Dr. Lewis added that monkeypox did not spread easily and typically required skin-to-skin contact for transmission.
No vaccines have been specifically developed against monkeypox, but the WHO estimates that smallpox vaccines are about 85% effective.
Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop rash and lesions on the face and hands that can spread to other parts of the body.
Acute hepatitis
The WHO, in its Disease Outbreak News, said 650 probable cases of acute hepatitis of unknown aetiology in children had been reported from 33 countries in five WHO Regions between April 5 and May 26.
Hepatitis is an inflammation of the liver. A sudden onset of hepatitis is called acute hepatitis. The most common causes of acute hepatitis are the viral hepatitis infections A and E, and less commonly hepatitis B and C. Certain medications and toxins can also cause acute hepatitis. Usually, it passes without any serious consequences or need for special care or treatment, but in rare cases may result in severe liver failure or death.
Regardless of the cause, the symptoms of acute hepatitis include vomiting, diarrhoea or abdominal pain, jaundice (yellow discoloration of the eyes and skin) and pale stools.
“The aetiology of this severe acute hepatitis remains unknown and under investigation; the cases are more clinically severe and a higher proportion develop acute liver failure compared with previous reports of acute hepatitis of unknown aetiology in children. It remains to be established whether and where the detected cases are above-expected baseline levels. WHO assesses the risk at the global level as moderate,’’ it said.
The agency added that as of May 26 there were 99 additional cases pending classification. The WHO noted that a majority of reported cases were from the WHO European Region.
Earlier this month, doctors in India raised alarm over a spike in unexplained hepatitis in children who had tested positive for COVID-19. This was after a team of doctors from Bundelkhand Medical College (BMC), Sagar, Madhya Pradesh, and the Post Graduate Institute of Medical Research, Chandigarh, reported that an investigation of 475 children who tested positive for COVID-19 between April and July 2021 showed that 37 (about 8%) of them had Covid Acquired Hepatitis (CAH). This is the first systematic investigation to quantify the scale of the syndrome in the country.
The WHO has maintained that these cases of acute hepatitis could be linked to COVID-19 vaccines are not supported. The vast majority of children affected had not been vaccinated.
Arvind Singh Soin, liver transplant surgeon, said in a tweet that they have had cases of unexplained post-COVID hepatitis in children. “Possibly due to excessive immune activation. Wise to test liver function in children after COVID monthly for two months,” Dr. Soin added.
