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Oropharyngeal swabs (OPS), nasopharyngeal swabs (<keyword id="118491" type="General" weightage="80" keywordseo="nps" source="Orion">NPS</keyword>) and urine samples should be considered as critical specimens for monkeypox diagnosis in cases with no active skin lesions, an <keyword id="6364396" type="General" weightage="100" keywordseo="icmr" source="Orion">ICMR</keyword> study said. It said the first fatal case of monkeypox in India from <keyword id="28504" type="General" weightage="80" keywordseo="kerala" source="Orion">Kerala</keyword> highlights the importance of maintaining a high index of suspicion to diagnose the viral disease in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from endemic or outbreak countries. The study, 'A fatal case of monkeypox virus infection from Kerala, India, 2022' has been published as pre-print on September 14 and has not been peer reviewed. So far, 11 cases of monkeypox have been reported in India -- five from Kerala and six from Delhi. A 22-year-old apparently immunocompetent male with no significant past medical history was admitted in an unconscious state to a private hospital in Kerala following a single episode of acute onset generalised tonic-clonic seizures, the study stated. The patient developed fever and headache on July 15 while in the UAE, followed by development of painful right inguinal lymphadenopathy with pus discharge, for which he had sought medical care on July 19. He was partially relieved of his symptoms and returned from the UAE to Kerala on July 21. He played football on July 23, which led to worsening of pain in right inguinal area for which he consulted a surgeon on July 25 in Kerala and was diagnosed to have hidradenitis suppurutiva. He continued to report fatigue and low-grade fever which was not associated with persistent headache, alteration of sensorium, loss of appetite or weight. On July 26, he had a fever spike followed by generalised tonic clonic seizure. Serological tests for HIV, <keyword id="65371" type="General" weightage="80" keywordseo="hepatitis-b" source="Orion">Hepatitis B</keyword>, Hepatitis C and syphilis were negative. At presentation, he had neutrophilic leucocytosis with normal hepatic and renal function. Over the next 48 hours he developed coagulopathy and acute kidney injury, the study said. On July 28, the patient developed features of worsening cerebral edema and was intubated and mechanically ventilated. Despite anti-cerebral edema measures, he progressed to brainstem dysfunction and succumbed on July 30. Just before his death, his relatives obtained a test result from the UAE, which showed that he had tested positive for <keyword id="14203806" type="General" weightage="80" keywordseo="mpxv" source="Orion">MPXV</keyword> in the UAE on July 19, the study stated. "This is the first fatal case of monkeypox reported from India. This case highlights the importance of maintaining a high index of suspicion to diagnose MPXV in those presenting with atypical manifestations, exanthematous fever with epidemiological linkage from monkeypox endemic or outbreak countries. "The OPS/NPS specimen as well as possibly urine specimens should be considered as the critical specimens for MPXV diagnosis in cases with no active skin lesions. In conclusion, the overall findings of the case and the history confirm the case to be monkeypox," the study stated. A total of 15 fatalities have been reported globally from endemic and non-endemic countries in 2022, it said. The current outbreak of monkeypox had been largely limited to the community of men who have intercourse with men primarily with multiple bisexual or homosexual partners, the study stated. The vast majority of the cases infected with monkeypox had recovered and the complications like sepsis and encephalitis had been reported in the immunocompromised individuals. The mortality in Brazil and Mexico were primarily in the immunocompromised individuals, while in Spain the fatal cases were immunocompetent with no underlying conditions. SEE ALSO : <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/business/news/self-employed-males-earn-2-5-times-more-than-females-oxfam/articleshow/94218585.cms">Self-employed males earn 2.5 times more than females: Oxfam</a> <a target="_blank" class="c-link c-message_attachment__title_link" href="https://www.businessinsider.in/business/news/delhi-is-looking-to-roll-over-70-lakh-unsold-liquor-bottles-to-the-current-excise-regime/articleshow/94218430.cms">Delhi is looking to roll over 70 lakh unsold liquor bottles to the current excise regime</a>

Oral, nasal, urine samples necessary for monkeypox diagnosis: ICMR

The <keyword id="22667872" type="General" weightage="100" keywordseo="mpox-outbreak" source="keywords">mpox outbreak</keyword> in <keyword id="19924003" type="General" weightage="20" keywordseo="africa" source="keywords">Africa</keyword> is yet another example of how <keyword id="20040661" type="General" weightage="20" keywordseo="infectious-diseases" source="keywords">infectious diseases</keyword>, perceived to be "someone else's problem", and affecting mainly poor, developing countries, may suddenly pose unexpected global threats. Other examples of <keyword id="22817243" type="General" weightage="20" keywordseo="neglected-diseases" source="keywords">neglected diseases</keyword> include the West Nile, Zika and Chikungunya viruses. Mpox was discovered in 1958 (in captive monkeys, hence the original misnomer "monkeypox") and the first human case was identified in 1970. Then, for decades it was largely neglected by the scientific and public health communities, regarded as an uncommon infection in remote rural areas in tropical Africa, without relevance for the rest of the world. When a massive mpox outbreak hit developed countries in 2022, increased research funding led to a surge in scientific studies. On just one medical search engine, there's been more research produced since April 2022 than in the preceding 60 years. The 2022-23 global mpox outbreak happened despite repeated calls from African researchers for increased global investment in diagnostic, therapeutic and infection prevention tools for mpox. The WHO has now declared the current upsurge of mpox in central Africa a <keyword id="21952478" type="General" weightage="20" keywordseo="public-health-emergency" source="keywords">public health emergency</keyword> of international concern. This is the highest alert level for events that constitute a public health risk to other countries and requires a coordinated international response. Mpox's recent history is yet another reminder that an infectious disease in one corner of the world should not be regarded as someone else's problem, as it can suddenly start to spread fast and far. It also highlights global inequities in resource allocation and access to vaccines, diagnostics and treatments. These were made available in many industrialised countries and helped curb the global outbreak, but are still largely lacking in most of Africa. <h2>The 2022 outbreak: a total surprise</h2>The disease has been renamed "mpox" but the name of the virus, for now, remains "monkeypox" (MPXV). It is closely related to the smallpox virus. MPXV was considered a <keyword id="21311828" type="General" weightage="20" keywordseo="zoonotic-disease" source="keywords">zoonotic disease</keyword> endemic in parts of central and west Africa. It was acquired mainly through close contact with wild mammals, especially handling bush meat, but there was no sustained human-to-human transmission. Only very occasionally were cases seen outside the endemic areas, due to infected travellers or import of infected small mammals. This changed abruptly in 2022: a massive, rapidly evolving global outbreak caused over 99,000 laboratory-confirmed cases in 116 countries. At its peak in August 2022, over 6,000 cases were reported each week. This outbreak came as a total surprise: most cases were reported from non-endemic countries, mostly in men who have sex with men, who had become infected during recent sexual encounters. Even though most cases were clinically not particularly severe and the death toll stands at just over 200, the global outbreak was declared a public health emergency of international concern by the <keyword id="19896311" type="General" weightage="20" keywordseo="world-health-organization" source="keywords">World Health Organization</keyword> on 23 July, 2022. Fortunately, case numbers soon plummeted due to a combination of behavioural changes and vaccination in at-risk groups. Modern vaccines and antiviral drugs with activity against mpox were made available in many affected high-income countries. These had been developed and stockpiled in the US and Europe, mostly in preparation for a potential bioweapon attack using a poxvirus. The global outbreak in 2022 was caused by clade II of MPXV, which is endemic in west Africa and not as virulent as clade I MPXV, which so far has only been seen in the Congo Basin. That first mpox public health emergency of international concern was declared over in May 2023. Clade II MPXV infections are still occurring globally, but the worst seems over - for now. Complacency would be misguided, as illustrated by the current mpox outbreak that is gathering steam. <h2>Upsurge in Africa</h2>The African region is experiencing an upsurge in mpox cases, which started in 2023. As the continent which includes the areas where mpox has been endemic for a long time, Africa now presents a complex mosaic. The current clade I MPXV (formerly called Congo Basin strain) is more virulent than the clade II (west African) strain, resulting in a higher case fatality rate. The ongoing outbreak has its epicentre in South Kivu province, eastern DRC, and has the potential to fuel a large pandemic. It has a distinct epidemiological pattern with sustained chains of human-to-human transmission, often via the sexual route. It may have increased transmissibility (we don't know yet). The virus which causes it is the newly defined clade Ib lineage. It displays mutations that are the hallmark of human-to-human spread that is estimated to have been happening since September 2023. Case numbers are rising rapidly, even though many suspected cases are likely not tested and thus not counted as confirmed. Complicating matters, a commonly used test was found to miss infections with this lineage of the virus. It affects mostly adults. The case fatality rate is higher than it was in the 2022 global outbreak. Already, this outbreak has resulted in mpox cases occurring in several neighbouring countries, including some (like Kenya), with no previous record of mpox. The challenge is enormous. The eastern DRC is an area beset by multiple problems. This includes natural disasters, violence and infectious diseases including measles, cholera and poliomyelitis for the DRC. In recent years the second-largest Ebola outbreak ever took place in the wider area and, despite the availability of vaccines and treatments, posed considerable challenges. <h2>What needs to happen</h2>Equitable access to diagnostic tests, vaccines and antiviral treatments requires political commitment and financial investments. Scientific investigations are needed to learn more about exposure settings, transmission routes and clinical presentations. It's important to find the best ways to make these interventions. There is no doubt that a disease in one corner of the world can suddenly become a global heath threat. It's time the global health system woke up to this reality.

Mpox outbreak in Africa was neglected - it could now turn into the next global pandemic

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Oral, nasal, urine samples necessary for monkeypox diagnosis: ICMR

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Mpox outbreak in Africa was neglected - it could now turn into the next global pandemic

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