explained | How is Kerala fighting the monkeypox?

the story So Far: On July 14, Kerala detected the first case of monkeypox in the country in a 35-year-old man who had come to Thiruvananthapuram from the UAE. Four days later, officials confirmed a second case, this time in Kannur, again in a traveler from the United Arab Emirates. While both the patients are in isolation and under treatment, the state health department has strengthened surveillance and containment measures in all districts.

Why were the first cases reported in Kerala?

As a state with four international airports, a large expatriate population and a globally preferred travel destination, the chances of any newly emerging pathogen hitting the shores of Kerala for the first time have always been high. Therefore, state health officials are relieved that the health system managed to catch the first two cases of monkeypox, which is a testament to the robustness and efficiency of the state’s disease surveillance system.

In Thiruvananthapuram as well as in Kannur, the patients themselves had approached doctors/officers, raising the suspicion that they may have monkeypox. Doctors point to increased public awareness, high levels of clinical suspicion created by the medical fraternity about the new disease, and the social commitment of people that led to the detection of monkeypox cases.

What steps are being taken by Kerala?

One of the first public health messages sent by the health department was that there was no need for the public to panic as monkeypox is not a disease that can spread through the air like COVID-19.

However, the public needs to be vigilant about maintaining all the universal precautions that were implemented when COVID-19 was first reported.

As soon as the patient was isolated, close contacts were also isolated. A list of primary contacts was also prepared for contact tracing. The contacts were put on symptomatic surveillance for 21 days and the districts concerned were asked to monitor them closely.

In addition, the advice of monkeypox was sent to the districts, resulting in the establishment of state and district-level monitoring cells. All districts were asked to set up isolation facilities in select hospitals and special ambulances for transportation of sick persons.

Subsequently, all districts were asked to strengthen field-level surveillance of cases of fever and rash along with one or more of these symptoms as well as enlarged lymph nodes, headache, body aches and deep weakness . Help desks were set up at all airports with trained health workers deployed.

Both the monkeypox cases were officially confirmed from the National Institute of Virology (NIV), Pune. However, as part of the surveillance network, it was important to strengthen the in-house diagnostic facility to avoid delays in treatment. Thus a monkeypox testing facility was provided at NIV’s field unit at Alappuzha.

How should cases of monkeypox be treated?

The Standard Operating Procedure (SOP) on monkeypox prepared by the Government of Kerala is a detailed document that outlines the steps to be taken with regard to isolation, treatment and sample collection of suspected and probable cases of the reported disease. need to be followed. State health facilities.

All public and private sector health institutions in the state are expected to strictly follow the SOPs to deal with cases of monkeypox or similar symptoms. A person having a travel history to monkeypox affected countries within the last 21 days and presenting an unexplained acute rash with one or more of the previously reported symptoms is defined as a ‘suspected case’ under the SOP Is.

The SOP details how the samples are to be collected as per the instructions of the NIV and the precautions to be taken by the health workers when a case has to be taken in an ambulance.

What does this mean for other states?

The fact that monkeypox has not been documented in other states does not mean that the virus has not spread to other parts of the country. Kerala’s detection of the first two cases from international travelers is a sign for other states to strengthen their surveillance network, especially among travellers, so that source cases can be identified early and others in the community to prevent contact.

States need to focus on creating greater awareness among the public, medical community and health workers about monkeypox and its transmission dynamics so that they learn to maintain a high index of suspicion when encountering cases of fever with rashes . While airport surveillance plays a big role, monkeypox has a long incubation period and it is possible that some travelers who have been infected may develop symptoms much later. These matters can be traced to the community only when adequate awareness is created.

Is Kerala worried about community transmission of monkeypox?

Public health experts point out that given the transmission dynamics of monkeypox, the secondary attack rate of the virus is less than 10%, indicating that even among close family contacts of confirmed cases, the chances of monkeypox spreading are very small. In fact, the Department of Health confirmed that two close contacts of the first case of monkeypox had tested negative for the virus (though they would remain under observation for 21 days).

Reports from health experts from the UK and some other European countries are now worrying that many recent cases of monkeypox are presenting with unusual symptoms – sometimes no fever at all and lesions few or limited to the genital area. It was reported that in many recent cases, health officials were not aware of how the person contracted the virus. In Belgium, asymptomatic cases were also detected.

Very high-risk skin-to-skin contact appears to be spreading the virus and so the health department is also tapping its HIV surveillance network to intensify surveillance and sensitize MSM (men who have sex with men) Will do Told communities about the risk of continued transmission of monkeypox within their groups.

• On July 14, Kerala detected the first case of monkeypox in the country in a 35-year-old man who had returned from UAE.

• The SOP outlines the steps that need to be followed with regard to isolation, treatment and sample collection of suspected and probable cases of the disease.

• Enlarged lymph nodes, headache, body aches and deep weakness are the major symptoms of monkeypox disease.