Monkeypox | 15 virology labs designated for surveillance of the virus
Even though there have been only 10 cases of the monkeypox disease reported so far in India, the government wants to keep its guard up to be able to pick up early signs of any unusual spread.
The central government has designated 15 virus research and diagnostic laboratories (VRDLs) spread across 13 states to monitor the incidence of monkeypox in the country, according to people familiar with the matter.
Even though there have been only 10 cases of the viral disease reported so far in India, the government wants to keep its guard up to be able to pick up early signs of any unusual spread.
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“Fortunately, India has not seen a surge in cases and the situation here is well under control. However, we cannot drop the guard just as yet. Therefore, a network of VRDLS has been established for surveillance purposes,” a top government expert said, seeking anonymity. “It will help pick signs early in case more cases get reported.”
There is a need for increased surveillance, especially since asymptomatic cases are being reported globally that could lead to missing cases within a community, experts said.
“Unlike in the past, monkeypox is presented in different ways. The typical criteria of lesion and lymphadenopathy may not be matching many times. Some recent studies have shown just a single lesion in genital areas, which is not easy to identify or sample,” said Dr Pragya Yadav, senior scientist at the Pune-based National Institute of Virology, an organisation under the Indian Council of Medical Research.
“The clinical presentation of VZV (the varicella-zoster virus that causes chickenpox) and other diseases, and lack of awareness also creates confusion and cases can be missed,” said Dr Yadav, who is co-author of a preprint study in which researchers lay emphasis on the need for robust surveillance, as five cases reported from Delhi did not have any history of international travel.
“These monkeypox cases suggest underdiagnosed monkeypox infection in the community. This emphasizes the need for active surveillance of MPXV (monkeypox virus) in the high-risk populations such as men having sex with men and female sex workers,” the researchers said in the paper that has been uploaded on Research Square, a free public preprint repository.
Such cases could be either asymptomatic or show very few symptoms, and could be identified with intensified surveillance involving gay men, sex workers and bisexuals, and areas where foreign nationals commonly reside with risk of imported infection, they said.
“This could lead to the establishment of community transmission also in the vulnerable population such as children, pregnant women and immuno-compromised individuals,” they said.
A heightened awareness is required among health care workers specifically working in the clinics treating sexually transmitted infections to understand the newer manifestations of monkeypox infection, the researchers said. “There is also a need for enhanced surveillance in the community so that the monkeypox cases are not missed,” they said.
ICMR is also preparing a serological survey within the community to understand whether there has been a spread due to asymptomatic cases.
“It’s too early to comment on this. We need to first develop a good ELISA assay,” Dr Yadav said. “The test is not available commercially. Our efforts are directed to achieve this goal first.” ELISA assay is an enzyme-linked pathological test.
The researchers said that the recovery period was around four weeks, in line with the global trend.
All five cases showed mild to moderate intermittent fever, muscular pain, and lesions on the genitals, groin, lower limb, trunk and upper limb. The cases were mild and had a good recovery, they said.
On July 14, India reported its first human monkeypox case from Kerala. Since then, 10 confirmed cases of monkeypox have been identified from Kerala and New Delhi (five each) till August 12.
Since early May, the World Health Organisation reported at least 40,000 cases from 94 countries outside Africa, where the disease is endemic. The UN health body declared the outbreak a public health emergency of international concern on July 23 amid rising cases.
The designated labs in India to monitor monkeypox are Government Medical College, Trivandrum; Kasturba Hospital for Infectious Disease, Mumbai; Government Medical College, Gauhati; Gandhi Medical College, Secunderabad; All India Institute of Medical Sciences, Delhi; Bangalore Medical College & Research Institute, Bangalore; National Institute of Virology Field Unit, Kerala; All India Institute of Medical Sciences, Nagpur; The King Institute of Preventive Medicine and Research, Chennai; National Institute of Cholera and Enteric Diseases, Kolkata; SMS Medical College, Jaipur; Sher-e-Kashmir Institute of Medical Sciences, Srinagar; Government Medical College, Amritsar; King George’s Medical University, Lucknow; and B.J. Medical College, Ahmedabad.