**More than Four Years After COVID-19, Another Outbreak Threatens: Is India at Risk of Monkeypox?**
Over four years have passed since the World Health Organization (WHO) declared COVID-19 a pandemic in March 2020, but fears of another widespread outbreak are growing. On August 14, the WHO declared the current surge of Mpox (Monkeypox) in Central Africa a global emergency, calling for urgent action. Concern over the virus escalated as it spread to other African nations, and soon, the deadly strain of Mpox—Clade 1b—crossed the African continent, reaching countries like Sweden and Pakistan.
So far, the virus has claimed more than 500 lives, primarily in the Democratic Republic of Congo, where it has been spreading since last year. This year, the country accounted for over 96% of the world’s approximately 17,000 recorded cases of Mpox.
While India has yet to report any cases, the Central government is closely monitoring the situation. The country’s healthcare infrastructure, which faced immense challenges during the COVID-19 pandemic resulting in thousands of deaths, cannot afford to be caught off guard again.
**Is Mpox as Dangerous as COVID-19 or Swine Flu?**
Mpox is a zoonotic infection that causes flu-like symptoms and skin lesions. Although it can be fatal in some cases, the WHO first declared it a global emergency in 2022.
**Mpox Virus: Understanding the Risks and Response Measures**
The Mpox virus is classified into two clades: Clade 1 and Clade 2. Clade 1, predominantly found in Central African countries, is more severe with a higher mortality rate. Clade 2, which has milder symptoms, is primarily found in Western Africa and was responsible for the public health emergency in 2022, with around 300 mild cases reported in Sweden. The current outbreak, however, is driven by a newer and more serious strain, Clade 1b, which was identified in September last year.
While experts express concern that Mpox could be as dangerous as COVID-19 or swine flu, the mode of transmission differs significantly. COVID-19 and swine flu were highly contagious due to airborne transmission, whereas Mpox spreads through close skin-to-skin contact, close talking or breathing, or sharing contaminated clothing or bedding. According to Rakesh K. Mishra, former director of the Centre for Cellular and Molecular Biology, "Mpox is unlikely to become a pandemic like COVID-19 due to its mode of spread. It requires very close physical contact, unlike the airborne SARS-CoV-2. Additionally, visible symptoms like skin blisters make it easier to identify and isolate infected individuals, thereby containing the spread."
India recorded its first Mpox case in Kerala in 2022 from a traveler returning from the UAE. The virus soon spread within the country, with cases reported in Delhi, including among individuals with no recent international travel. According to WHO, India reported 27 confirmed cases and one death that year. The last reported case in the country was in March this year, also in Kerala, with no new cases since then.
**Staying Safe**
In response to the WHO's warning, both Central and state governments in India have taken proactive measures. Monkeypox advisories have been issued, and public health initiatives are underway. The Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC) are closely monitoring the situation and reviewing international developments.
In Tamil Nadu, the Directorate of Public Health and Preventive Medicine (DPH) has issued alerts, with reports indicating that passengers arriving from the Democratic Republic of Congo and Central African countries are being monitored by airport and port health officials. Hyderabad and New Delhi, cities with large African student populations, have also been placed on high alert.
**The Need for Vaccines**
ICMR researchers isolated the first Mpox strain in 2022, and pharmaceutical companies and drug manufacturers are now being urged to develop vaccines and testing kits for the virus. Existing vaccines for smallpox and chickenpox may also offer some protection in India.
Mishra emphasizes the importance of monitoring the spread of the disease internationally and being prepared for screening with DNA-based diagnostic methods. He notes that while an effective vaccine exists, ensuring its availability may be challenging. Simple preventive measures such as avoiding close physical contact with potentially infected individuals, maintaining distance from those showing symptoms, and wearing masks should help contain the spread of the infection.
Developed nations, particularly in Europe, already have vaccines available for those at higher risk of monkeypox, and their advanced healthcare systems make it easier to contain the disease. However, underdeveloped African countries, which lack vaccines and the resources to obtain them, remain at the greatest risk and are most in need of assistance.
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