The A.2 strain of monkeypox virus has been found in travelers who had returned from the United Arab Emirates (UAE)
The Indian Council of Medical Research (ICMR)- National Institute of Virology (NIV) identified two cases of monkeypox on Friday. The A.2 strain of monkeypox virus has been found in two new cases of travelers who had returned from the United Arab Emirates (UAE).
"The complete genome sequences obtained from skin lesions of case 1 and 2 showed similarity of 99.91 and 99.96% respectively with MPXV_USA_2022_FL001 West African clade. Phylogenetic analysis revealed that the two cases were infected with Monkeypox virus strain A.2 which belong to hMPXV-1A lineage of clade 3," reads the research paper of ICMR-NIV which has been published in the Research Square, a preprint server, and has not been peer reviewed.
“The West African and Central Africa (Congo Basin) are the two known clades of the MPXV, of which Congo Basin strain causes more severe illness, 0–11% mortality and increased transmissibility. The West African clade is found to be circulating in the current ongoing outbreaks of 2022 in non-endemic countries,” the ICMR paper says.
The paper was published on August 5.
Read: Study finds two new symptoms of monkeypox you should know about
Monkeypox: Details of the symptoms seen in these patients
The oropharyngeal & nasopharyngeal swab, EDTA blood, serum, urine, lesion samples from multiple sites (lesion fluid, lesion roof and lesion base) were collected from both the cases on the ninth post onset day of illness, the ICMR says.
Case 1 is a 35-year, male, resident of UAE who developed the following symptoms on July 5:
- low grade fever
- myalgia
- multiple vesicular rashes in the oral cavity and lips
- single lesion on the genital organ
- umbilicated vesicular lesions in right infra-mammary, right tragus, right temple, and right
- deltoid region
- maculopapular rashes on both hands
He denied sexual contact with his friends and contacts with suspected monkeypox case, the ICMR says.
Case 2 is a 31 year old male and a resident of Dubai, UAE. He developed the following symptoms:
- dysuria
- genital swelling
- chills
- myalgia
- backache
- headache
- multiple vesicular rashes on the genital organ
- multiple vesicular rashes on both hands
- e lesions progressed and later spread to face, back, neck and forearm with
- cervical lymphadenopathy
Monkeypox: The timeline of symptoms is crucial
As per the ICMR report, both the cases arrived at respective medical centres within a week of the onset of the symptoms.
In the case of the first patient, symptoms appeared on July 5 and by July 9 he already had rashes on hands. Upon reaching his home town in Kerala on July 12, when he had developed symptoms like sore throat along with worsening of oral lesions, he visited a medical facility. Based on his history of being in contact with suspected monkeypox cases he was referred to the Government Medical College, Thiruvananthapuram.
The second case had developed symptoms on July 8. By July 10, he had rashes on genitals and on both hands. Two days after he reached his home in native, which is on July 15 the lesions had progressed. "He visited government hospital locally and on the suspicion as Monkeypox case, he was isolated on July 16, 2022 He did not have any co-morbidity and denied any sexual or physical contact with suspected or confirmed MPXV case," the ICMR says.
On the A.2 strain of monkeypox virus
" All MPXV genomes from the 2022 outbreak belong to new latter clade hMPXV-1A and the newly classified lineages: A.1, A.1.1, A.2 and B.1," the ICMR says.
The current monkeypox outbreak in the USA represents the A.2 strain of monkeypox which is said to be evolved from the lineage which caused the Nigeria outbreak in 2017 and 2018.
B.1 strain of monkeypox is currently driving the monkeypox worldwide. On July 23, the World Health Organisation (WHO) had declared monkeypox as a public health emergency.
The paper titled "First two cases of Monkeypox virus infection in travellers returned from UAE to India, July 2022" has been authored by 20 scientists and experts working at ICMR-NIV, GMC-Thiruvananthapuram, GMC-Pariyaram, ICMR-Delhi, District Medical Office, Vanchiyorm Thiruvananthapuram and District Surveillance Unit Integrated Disease Surveillance Project, District Medical Office, Kannur, Kerala.
Here's what you should know about monkeypox symptoms
It starts with a " febrile illness with average incubation of 5–13 days with lymphadenopathy, myalgia, and headache, followed by deep-seated umbilicated vesicular/pustular rashes," says the paper.
The rash starts from the oral region, genital and perianal region and then progresses to other parts of the body.
Human to human transmission is primarily responsible for monkeypox outbreak. The human to human transmission is mainly through large respiratory droplets, direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens of an infected person.
Animal to human transmission is possible through bite or scratch of infected animals like small mammals including rodents (rats, squirrels) and non-human primates (monkeys, apes) or through bush meat preparation.
Is monkeypox more contagious than COVID?
“Monkeypox is unlikely to spread drastically like COVID-19 and is much less contagious as well. Infected patients usually recover on their own in 2-3 weeks, by keeping themselves isolated,” says Dr. Mahesh Kumar, Consultant, Internal Medicine of Narayana Health City.
On the rumors around monkeypox, the expert says, “Although monkeypox is not a sexually transmitted infection in the traditional sense, it can nevertheless be spread through sexual contact.”
However, he urges people to remain isolated and practice hygiene habits to avoid contracting an infection.
On whether the infection can be a contagious one, the WHO says, "Monkeypox is not as contagious as some other infections because it requires close contact with someone who has monkeypox (e.g., face-to-face, skin to skin, mouth-to-skin or mouth-to-mouth), with a contaminated environment or with an infected animal to spread."
How can we prevent monkeypox infection?
“Avoid traveling to places where there are cases of monkeypox, maintain hygiene, stay hydrated and consume healthy juices, and keep away from unplanned travels for the next couple of weeks will be the key to safeguarding health from monkeypox infections, especially in the case of those who travel frequently,” suggest Dr Kumar.
“Though it has been observed that monkeypox cases seen in adults have generally been mild so far, children with immunocompromised systems can, however, die from it in extreme circumstances,” he adds and draws attention towards safety within the community.
In recent times, the case fatality ratio has been around 3–6%.
The bottom line
The risk of contracting a monkeypox infection can be avoided if one is well informed about the disease, avoids contact with a suspected case and even if one has already come in contact with such a case, he or she should immediately contact a doctor, get tested and remain in isolation.
In addition to this, one should also actively participate in creating awareness around the disease and make sure to bust rumors and myths surrounding the infection.
The right information and the healthy practices can help us win a fight against disease causing microorganisms.