Perilous pathogen

In the largest Monkeypox outbreak outside Africa ever, nearly 800 cases of infection have come out — mostly in European countries. Just appearing to emerge from the COVID-19 pandemic, the global population and governments across the world are now seriously concerned about the unfolding threat.

Though the pathogen is not new, its unprecedented spread outside the African continent has given birth to numerous uncertainties. Different countries, including India, are reacting differently to sail themselves through these uncertainties. In this article, we shall trace the genesis of the viral outbreak, explore theories around its transmission and see how India and other countries are preparing to prevent the Monkeypox virus from spreading. We shall also retrospect how we, as humans, should evolve in general to shield ourselves from viral outbreaks that are becoming more and more normalised these days.

Origin and history

Human race is not new to viral encounters. A study by the science magazine Nature traces the lineage of certain viral infections way back to thousands of years ago. Smallpox virus — variola — is learnt to have circulated among humans some 1,700 years ago; Hepatitis B virus has been infecting humans since the Bronze age and Tuberculosis for over 6,000 years.

Tracing the exact origins of a particular virus may be a tricky thing. For record, however, the Monkeypox virus — belonging to the Orthopoxvirus genus of the Poxviridae family — was first detected in 1958 among monkeys in a laboratory in Denmark. The first case of human infection came 12 years later in the Democratic Republic of Congo.

Since then, the Central and Western parts of Africa have been witnessing occasional outbreaks. Though mostly limited in Africa throughout history, the disease spilled over to the United States in 2003 when the country registered 70 cases of Monkeypox. The US, at that time, had an explanation for the outbreak. Prairie pet dogs, that were housed with Gambian rats and dormice imported from Ghana, had become the major carrier of the disease.

In the recent past, however, the outbreak of the disease in non-African countries has rung an alarm bell across the world. The detection of cases in countries including Israel and the United Kingdom in 2018, 2019 and 2022 were attributed to international travel. This year, in an unprecedented manner, hundreds of people across dozens of countries have been infected — leaving scientists and health experts scratching their heads in bewilderment.

While exact reasons behind this unprecedented transmission are unfounded, the root remains undisputable — rodents from the rainforests of Central and Western Africa. Being a viral zoonosis — which spreads from animals to humans — Monkeypox has a great deal to do with the area under the forest cover. To prevent the spread of Monkeypox and other viral zoonosis from taking worse forms, attention must be turned towards preserving natural habitats of animals — failing which, we may see the repeat of the consequences we have witnessed over the past two years.

Transmission

Conventionally, the Monkeypox virus is known to transmit through close physical contact with an infected person or animal, or with material contaminated with the virus. Until recently, human-to-human transmission was considered a rare phenomenon but, now, it is known to spread among persons by close contact with lesions, body fluids, respiratory droplets and other contaminated materials.

Its spread through respiratory droplets is particularly concerning — as the mode of transmission is quite similar to that of Covid. Moreover, unlike the SARS-Cov-2, the Monkeypox virus is known to exist on the contaminated surface for a longer duration — increasing the chances of transmission.

The explanation for the present outbreak, however, demands more than conventional wisdom. Scientists and health experts are at their wits end in decoding the transmission. The air of uncertainty has led to several theories floating without much evidence. One among those prominent theories suggests that increased international travel in the wake of the subsiding pandemic could have led to such an expansive outbreak. This theory merits consideration.

Genome sequencing of recently collected Monkeypox samples in countries including Belgium, France, Germany, Portugal and the United States has shown that almost all the samples resemble the West African strain of Monkeypox virus. Essentially, there are two strains of the Monkeypox virus — Western Africa strain and Congo Basin strain (alternatively called Central African strain). The one in prevalence currently — the West African strain — has a case fertility ratio (CFR) of three per cent while the Central Africa strain has a CFR of 10 per cent. For the sake of relative comparison, the CFR of smallpox virus before it was eradicated stood at 30 per cent. A low CFR of three per cent means the current outbreak is less lethal.

The other theory states that Monkeypox may have been prevailing undetected among populations outside Africa for quite some time. This theory is gaining traction but is limited by the fact that symptoms of Monkeypox virus among humans are visible on their skins. If these were prevalent, then health experts would have taken notice of it. Another unresolved conundrum of Monkeypox transmission is its spread among men having sex with other men (MSM).

Prevention measures

Two years of COVID-19 pandemic have brought to us the realisation that viral outbreaks can't be taken lightly. Coming on its back, Monkeypox has attracted a fair degree of caution from countries across the globe. In sync with World Health Organisation's guidelines, India's Ministry of Health and Family Welfare has maintained that even the detection of a single case within the country should be considered an outbreak. The Ministry has issued detailed guidelines for detecting and monitoring the situation.

Considering that the outbreak is mostly centred in Europe and the United States, and India has not registered a single case as of now, the Indian government hasn't passed any direction regarding the stockpiling of smallpox vaccines. This stands contrary to the proactive actions taken by countries like the United States that have stockpiled millions of doses of vaccines and drugs for smallpox as a precaution against its return. Notably, smallpox vaccines are also effective in combating Monkeypox. As per a report by The New York Times, in Switzerland, the World Health Organisation maintains about 2.4 million doses of the vaccine used to eradicate smallpox, and it has stockpiled another 31 million doses in five donor countries that could be released to countries in need.

Stockpiling of Monkeypox vaccines and drugs has its own set of limitations. In the first place, most of these are only tested on animals. Secondly, the United States, for instance, has stockpiled 100 million doses of older smallpox vaccine ACAM2000, and 28 million doses of Jynneos vaccine. While the former is learnt to have adverse side-effects on the health and is forbidden for certain immunocompromised segments, a large number of doses of the latter have expired.

India's efforts are thus far limited to detecting and monitoring cases. As per the guidelines, the contacts of a confirmed case will have to be monitored for a period of 21 days from the day they last met the patient. Monkeypox is largely a self-eliminating disease and lasts for 21 days. The guidelines also suggest simple protective behaviours to be adopted by citizens. People are expected to maintain a vigil on their own health conditions for tracing any of the symptoms of Monkeypox.

The way forward

The COVID-19 pandemic introduced us to a new normal and Monkeypox outbreak should further consolidate this concept. Drastic climatic shifts, human invasion over animal habitats, evolving nature of viruses — whatever be the reasons, the world stands vulnerable to more frequent and intense viral outbreaks today. Undoing the wrongs may be a long game. For the present, one has to believe that living with viruses is the only option humans have.

A permanent modification in lifestyle and precautionary behaviours will have to be incorporated. Safety protocols related to the COVID-19 pandemic are reported to share a good deal of similarity with those related to Monkeypox. New behaviours including masking, sanitising and being vigilant of strange symptoms should be normalised. An altogether different ambience needs to be created where emergence of new viral threats won't find humans completely dumbfounded. We need to keep ourselves by and large ready for all situations.

Views expressed are personal