After a 34-year-old man with no travel history was found to be infected with monkeypox in Delhi on July 24, India’s tally rose to four. The Union government held a high-level review meeting on the matter, with the other three cases being detected from Kerala. Meanwhile, the World Health Organisation (WHO) has declared the current monkeypox epidemic a global health emergency on July 21.
According to WHO, monkeypox is a viral zoonosis (a virus transmitted to humans from animals), with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. While contact tracing and quarantining of those who came in contact with the most recent patient – the infected man in Delhi – are going on, the Lok Nayak Jai Prakash (LNJP) Hospital, which was the nerve centre of the national capital's fight against COVID-19, also constituted a 20-member team comprising dermatologists, physicians, doctors of different specialities, nurses, orderlies and technicians.
Here’s what the south Indian states are doing to prepare for and prevent spread of the disease.
Kerala has three known cases of monkeypox — the most recent was a 35-year-old man, who came to the state from the UAE July 6 and confirmed to have monkeypox on July 22. The first patient — in the state and the country — is a Kollam native who had travelled to the UAE and was confirmed to have monkeypox on July 14. And the second case is a 31-year-old Kannur native who returned to the state from Dubai on July 13, whose infection was confirmed on July 18.
The state government issued standard operating procedures (SOP) on July 20 pertaining to isolation, sample collection, and treatment of those suspected to have monkeypox or showing symptoms. Kerala Health Minister Veena George said that any person who has travelled in the last 21 days to a country where monkeypox has been reported, and has red spots on the body along with one or more of the other symptoms, like fever, headache or body ache, should suspect infection by the virus. Further, all primary contacts should be monitored for 21 days by checking on them over the phone and recording their temperature twice a day.
Monkeypox patients and those transporting them to healthcare facilities are required to wear PPE kits, N95 masks, gloves, and other protective gear.
The state government has also mandated that samples should be collected based on National Institute of Virology (NIV) protocols, and should be sent to the same lab. Patients should be referred to private hospitals from government hospitals based on patients’ requests, and only critically ill patients from state-run hospitals with isolation facilities should be referred to medical colleges.
Telangana currently has one suspected case of monkeypox — a 40-year-old who returned from Kuwait on July 6 and hails from Kamareddy district in Telangana. He developed a fever on July 20 and rashes on July 23, and has been shifted to the Government Fever Hospital in Hyderabad. Six of the individuals' contacts are also being kept in isolation.
Telangana Health Minister Harish Rao has asked for testing for monkeypox to be done at airports, however, a decision on the same will need to be taken by the Union government.
Apart from following Union government protocols, specific government hospitals will also be reportedly identified so that patients can be given the required support without delays. The state government is reportedly in the process of designating isolation centres.
“As per the orders of Hon’ble Chief Minister K Chandrashekar Rao, they are studying the disease which is being reported in different countries and other states and keeping updated about WHO and ICMR guidelines,” Rao had said, as per a press release from July 18. “As soon as the suspected symptoms related to the virus are identified, samples should be collected from the victims and tests should be done,” he added.
People are also advised to contact 04024651119 and 9030227324 for seasonal diseases, monkeypox, vaccination, and advice in flood affected areas.
Karnataka has amped up surveillance for monkeypox given the three cases in Kerala. The state government has instructed all the districts to ensure effective preparedness and take required action as per the Union government’s guidelines and Technical Advisory Committee recommendations regarding monkeypox.
District Health Officers (DHOs)/ District Surveillance Officers (DSO) have been instructed to ensure that the health screening teams at Points of Entries (PoEs) into the state (airports or sea ports), disease surveillance teams and doctors working in hospitals are to be re-oriented on the common signs and symptoms, diagnosis, case definitions etc. of suspected, probable, confirmed monkeypox cases and contacts. They should also be trained on contact tracing and other surveillance activities that need to be undertaken following detection of a probable Monkeypox case like testing and other associated IPC (Infection Prevention and Control) protocols and clinical management, the circular said. Intensive risk communication is to be undertaken for the healthcare workers in the health facilities and in commonly identified sites such as skin and paediatric, OPDs, immunization clinics and intervention sites identified by NACO etc.
In all district hospitals, two beds are to be designated for isolation for suspected and confirmed cases.
While a child who was suspected to have monkeypox in Andhra Pradesh has tested negative for the disease, the Andhra Pradesh chapter of the Indian Medical Association (IMA) has advised the state to take precautions. According to a report, IMA Andhra Pradesh President Srinivasa Raju said that steps like screening international travellers, getting monkeypox vaccine from Australia and designating isolation wards in district hospitals for those suspected to have the disease in the future should be taken. The IMA has also advised awareness programmes for medical and nursing professionals and for those who have not been immunised against smallpox as children.
Like Karnataka, which has intensified surveillance for monkeypox after neighbouring Kerala recorded monkeypox cases, Tamil Nadu too has done the same. According to reports, people in the districts in TN bordering Kerala are undergoing screeding. Further, district hospitals and medical college hospitals are also testing people with fever and skin lesions, which is a symptom of monkeypox.
Last week, the state had intensified screening at the international airports in the state – Chennai, Madurai, Coimbatore, and Tiruchi – after preparing and communicating a list of high-risk countries to airport authorities. A 10-bed ward has also been started at Rajiv Gandhi Government General Hospital (RGGGH), in Chennai, to prepare for monkeypox cases.
With PTI inputs