Mpox: a disease at our doorstep

Health Matters newsletter: Mpox: a disease at our doorstep - the latest health concerns, including India’s first mpox case, and what it means for the country’s public health landscape

In this week’s Health Matters newsletter, Ramya Kannan discusses the latest health concerns, including India’s first mpox case, and what it means for the country’s public health landscape

While it has been a hectic week in the medical world the past seven days, with a number of issues hogging the limelight, it was the news of India’s first mpox case that swam right up above, to garner most attention. What with a pandemic right behind us, the natural response is to react with caution to any infectious disease that is fast spreading, for the possibility that it might be the next big thing to send nations on shutdown mode again. While the WHO has reassured the world that mpox has not yet reached that stage yet, (WHO has said that the risk of spread of current outbreak beyond Africa is moderate), the news of the first case being detected here still has the alarm bells ringing. 

Bindu Shajan Perappadan reported that while confirming the case of mpox,of the West African Clade 2, as a travel-related infection, the Centre let out no other details of the patient, except to say that the person was stable and was isolated. “The individual, a young male who recently traveled from a country experiencing ongoing Mpox transmission, is currently isolated at a designated tertiary care isolation facility. The patient remains clinically stable and is without any systemic illness or comorbidities,” noted the Ministry. 

Mpox is suspected when a patient develops fever, headache, muscle pain, back pain, weakness, and/or fatigue along with a developing skin rash that starts in the tongue and mouth before spreading to other parts of the body, especially among people who have travelled to countries with endemic Mpox, or those who have come in contact with a suspected or confirmed case of Mpox. It is also accompanied with swollen lymph nodes. High risk groups have been identified as those who are immunocompromised, children, elderly, pregnant women, and people with multiple sexual partners.

The World Health Organisation (WHO) declared Mpox a public health emergency of international concern (PHEIC) on August 14, due to the emergence of a new strain of the virus, known as Clade I. So, naturally, while assuring the public that the situation was well under control, the Centre went head and advised States to screen, test all suspect mpox cases. The Union Health Secretary, even earlier, called for the orientation of all key stakeholders with a focus on surveillance units under the Integrated Disease Surveillance Programme (IDSP) at state and district levels to re-orient them on definitions of suspect, probable, confirmed cases, contact tracing and other surveillance activities. In the letter, the Union Health secretary asked all States to make people aware of the mpox disease, its mode of spread, the need for timely reporting and taking preventive measures, besides reviewing the public health preparedness and isolation facilities for both suspect and confirmed. After all, as COVID has taught us, being prepared is half the work done during a pandemic.  

In addition, we followed up on articles that addressed the inequities of health care in Africa that have been highlighted along with the rise of the current mpox transmission. The first 100,000 doses of mpox vaccine reach Congo, three weeks after the World Health Organization declared mpox outbreaks in 12 African countries a global emergency, worse still, it’s a fraction of what is needed. In a DR Congo hospital, reports said, Mpox patients lack medicine, food. 

 The other big news was something that will revolutionise TB care in the country in the future - the Union health ministry appoved new treatment for multidrug resistant TB last week. Less than years after the WHO recommended the BPaLM treatment regimen, India has adopted it too. The new BPaLM regimen consisting of four drugs — Bedaquiline, Pretomanid, Linezolid and Moxifloxacin — has proven to be a safe, more effective and quicker treatment option than previous procedures. It has the added advantage of being less toxic and having less side effects than the current regimen, besides being cost effective too. While traditional treatments can last up to 20 months with severe side effects, the BPaLM regimen can cure drug-resistant TB in just six months with high treatment success rate. India’s 75,000 drug-resistant TB patients will now be able to avail benefits of this shorter regimen. Do read The Hindu’s editorial on the subject: Taking TB seriously, welcoming the early introduction of the new regimen, and calling for leadership from India in this long-standing battle against mycobacterium tuberculosis, and drug resistance.