More than four years since Covid-19 was declared a pandemic by the WHO (World Health Organization) in March 2020, fear of another mass outbreak looms large. The WHO, on August 14, declared the current upsurge of Mpox or Monkeypox in Central Africa as a global emergency requiring urgent action. The global concern for the virus grew as it spread to other African countries, and, within no time, the deadly strain of Mpox – Clade 1b – crossed the African continent to reach Sweden, Pakistan, and other countries.

The virus has killed more than 500 people so far, mainly in the Democratic Republic of Congo, where the disease has been spreading since last year. The country saw more than 96% of the world’s roughly 17,000 recorded cases of Mpox this year.

Though India has not reported any cases yet, the Central government is keeping a close eye on the situation. Our healthcare infrastructure faced severe challenges during the Covid-19 pandemic, which resulted in thousands of deaths. One wouldn’t wish to be caught unawares this time.

Is Mpox As Dangerous As Covid-19 Or Swine Flu?

Mpox is a zoonotic infection that causes flu-like symptoms and skin lesions. Fatal in some cases, the WHO first declared it a global emergency in 2022. 

Mpox virus can be categorised into two clades: Clade 1 and Clade 2. The first, which is found mainly in Central African countries, is more severe and has a high mortality rate. Clade 2 has milder symptoms and is found in western Africa. The latter caused a public health emergency in 2022, wherein some 300 cases — though mild — were reported from Sweden. This time, it’s the newer and more serious Clade 1b, identified in September last year, that has been driving the current outbreak.

Though experts worry that Mpox may be as dangerous as Covid-19 or the swine flu, there is a difference in the nature of transmission. Both Covid-19 and swine flu were highly infectious because they were airborne. In contrast, Mpox is transmitted through close skin-to-skin contact, talking or breathing close to an infected person, or using their soiled clothes or bedsheets. “Mpox is unlikely to become a pandemic like Covid-19 primarily due to its mode of spread. It requires very close and physical contact, unlike the airborne SARS-CoV-2. Also, symptoms like blisters on the skin are more visible indicators and therefore, it’s easier to identify the disease and isolate a person to contain the spread,” says Rakesh K. Mishra, former director of the Centre for Cellular and Molecular Biology.

India’s first Mpox case was recorded in Kerala in 2022, from a traveller from the UAE. Soon, the virus spread within the country, with cases emerging in Delhi even from individuals who had no recent international travel. India reported 27 confirmed cases and one death that year, according to WHO. The last case in the country was in March this year, in Kerala, and since then, no new cases have been recorded.

How To Stay Safe

In response to the WHO’s warning, both Central and state governments have sprung into action. There are monkeypox advisories in place and public health measures are being taken. Both the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC) are closely monitoring the situation and reviewing international trends.

In Tamil Nadu, the Directorate of Public Health and Preventive Medicine (DPH) has already issued alerts. Reports say that passengers arriving from the Democratic Republic of Congo and Central African countries are being tracked by airport health officers and port health personnel. Both Hyderabad and New Delhi — cities popular among African students pursuing higher education — have also been placed on high alert.

The Need For Vaccines

The first Mpox strain was isolated by ICMR researchers in 2022. Pharmaceutical companies and drug manufacturers are being called upon to develop vaccines and testing kits for the virus. Existing vaccines for smallpox and chickenpox might also offer protection in India. 

About other prevention strategies, Mishra says, “It is important to closely monitor the spread of the disease in different countries and be ready for screening by already available methods of DNA-based diagnostics. There is an effective vaccine already available but supply of that may not be easy to ensure.”  

“Simple practices like avoiding close physical contact with suspected/potentially infected person, maintaining distance from people with symptoms, and wearing a mask, should be effective in containing the spread of the infection,” Mishra adds. 

Developed nations, mostly those in Europe, already have vaccines available for those at greater risk of monkeypox. And given the high quality of healthcare there, containing the disease will be less challenging. It’s underdeveloped African countries, which have neither vaccines nor the resources to buy them, that remain at most risk and which need the most help. 

(Bharti Mishra Nath is Contributing Editor, NDTV)

Disclaimer: These are the personal opinions of the author

Reminders that Covid-19 has not gone away pop up from time to time, even if the world seems to have moved on. More than 40 athletes at the 2024 Olympics in Paris have tested positive, highlighting a new global rise in cases, the World Health Organization (WHO) said on August 6. And now, the subgenus Sarbecovirus, of which SARS-CoV-2 is a member, is on the list of ‘priority pathogens’ in the WHO’s recently-released ‘Pathogens Prioritization’ report.

The report, which is a framework for epidemic and pandemic research preparedness, is the result of work that began in late 2022, involving over 200 scientists from 54 countries who evaluated the evidence related to 28 viral families and one core group of bacteria, encompassing 1,652 pathogens. The final list comprises over 30 ‘priority pathogens’.

Sarbecovirus is classified as ‘high’ in the WHO list, for its risk of causing a Public Health Emergency of International Concern or PHEIC. The list also includes Subgenus Merbecovirus, which includes the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Both MERS-CoV and the Severe Acute Respiratory Syndrome (SARS) virus were also listed in the 2017 and 2018 WHO reports, but not their entire subgenuses.

On the list of priority pathogens, but not a new addition, is another virus that India has been dealing with of late: Nipah, a 14-year-old boy died at the Government Medical College Hospital, Kozhikode, Kerala, after contracting it. Both Ebola and Zika virus too, feature on the list, as they did in 2018, with both classified as ‘high’ for a Publuc Health Emergency of International Concern or PHEIC risk. Maharashtra is currently grappling with a Zika virus outbreak – reports indicate there have been over 70 cases of Zika in Pune in the past two months and these include 26 pregnant women.

The list of priority pathogens, says Chennai-based infectious diseases specialist Subramanian Swaminathan, is a pointer towards the pathogens that governments could allocate resources towards, for surveillance and medical countermeasures. This does not mean all of them are currently a problem, he says, but it means that countries have to monitor these pathogens as they have the potential to turn into a problem. 

“Surveillance of these pathogens has to involve multiple aspects – is the pathogen spreading beyond a geographical area, is it becoming more virulent, is its transmissibility increasing, is the clinical manifestation of the disease it causes changing, is it becoming more resistant to known treatment and does it have vaccine escape properties – all of these aspects have to be monitored,” he says.

What else is new on the list? The dengue virus and the influenza A viruses, including the H5 subtype, which caused an avian influenza outbreak in India and which even affected cattle in the United States are now on the list, along with mpox, which has currently erupted in parts of Africa.

Among bacteria added to the list are those that cause plague, cholera, pneumonia, dysentery and non-typhoidal salmonella, a key cause of diarrhoeal diseases. 

It may be recalled that early this year, the WHO had updated the Bacterial Pathogens Priority List (BPPL) and this had included gram-negative bacteria resistant to last resort antibiotics, and Mycobacterium tuberculosis resistant to the antibiotic Rifampicin. The list had featured 15 families of antibiotic-resistant bacteria.

In the Southeast Asia region, the report notes, bacterial pathogens are priorities including Vibrio cholera O139 (cholera) and Shigella dysenteriae serotype 1 (dysentery). Priority pathogens Henipavirus nipahense (Nipah) and Bandavirus dabieense (causes severe fever with thrombocytopenia syndrome) are endemic it said, as are the mosquito-borne Orthoflavivirus denguei (dengue) and Zikaense (Zika virus disease), and Alphavirus chikungunya.

Resources, says Priscilla Rupali, senior professor & head, Department of Infectious Diseases, Christian Medical College, Vellore, need to be focussed on diseases of high mortality that have pandemic potential such cholera, Nipah, dengue and Zika. For other diseases that cause a fair bit of morbidity such as chikungunya, and shigella etc., surveillance to predict epidemics is important, Prof Rupali notes.

The report, says Abdul Ghafur, consultant infectious diseases, Apollo hospitals, Chennai, has on its list some diseases that India is already aware of and grappling with including Nipah, Zika and dengue. “What we need is more data and more research, but crucially, more low-cost diagnostics for priority pathogens. The Indian government needs to support start-ups to develop such diagnostics for these pathogens,” he says.

Prototype pathogens

The 2024 report, incorporates for the first time, the concept of the ‘Family approach’ and the ‘Prototype Pathogen’. The family approach, says Dr. Swaminathan, is important, as pathogens within a family have a lot of similarities, and even share genetic material, meaning an existing treatment option or vaccine for one strain of the pathogen family could potentially be repurposed for another. “By prioritizing research on entire pathogen Families as opposed to a handful of individual pathogens, this strategy bolsters the capability to respond efficiently to unforeseen variants, emerging pathogens, zoonotic transmissions, and unknown threats such as ‘Pathogen X,’ the report states.

The ‘prototype pathogens’, the report says, are “representative pathogens within a family selected to serve as a model for fundamental research” to develop medical countermeasures that can be applied to other members of the family.

As the report notes, the global health landscape is subject to constant evolution, with the potential emergence of new pathogens and evolution in the threat levels posed by existing ones: it emphasises the critical necessity for investments in research, development, and innovation on an international scale.

For the full report, click here.

(Zubeda.h@thehindu.co.in)