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Mpox in India: Navigating the Unseen Epidemic with Vigilance and Innovation

BY DR. ANAND SUBHASH WANI, Consultant Paediatrician & Paediatric Allergy Specialist

Ankura Hospital for Women and Children

The resurgence of Mpox, previously known as Monkeypox, has brought about renewed concerns in India, as the country grapples with a steady increase in confirmed cases. Since the first case was reported in May 2022, India has witnessed over 200 confirmed cases across various states. The spread has been particularly pronounced in urban centres such as Delhi, Maharashtra, and Kerala, with these regions accounting for nearly 70% of the total cases. Delhi, in particular, has emerged as the epicentre, with around 40% of the country’s cases concentrated there.

The demographics of those affected reveal that the virus predominantly impacts young adults between the ages of 20 and 40, with a male-to-female ratio of 3:1. Despite the rising number of cases, the mortality rate has remained low, with a case fatality rate (CFR) of 1.5%. Most patients have shown recovery within 2 to 4 weeks, though individuals with compromised immune systems or pre-existing health conditions are at a higher risk of severe outcomes.

In response to the growing threat, India has bolstered its public health initiatives, including a strategic vaccination campaign aimed at high-risk groups. By July 2024, more than 100,000 individuals had received the Mpox vaccine, focusing on healthcare workers, close contacts of confirmed cases, and vulnerable populations. The government is determined to vaccinate 80% of the at-risk population by the year’s end, a move that is expected to significantly curb the spread of the virus.

In addition to vaccination efforts, testing and surveillance have been intensified across the country. The Indian Council of Medical Research (ICMR) has expanded testing capabilities, with over 500,000 samples tested so far. The positivity rate has stabilized at approximately 0.04%, suggesting that the containment measures are effective. On a global scale, India accounts for about 2.5% of Mpox cases worldwide, underscoring the importance of sustained vigilance and proactive health measures.

Mpox typically presents with a set of flu-like symptoms, including fever, headache, muscle aches, chills, and exhaustion, often accompanied by swollen lymph nodes. These initial symptoms are followed by the development of a rash, which usually begins 1 to 3 days after the onset of fever. The rash progresses from flat, red spots to raised bumps, and then to fluid-filled blisters, which may turn into pustules. It often starts on the face and spreads to other parts of the body, including the hands, feet, and mucous membranes. The blisters eventually crust over and fall off, and the illness generally lasts 2 to 4 weeks.

Paediatric data for Hyderabad indicates that children have been less affected compared to adults, with children under the age of 15 accounting for approximately 10% of the total cases in the city. Paediatric cases have generally presented with milder symptoms, including fever, fatigue, headache, and rash. Most children have recovered within the typical 2 to 4 weeks, with severe cases being rare. Healthcare providers have remained vigilant, ensuring appropriate care and considering antiviral treatments like Tecovirimat for children with severe symptoms or underlying conditions. Preventive measures in households with infected individuals are emphasized to protect children from exposure.

While there is no specific cure for Mpox, treatment options have seen significant advancements. Supportive care remains the cornerstone, focusing on managing fever, pain, and dehydration. Antiviral medications, such as Tecovirimat (TPOXX), have been introduced and are used in severe cases or for those at high risk of complications. Tecovirimat works by inhibiting the virus's ability to spread to other cells and has been approved for emergency use in several countries, including India. Other antivirals like Cidofovir and Brin cidofovir have been explored as potential treatments, though their use is more limited due to side effects. Vaccinia Immune Globulin (VIG) has also been utilized in cases with severe complications, providing passive immunity against the virus.

For those affected, symptomatic treatment includes topical care for skin lesions to prevent secondary infections, along with the use of antibiotics when necessary. Isolation and infection control remain critical components of treatment to prevent the spread of the virus. Patients with confirmed Mpox are isolated until all lesions have healed completely.

To stay clear of the disease, public health experts advise avoiding close contact with individuals diagnosed with Mpox, especially those with visible skin lesions or rashes. Regular handwashing with soap and water, or using an alcohol-based hand sanitizer, is also recommended, particularly after coming into contact with potentially contaminated surfaces or materials. Vaccination remains the most effective preventive measure for those in high-risk groups, and public health officials emphasize the importance of staying informed about potential outbreaks and following guidance from health authorities.

As India navigates through this health challenge, it is crucial to remember that the battle against Mpox is far from over. Continued surveillance, robust vaccination drives, and widespread public awareness are essential to preventing a resurgence. The efforts made thus far have positioned India well in managing the outbreak, but sustained dedication and vigilance will be key in ensuring the nation remains resilient against future threats posed by Mpox.