Focus on entry points not enough to stem spread of monkeypox, experts say

A few weeks ago, the Tribhuvan International Airport Health Unit sent a 26-year-old man to Sukraraj Tropical and Infectious Diseases Hospital after checking in at the airport because he was suspected of having monkeypox infection.

But tests at the hospital revealed that he was instead infected with leprosy.

“We have screened people returning from countries that have reported cases of monkeypox,” said a health worker deployed to the airport health office. “But the problem is that cases of viral illness have been detected in so many countries and not everyone who comes into contact with the infected people shows the symptoms.”

With the viral disease spreading to around 80 countries so far, the Ministry of Health and Population has alerted all relevant agencies, including health offices deployed at the two international airports – in Kathmandu and Bhairahawa – and at international land crossing points.

“Our health workers had suspected three cases of monkeypox,” said Dr. Chuman Lal Das, director of the Division of Epidemiology and Disease Control. “But the three suspects tested negative for the monkeypox virus in hospital. One was infected with leprosy while the other two had chickenpox.

Monkeypox is a rare disease caused by infection with the monkeypox virus and one in 10 infected people can die from it. Most common in remote parts of central and western Africa, the disease has now been reported in at least 78 countries.

The World Health Organization declared on Saturday that the outbreak was “a public health emergency of international concern”.

An international public health emergency is different from a pandemic, such as that caused by the coronavirus.

A pandemic is a worldwide outbreak of a virus that infects a large number of people and causes a high number of deaths, often disrupting daily life and causing general hardship.

The United Nations health body says an international public health emergency is an “extraordinary event” that poses a serious risk to public health.

The Covid-19 and Ebola epidemics were also followed by such a declaration.

Experts in Nepal say screening suspects at health offices at international airports and land crossings is not enough to prevent a possible outbreak of monkeypox in the country, as it usually takes between five and 21 days to only the first symptoms appear and not all cases of infection. can be detected at health offices.

Cases of monkeypox have been reported in neighboring India, with which Nepal shares a long porous border.

In India, at least four cases of monkeypox have been reported since July 15, including one detected in the capital Delhi in a man with no travel history.

Dr Bikesh Tamrakar, an epidemiologist and assistant professor at Kathmandu University, said authorities should step up comprehensive surveillance measures to prevent a community outbreak of the virus. “Not all infected people show symptoms when screened at health offices and it is not possible to quarantine them for 21 days to find out their infection status,” Tamrakar said. “That’s why it’s important to increase surveillance at the community level.”

More than 18,000 cases in nearly 78 countries including India have been reported so far. The number of monkeypox cases is expected to top 27,000 in 88 countries by August 2, according to a Reuters report.

Scientists advising the UN health agency on monkeypox say the window to stem the spread of the virus is narrowing, with cases currently doubling every two weeks, raising fears the outbreak could peak in the coming month.

Monkeypox has been a largely neglected public health problem in parts of Africa for decades; the disease received widespread attention after May, with countries outside Africa reporting new cases.

Doctors say monkeypox symptoms include fever, headache, swelling, body aches, exhaustion and itching on the face, hands and feet.

As the disease spreads primarily through close person-to-person contact, public health experts recommend self-isolation and good hygiene practices to avoid it.

About 10% of monkeypox patients have been hospitalized in the current outbreak and five patients have died, all in Africa, the WHO said.

Beyond Africa, monkeypox is spreading mainly among men who have sex with men, putting sexual health clinics on high alert for new cases.

Meanwhile, Nepal’s health ministry said it had developed a system to collect samples from the suspects, followed by testing at a provincial health laboratory and the National Public Health Laboratory from where the samples were taken. will be sent to the WHO Collaborating Center in India. for final confirmation.

“We have also designated dermatologists working in 14 central hospitals as focal points,” said Dr. Samir Kumar Adhikari, joint spokesperson at the Ministry of Health. “We expect patients to see a dermatologist once they have symptoms of monkeypox. The doctor will then recommend tests for infection.

Experts, however, say things won’t be as straightforward in which patients with rashes go to dermatologists as planned. In non-serious cases, symptoms in a suspected monkeypox may gradually subside over time without treatment, but during this time infected people can pass the virus on to close contacts.

On Thursday, WHO Nepal handed over real-time polymerase chain reaction test kits for monkeypox to the National Public Health Laboratory. The UN health agency said access to monkeypox diagnosis enables Nepal’s diagnostic capacity and supports timely surveillance, case identification and strengthens containment activities.

Tamrakar, the epidemiologist, said that since monkeypox has already been detected in India, the chances of it spreading to Nepal are high. “What we must not forget is that every disease seen in any corner of the world has the possibility of coming to Nepal due to the high mobility,” he said.