This document provides an overview of monkeypox, including its history, epidemiology, transmission, and current global situation. It notes that monkeypox cases have been increasing globally since May 2022, with over 19,000 cases reported across 76 countries as of July 2022. The majority of recent cases have been among men who have sex with men. Human-to-human transmission occurs primarily through close contact with infectious skin lesions or respiratory droplets. The WHO declared monkeypox a public health emergency of international concern in July 2022.
Monkey Pox is a zoonotic disease transmitted from animals to humans. It is originated in Africa and then spread throughout the world. Recently epidemiology of Monkeypox has been changing which was once confined to the African continent. In this presentation, The epidemiology, geography distribution, transmission, and its changing epidemiology of Monkeypox is discussed.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
Monkey Pox is a zoonotic disease transmitted from animals to humans. It is originated in Africa and then spread throughout the world. Recently epidemiology of Monkeypox has been changing which was once confined to the African continent. In this presentation, The epidemiology, geography distribution, transmission, and its changing epidemiology of Monkeypox is discussed.
Emerging and reemerging infectious diseasesarijitkundu88
Various emerging and reemerging diseases. Factors contributing to the emergence of infectious diseases. Antibiotic resistance. The global response to control them. Laboratories network in surveillance.
🔥HOT TOPIC🔥
Sharing my PowerPoint slides on 🐵 MONKEYPOX🐵
(a potential/sure shot question for MD exam)
This can be used for a 2 hour session of PG seminar since all the aspects of the disease are covered.
It includes a compilation of;
1. Infectious history (in detail)
2. Epidemiology (Global, local)
3. Case definitions
4. Clinical features
5. Differential diagnosis (including comparison with common DDs)
6. Complications
7. Investigations
8. Management
9. Vaccines
10. Other specific preventive measures
Share among Community Medicine residents for maximum reach and benefits...😊
Here is a comprehensive and updated presentation on the Monkeypox by noted infectious diseases expert Dr ISHWAR GILADA, Consultant in HIV/STDs, Unison Medicare & Research Centre, and Secretary General, Organised Medicine Academic Guild-OMAG;
President, AIDS Society of India (ASI) &
Governing Council Member, International AIDS Society (IAS)
E-mail: gilada@usa.net, drisgilada@gmail.com
Epidemiology of Malaria & Dengue_Sagar Parajuli.pptxSagarParajuli9
This presentation is prepared as part of the Course assignment of “Epidemiology of Diseases and Health Problems” for the Master's Degree of Public Health (MPH), Pokhara University and can be used as reference materials. The content and facts included in the presentation are as of information available till December 2022 and no conflict of interest is associated with the presentation. The presentation is prepared by Sagar Parajuli.
Let's talk about Dengue. I made this powerpoint to put some light on Dengue, that is found almost everywhere in the world and responsible for thousands of deaths worldwide. Please feel free to share but credit
🔥HOT TOPIC🔥
Sharing my PowerPoint slides on 🐵 MONKEYPOX🐵
(a potential/sure shot question for MD exam)
This can be used for a 2 hour session of PG seminar since all the aspects of the disease are covered.
It includes a compilation of;
1. Infectious history (in detail)
2. Epidemiology (Global, local)
3. Case definitions
4. Clinical features
5. Differential diagnosis (including comparison with common DDs)
6. Complications
7. Investigations
8. Management
9. Vaccines
10. Other specific preventive measures
Share among Community Medicine residents for maximum reach and benefits...😊
Here is a comprehensive and updated presentation on the Monkeypox by noted infectious diseases expert Dr ISHWAR GILADA, Consultant in HIV/STDs, Unison Medicare & Research Centre, and Secretary General, Organised Medicine Academic Guild-OMAG;
President, AIDS Society of India (ASI) &
Governing Council Member, International AIDS Society (IAS)
E-mail: gilada@usa.net, drisgilada@gmail.com
Epidemiology of Malaria & Dengue_Sagar Parajuli.pptxSagarParajuli9
This presentation is prepared as part of the Course assignment of “Epidemiology of Diseases and Health Problems” for the Master's Degree of Public Health (MPH), Pokhara University and can be used as reference materials. The content and facts included in the presentation are as of information available till December 2022 and no conflict of interest is associated with the presentation. The presentation is prepared by Sagar Parajuli.
Let's talk about Dengue. I made this powerpoint to put some light on Dengue, that is found almost everywhere in the world and responsible for thousands of deaths worldwide. Please feel free to share but credit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. CME
Monkeypox -An emerging Pandemic:
Epidemiology & Problem Statement for India
Prof Dr. Sanjev Dave
HOD Department of Community Medicine
Soban Singh Jeena Govt Institute of Medical sciences &
Research,
Almora (Uttarakhand)
11/26/2022 1
2. Outline
• History
• Past Journey to Current Scenario Across the World
• Epidemiology & Problem Statement -India
• Prevention
• Surveillance
• Contact tracing
• Way forward
11/26/2022 2
3. Introduction
• Monkeypox is an emerging zoonotic infection caused by monkeypox
virus (MPXV) of the Poxviridae family
• The incubation period of Monkeypox can be up to 21 day ( usually 5-21
days )
• Period of communicability: 1-2 days before the rash to until all the
scabs fall off
• Severity: Rare, sometimes life-threatening
• Endemic in West and Central Africa
• Can spread from infected animals to humans and person-to-person
• Respiratory secretions
• Skin-to-skin contact with infected body fluids
• (e.g., fluid from vesicles and pustules)
• Fomites (e.g., shared towels, contaminated bedding)
11/26/2022 3
7. Monkey Pox Outbreaks-History
• Human monkeypox first identified in humans in
1970 in the Democratic Republic of the Congo
• In a 9-month-old boy in a region where smallpox
had been eliminated in 1968.
• Most cases reported --- Rural, rainforest regions
of the Congo Basin(Democratic Republic of the
Congo)
• Human cases increasingly reported ----central
and west Africa.
11/26/2022 7
8. Monkeypox Endemicity in Africa
• Since 1970, human cases of monkeypox---
reported in 11 African countries:
• Benin, Cameroon, the Central African Republic,
the Democratic Republic of the Congo, Gabon,
Cote d’Ivoire, Liberia, Nigeria, the Republic of the
Congo, Sierra Leone and South Sudan.
• The true burden of monkeypox was not known.
• In 1996–97, an outbreak reported in the
Democratic Republic of the Congo -------
• a lower case fatality ratio and
• a higher attack rate than usual.
11/26/2022 8
9. • A concurrent outbreak of chickenpox (caused by
the varicella virus, which is not an orthopoxvirus)
and monkeypox ----found, which could explain
real or apparent changes in transmission
dynamics in this case.
• Since 2017, Nigeria -a large outbreak,
• ---over 500 suspected cases and
• ----over 200 confirmed cases and
• Case fatality ratio --3%.
• Cases continue to be reported until today.
Concurrent Outbreak of
Chicken Pox & Monkeypox
11/26/2022 9
10. • In 2003, the first monkeypox outbreak outside of
Africa was in the United States of America ----linked
to contact with infected pet prairie dogs.
• Pets housed with Gambian pouched rats and
dormice ----imported into the country from Ghana.
• This outbreak led to over 70 cases of monkeypox in
the U.S.
Outbreak of Monkeypox( United States)
11/26/2022 10
11. • Monkeypox has also been reported in travellers:
• --Nigeria to Israel in September 2018,
--to the United Kingdom in September 2018,
December 2019,
May 2021 and May 2022,
--to Singapore in May 2019, and to the
--United States of America in July and November
2021.
• In May 2022, multiple cases of monkeypox ---
identified in several non-endemic countries.
Monkeypox Spread in Travellers
11/26/2022 11
12. Geographical Spread of Monkeypox
• Since early May 2022,
---cases of monkeypox have been reported from countries
-----where the disease is not endemic, and
-----continue to be reported in several endemic countries.
• Most confirmed cases with travel history reported
travel to countries in Europe and North America,
rather than West or Central Africa where the
monkeypox virus is endemic.
• This is the first time that many monkeypox cases and
clusters have been reported concurrently in non-
endemic and endemic countries in widely disparate
geographical areas.
11/26/2022 12
16. • Between 1 January and 7 July 2022, a total of 7,892 confirmed cases,
including three deaths, were reported from 63 Member States in five
World Health Organization (WHO) Regions.
• The 3 fatal cases were reported from Nigeria (1) and the Central
African Republic (2).
• As of 7 July 2022,
• 82% (6,496 cases in 34 countries) of the confirmed cases were
reported in the WHO European Region;
• 15% (1,184 cases in 14 countries) in the WHO Region of the Americas,
• 2% (173 cases in 8 countries) in the WHO African Region,
• <1% (24 cases in 4 countries) in the WHO Western Pacific Region, and
• <1% (15 cases in 3 countries) in the WHO Eastern Mediterranean
Region.
• In 1st half- there was an increase of 41.6% in reported cases globally.
Global Journey in 1st half of 2022:-
11/26/2022 16
17. WHO – Monkeypox Data till July 2022
• World Health Organization (WHO) confirmed -
---global outbreak of monkeypox has grown
to more than 6,000 cases, with 80% in
European countries.
• WHO Director-General Tedros Adhanom
Ghebreyesus, PhD, said –infections detected
in 58 countries.
• WHO Data listed 7,075 confirmed cases
worldwide on 06th Jul-2022.
11/26/2022 17
18. Spain 3,125
United States of
America
2,316
Germany 2,268
The United Kingdom 2,137
France 1,453
Netherlands 712
Canada 615
Brazil 592
Portugal 588
Italy 374
• Together, these
10 countries
account
for 88.5% of the
cases reported
globally.
THE 10 MOST AFFECTED COUNTRIES
11/26/2022 18
20. Monkeypox - a PHEIC
• WHO Director-General Tedros Adhanom
Ghebreyesus, PhD, said today that infections was
detected in 58 countries.
• WHO World in Data lists 7,075 confirmed cases
worldwide in July 2022.
• Over 19,188 cases and 5 deaths (all in Africa)
across 76 countries this year since 4th May,2022
till 26th July.
• WHO declared the Monkeypox outbreak as Public
Health Emergency of International Concern
(PHEIC) on 23 July 2022.
11/26/2022 20
21. MonkeyPox- Entery in India?
• Though no Monkeypox case was reported
from India till mid-June 2022,
• considering the rate of its spread in non-
endemic countries,
• So urgent planning of better understanding of
the disease epidemiology to help clinicians,
public health specialists and policymakers for
any eventuality was done.
11/26/2022 21
23. Kerala reported Monkeypox
Index case
• A person who had recently returned from abroad has been admitted to a
hospital in Kerala after he showed symptoms of monkeypox, news agency
Press Trust of India reported, citing Health Minister Veena George. The
samples was sent to the National Institute of Virology for testing.The
Kerala minister said the person showed symptoms of monkeypox and he
was in close contact with a monkeypox patient abroad.
• So India Strengthened all the measures to rapidly detect and take
appropriate measures to prevent spread of Monkeypox.
• The first case of Monkeypox in WHO South-East Asia Region
was reported from India on 14th July,2022, in a 35-year old
man who arrived from the Middle East.
• In July 2022, 8 cases diagnosed in India (3 in Kerala and 1 in
Delhi) Including 1 Death.
11/26/2022 23
26. 11/26/2022 26
US Centers for Disease Control and Prevention (CDC) report-- 13 September 2022
than 57,995 confirmed cases had been documented in
100 countries/territories
27. Current cases of Monkeypox ??
How many confirmed
cases of monkeypox in
World in Oct 2022?
20 455
confirmed cases
Since the start of the monkeypox
outbreak and as of 11 October
2022, 20 455 confirmed cases of
monkeypox (MPX) have been
reported from 29 EU/EEA
countries.
In total, 63 cases have been
reported from three Western
Balkan countries and Turkey
How many confirmed cases
of monkeypox in India?
Currently, India has reported
10 confirmed cases of
monkeypox,
--three of them in Kerala and
---five in Delhi, and
--eight suspected cases,
one case each in Delhi and
Telangana,
---four in Bihar and
--- four in Uttar Pradesh.
11/26/2022 27
28. Indian Scenario:
The total number of monkeypox cases in the
country have climbed to 19 after a Nigerial
tested positive for the virus in Delhi. Oct 25,
2022 .
Developed Countries( US) :
The latest data available on the US
Centres for Disease Control and
Prevention website is over 28, 000
Monkeypox cases have been confirmed
in the US, with six deaths and 75,568
global cases.
Rising Cases of Monkeypox- An issue?
During the week of 10 October to 16
October 2022, the number of
monkeypox cases reported in the
Regions of Europe and the Americas
continue to decline, driving the overall
downward trend observed since August
2022.
11/26/2022 28
Since the start of the monkeypox (MPX) outbreak and as of 25
October 2022, 20 675 confirmed cases of MPX have been reported
from 29 EU/EEA countries. In total, 51 cases have been reported
from three Western Balkan countries and Türkiye.
The five countries reporting most cases since the start of the
outbreak are: Spain (7 317), France (4 084), Germany (3 662),
Netherlands (1 235) and Portugal (932).
Deaths have been reported from: Spain (2), Belgium (1) and Czechia
(1).
The highest cumulative notification rates have been reported in
Spain, Portugal and Luxembourg
30. Case profiles, As of July 25 2022
(Figures are not mutually exclusive)
Reported cases
MSM 3589 (98.0%)
HIV-Positive 1119 (41.4%)
Travel History 603 (36.8%)
Hospitalised2
380 (9.9%)
ICU 1 (0.1%)
Died 5
• Among cases with
known data on
sexual
orientation, 98.0%
(3591/3664) identifi
ed as MSM.
• Among those with
known HIV
status 41.4%
• Note that
information on
HIV status is not
WORLD WIDE CASES PROFILE
11/26/2022 30
33. Case fatality ratio of Monkeypox
• Historically ranged : 0 to 11 % in the general
population
• Higher among young children.
• Currently case fatality ratio : 3–6%.
11/26/2022 33
34. Regional Profile:
Increase of 82% in the Africa Region,
60% in the Western Pacific Region,
57% in the Region of the Americas and 38% in the European
Region.
Age Profile:
Globally, 78% of confirmed cases are males aged 18 to 44 years
old (7 cases among children under 18 years of age in countries
in the African and European Regions).
Sexual history:
Overall, 98% of cases were identified as men who have sex with
men (MSM) and of these, 41% are HIV-positive.
Prior Exposure:
Among the cases, 47% indicated that they had prior exposure to
the disease during social events with sexual contact.
Epidemiological Profile of Monkeypox Cases
11/26/2022 34
35. • 1,110 cases with available information----
• 113 (healthcare workers).
• Infection in above cases ---caused by
occupational exposure??.
Monkeypox Cases in Health workers
11/26/2022 35
37. Monkeypox Clads
• Two clades of monkeypox viruses, the West
African and Congo Basin viruses have been
identified.
• The Congo Basin viruses are more virulent.
11/26/2022 37
39. Clade West african clade Congo basin clade
Severity Less severe More severe
Case fatality rate 3.6% 10.6%
Transmissibility Less More
Features of CLADES OF MONKEYPOX VIRUS
(The present PHEIC belongs to West African Clade)
11/26/2022 39
41. MODES OF TRANSMISSION
◾Virus enters body through broken skin, respiratory
tract, or mucous membranes [eye, nose, mouth].
Direct contact
Close contact
with lesions, body
fluids, respiratory
droplets
Indirect contact
Contaminate
d
materials such as
bedding.
Human to
Human
Animal to
Human
Bites
Scratches
Bush meat
preparation
11/26/2022 41
45. Modes of Transmission
• Most reported cases identified ----
• sexual health or other health services in
primary or secondary health-care facilities
and
• have involved mainly, but not exclusively, men
who have sex with men.
11/26/2022 45
48. Transmission Dynamics
• Animal-to-human (zoonotic) transmission can occur from direct
contact with the blood, bodily fluids, or cutaneous or mucosal
lesions of infected animals.
• In Africa, evidence of monkeypox virus infection has been found in
many animals including rope squirrels, tree squirrels, Gambian
pouched rats, dormice, different species of monkeys and others.
• The natural reservoir of monkeypox has not yet been identified,
though rodents are the most likely.
• Eating inadequately cooked meat and other animal products of
infected animals is a possible risk factor.
• People living in or near forested areas may have indirect or low-
level exposure to infected animals.
11/26/2022 48
49. Modes of transmiss
• 98% cases have
been reported
in MSM (not
mutually
exclusive) due
to intimate
contact during
sex with
infectious skin
lesions
• Oral Sex is a
cause too
• Modes of
transmission
yet to be fully
understood &
evolving
11/26/2022 49
50. Human Transmission
• Human-to-human transmission can result from close contact with respiratory
secretions, skin lesions of an infected person or recently contaminated
objects.
• Transmission via droplet respiratory particles usually requires prolonged
face-to-face contact, which puts health workers, household members and
other close contacts of active cases at greater risk.
• However, the longest documented chain of transmission in a community has
risen in recent years from 6 to 9 successive person-to-person infections.
• This may reflect declining immunity in all communities due to cessation of
smallpox vaccination.
• Transmission can also occur via the placenta from mother to fetus (which can
lead to congenital monkeypox) or during close contact during and after birth.
• While close physical contact is a well-known risk factor for transmission, it is
unclear at this time if monkeypox can be transmitted specifically through
sexual transmission routes.
• Studies are needed to better understand this risk.
11/26/2022 50
55. Case Definitions
Suspected case:
– A person of any age having
history of travel to affected
countries within last 21 days
presenting with an
unexplained acute rash AND
one or more of the
following signs or symptoms
• Swollen lymph nodes
• Fever
• Headache
• Body aches
• profound weakness
Probable case:
A person meeting the case
definition for a suspected case,
clinically compatible illness and
has an epidemiological link
Confirmed case:
A case which is laboratory
confirmed for Monkeypox virus
(by detection of unique
sequences of viral DNA either by
polymerase chain reaction (PCR)
and/or sequencing by WGS)
11/26/2022 55
56. Suspected case:
A person of any age having history of travel to
affected countries within last 21 days presenting
with an unexplained acute rash AND
one or more of the following signs or symptoms
Swollen lymph nodes
Fever
Headache
Body aches
profound weakness
11/26/2022 56
57. Probable case:
A person meeting the case definition for a
suspected case,
-clinically compatible illness and
--has an epidemiological link (face-to-face
exposure, including health care workers without
appropriate PPE;
-direct physical contact with skin or skin lesions,
including sexual contact; or
--contact with contaminated materials such as
clothing, bedding or utensils is suggestive of a
strong epidemiological link.
11/26/2022 57
58. Confirmed case:
• A case which is laboratory confirmed for
monkeypox virus (by detection of unique
sequences of viral DNA either by
• Polymerase Chain Reaction (PCR) And/Or
Sequencing).
11/26/2022 58
59. Smallpox vs Monkeypox
• The clinical presentation of monkeypox
resembles that of smallpox, a related
orthopoxvirus infection which was declared
eradicated worldwide in 1980.
• Monkeypox is less contagious than smallpox
and causes less severe illness.
• Monkeypox typically presents clinically with
fever, rash and swollen lymph nodes and may
lead to a range of medical complications.
11/26/2022 59
61. Prevention
• Raising awareness of risk factors and educating
people about the measures they can take to
reduce exposure to the virus is the main
prevention strategy for monkeypox.
• Scientific studies are now underway to assess the
feasibility and appropriateness of vaccination for
the prevention and control of monkeypox.
• Some countries have, or are developing, policies
to offer vaccine to persons who may be at risk
such as laboratory personnel, rapid response
teams and health workers.
11/26/2022 64
62. PREVENTION
• Prevention includes activities mainly screening and vaccination
against the disease (India has started discussion with the
vaccine manufacturers)
• But now, we have to work on raising awareness of risk factors
and educating people about the measures they can take to
reduce exposure to the virus is the main prevention strategy for
Monkeypox.
• Scientific studies are now underway to assess the feasibility and
appropriateness of vaccination for the prevention and control
of Monkeypox.
11/26/2022 65
63. INFECTION CONTROL
Isolation of Patient
Persons with extensive lesions should be isolated in a separate room.
Household members should limit contact with the infected person.
Infected people should also avoid contact with animals, including pets.
Use of Personal Protective Equipment (PPE)
Persons with Monkeypox should wear a surgical mask,
Disposable gloves should be worn for direct contact with lesions and
disposed of after use.
Skin lesions should be covered to the best extent possible (Long
sleeves, long pants) to minimize risk of contact with others.
Contain and dispose of contaminated waste (such as dressings and
bandages) should be done according to biomedical waste disposal.
11/26/2022 66
64. Proper hand hygiene and cleaning procedures
Hand hygiene- Hand washing with soap and water
or use of an alcohol-based hand rub should be done.
Hand hygiene is to be performed after touching
lesion material, clothing, linens, or environmental
surfaces.
Household disinfection
Laundry: To be washed separately to avoid direct
contact with contaminated material.
Soiled dishes and utensils should be with warm
water and soap.
Contaminated surfaces should be cleaned and
disinfected. Standard household
cleaning/disinfectants may be used.
11/26/2022 67
65. INFECTION CONTROL PRECAUTIONS
By health workers-
To implement standard, contact and droplet precautions
Recommended Personal Protective Equipment (PPE)
includes gloves, gown, medical mask and eye
protection – goggles or face shield
Aerosol generating procedures should be done by
taking proper precautions.
Continue until all lesions have resolved and a fresh
layer of skin has formed.
11/26/2022 68
66. SURVEILLANCE STRATEGIES
• The aims of the proposed surveillance strategy
are to rapidly identify cases and clusters of
infections and the sources of infections (Index
Case) as soon as possible in order to:
1. Isolate cases to prevent further transmission
2. Provide optimal clinical care
3. Identify and manage contacts
4. Protect frontline health workers
5. Effective control and preventive measures based on
the identified routes of transmission
11/26/2022 69
67. Role of APHOs/PHOs/LPHOs
• Remain in a state of alert, particularly for the passengers arriving
from countries reporting monkey pox outbreaks,
• Familiarize yourself with clinical presentation of monkey pox,
• Undertake strict thermal screening and history of travel to affected
countries in last 21 days,
• Establish/strengthen referral arrangements from airport/Sea-
port/Land-port to identified link hospital.
• Also, familiarize Bureau of Immigration personnel, Airline
personnel, Customs officials, Airport/Sea-port/Land-port officials,
State health officials and other stakeholders about the disease,
• Inform concerned airlines about detection of a suspect case for the
purpose of disinfection procedure to be followed as per standard
guidelines.
11/26/2022 70
68. PUBLIC HEALTH ACTION
1. Health units to keep heightened suspicion in people who;
a. Present with otherwise unexplained rash and
b. Who have travelled in the last 21 days to a country that
has recently confirmed or suspected cases of Monkeypox
or
c. Report contact with a person or people with confirmed or
suspected Monkeypox.
2. Refer suspected travelers to the designated isolation
facilities for further investigation and treatment
11/26/2022 71
69. 2. All suspected cases to be isolated at designated healthcare facilities
until all lesions have resolved and a fresh layer of skin has formed OR
until the treating physician decides to end isolation.
3. All such patients to be reported to the district surveillance officer of
IDSP.
4. All infection control practices to be followed while treating such
patients.
5. Laboratory samples consisting of fluid from vesicle ,blood, sputum etc
to be sent to NIV Pune and other 15 ICMR labs for testing in case of
suspicion
6. In case a positive case is detected, contact tracing has to be initiated
immediately to identify the contacts of the patient in the last 21 days.
11/26/2022 72
70. Reducing the risk of human-to-human
transmission
• Surveillance and rapid identification of new cases is critical
for outbreak containment.
• During human monkeypox outbreaks, close contact with
infected persons is the most significant risk factor for
monkeypox virus infection.
• Health workers and household members are at a greater
risk of infection.
• Health workers caring for patients with suspected or
confirmed monkeypox virus infection, or handling
specimens from them, should implement standard
infection control precautions.
• If possible, persons previously vaccinated against smallpox
should be selected to care for the patient.
11/26/2022 73
71. Reducing the risk of human-to-human
transmission
• Samples taken from people and animals with suspected
monkeypox virus infection should be handled by trained
staff working in suitably equipped laboratories.
• Patient specimens must be safely prepared for transport
with triple packaging in accordance with WHO guidance for
transport of infectious substances.
• The identification in May 2022 of clusters of monkeypox
cases in several non-endemic countries with no direct
travel links to an endemic area is atypical.
• Further investigations are underway to determine the
likely source of infection and limit further onward spread.
• As the source of this outbreak is being investigated, it is
important to look at all possible modes of transmission in
order to safeguard public health.
11/26/2022 74
72. Reducing the risk of zoonotic transmission
Over time, most human infections have resulted from a
primary, animal-to-human transmission. Unprotected contact
with wild animals, especially those that are sick or dead,
including their meat, blood and other parts must be avoided.
Additionally, all foods containing animal meat or parts must be
thoroughly cooked before eating.
Preventing monkeypox through restrictions on animal trade
Some countries have put in place regulations restricting
importation of rodents and non-human primates. Captive
animals that are potentially infected with monkeypox should be
isolated from other animals and placed into immediate
quarantine. Any animals that might have come into contact
with an infected animal should be quarantined, handled with
standard precautions and observed for monkeypox symptoms
for 30 days.
11/26/2022 75
73. Surveillance Strategies
The aims of the proposed surveillance strategy are
to rapidly identify cases and clusters of
infections and the sources of infections as soon
as possible in order to:
a) isolate cases to prevent further transmission
b) provide optimal clinical care
c) identify and manage contacts
d) protect frontline health workers
e) effective control and preventive measures
based on the identified routes of transmission.
11/26/2022 76
74. Surveillance outline
a) Use Standard Case Definitions by all District Surveillance Units (DSUs) under
Integrated Disease Surveillance Programme (IDSP) and at Points of Entry (PoEs).
b) Even one case of monkeypox is to be considered as an outbreak. A detailed
investigation by the Rapid Response Teams need to be initiated through IDSP.
c) Report any suspected case immediately to the DSU/State Surveillance Units (SSUs)
and CSU (Central Surveillance Unit), which shall report the same to Dte. GHS
MoHFW.
d) Send the samples as per the guidelines to the designated laboratories.
11/26/2022 77
75. Features of Surveillance
The salient features include:
a) Targeted surveillance for probable case or
clusters.
b) Initiate contact tracing and testing of the
symptomatic after the detection of the
probable/confirmed case.
11/26/2022 78
76. Core Surveillance Strategy
a) Hospital based Surveillance: - Health facility-
based surveillance & testing – in
Dermatology clinics, STD clinics, medicine,
paediatrics OPDs etc.
b) Targeted Surveillance: This can be achieved
by:
i) Measles surveillance by Immunization division
ii) Targeted intervention sites identified by
NACO for MSM, FSW population
11/26/2022 79
77. Contact tracing
Definition of a contact
• A contact is defined as a person who, in the period
beginning with the onset of the source case’s
• first symptoms, and ending when all scabs have fallen off,
has had one or more of the following
• exposures with a probable or confirmed case of monkey
pox:
• face-to-face exposure (including health care workers
without appropriate PPE)
• direct physical contact, including sexual contact
• contact with contaminated materials such as clothing or
bedding
11/26/2022 80
78. Contact identification
Cases can be prompted to identify contacts
across household, workplace, school/nursery,
sexual contacts, healthcare, houses of worship,
transportation, sports, social gatherings, and
any other recalled interactions.
11/26/2022 81
79. Contact monitoring
a) Contacts should be monitored at least daily for the onset of
signs/symptoms for a periodof 21 days (as per case definition above)
from the last contact with a patient or their contaminated materials
during the infectious period. In case of occurrence of fever clinical/lab
evaluation is warranted.
b) Asymptomatic contacts should not donate blood, cells, tissue, organs or
semen while they are under surveillance.
c) Pre-school children may be excluded from day care, nursery, or other group
settings.
d) Health workers who have unprotected exposures to patients with
monkeypox or possibly contaminated materials do not need to be
excluded from work duty if asymptomatic, but hould undergo active
surveillance for symptoms for 21 days.
Advisory for International Passengers and surveillance at Airports and Role of
APHOs/PHOs
11/26/2022 82
81. One Health Approach
Therefore, appropriate measures should be taken, such as:
1. physical distancing between people infected with
monkeypox and domestic pets
2. proper waste management to prevent the disease from
being transmitted from infected humans to susceptible
animals at home (including pets), in zoos and wildlife
reserves, and to peri-domestic animals, especially rodents.
3.Residents and travellers to countries that have previously
reported monkeypox should avoid contact with sick
mammals such as rodents, marsupials, non-human
primates (dead or alive) that could harbor monkeypox virus
and should refrain from eating or handling wild game (bush
meat).
11/26/2022 84
83. Vaccination
• Vaccination against smallpox was demonstrated through several
observational studies to be about 85% effective in preventing monkeypox.
• Thus, prior smallpox vaccination may result in milder illness. Evidence of
prior vaccination against smallpox can usually be found as a scar on the
upper arm.
• At the present time, the original (first-generation) smallpox vaccines are
no longer available to the general public.
• Some laboratory personnel or health workers may have received a more
recent smallpox vaccine to protect them in the event of exposure to
orthopoxviruses in the workplace.
• A still newer vaccine based on a modified attenuated vaccinia virus
(Ankara strain) was approved for the prevention of monkeypox in 2019.
• This is a two-dose vaccine for which availability remains limited. Smallpox
and monkeypox vaccines are developed in formulations based on the
vaccinia virus due to cross-protection afforded for the immune response
to orthopoxviruses.
11/26/2022 86
85. Prognosis
• At this time, there are no specific treatments available for Monkeypox infection,
but Monkeypox outbreaks can be controlled.
• Many individuals infected with Monkeypox virus have a mild, self-limiting
disease course in the absence of specific therapy
• The prognosis for Monkeypox depends on multiple factors such as previous
vaccination status, initial health status, and concurrent illnesses or
comorbidities
11/26/2022 88
86. Take Home Message
11/26/2022 89
Monkeypox is a viral zoonotic infection that results in a rash similar to that of
smallpox.
However, historically, person-to-person spread outside the household and
mortality from a monkeypox infection are significantly less than for smallpox.
Globally, there have been more than 68,000 monkeypox cases and 25 confirmed
deaths in the current outbreak, according to the World Health Organization.
According to the CDC, 71,096 monkeypox cases have been reported globally in
107 countries since January 1, 2022.
The U.S. has reported the highest number of monkeypox cases, followed by
Brazil with 8,207 and Spain with 7,209.
In the U.S., two vaccines (JYNNEOS and ACAM2000) may be used to prevent the
spread of monkeypox.