Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
Dr. Pragya Yadav ICMR NIV Naipunyam_4_Keynote_Monkey Pox.pdf
1. Monkeypox
(Introduction, Epidemiology,, Case Definition Current Scenario)
Orientation on Monkeypox Disease
Naipunyam-4
June 18, 2022
Dr. Pragya D Yadav, FIVS, FNAAS.
Scientist F & In-charge, Maximum Containment Facility,
ICMR-NIV, Pune, Department of Health Research, Ministry of Health & Family
Welfare, Government of India
2. Introduction
Why India needs preparedness?
• Zoonotic disease
• Found primarily in Africa, mostly around tropical
rainforest regions
• Importation of cases observed through traveler
from Endemic countries
• Focal outbreaks reported amongst close contacts
in UK (mostly amongst MSM group)
3. • Belonging to Orthopoxvirus genus, family Poxviridae
• Linear Double-stranded DNA virus
• Genome size of around 190 kb
• Contains ≈190 nonoverlapping Open Reading Frames (ORFs) which are >180 nucleotide long
• Like all orthopoxviruses, the central coding region sequence (CRS) is highly conserved
• CRS is flanked by variable ends that contain inverted terminal repeats (ITRs)
• Unlike Variola virus, which lacks ORFs in the ITR region, MPXV contains at least 4 ORFs in the ITR region
• Vaccinia virus (VACV) A27 protein and its homologs, which are found in a large number of members of the
genus Orthopoxvirus (OPXV), are targets of viral neutralization by host antibodies
• VACV homologs to genes found in the terminal ends of the MPXV genome are predominantly involved in
immunomodulation, and are either predicted or known to influence host range determination and pathogenicity
Genome of Monkeypox
4. Confirmed Human Monkeypox cases (Ref open who.org 2021)
• First human case of monkeypox was recorded in 1970 in the DRC
• Many outbreaks and cases has been reported from central and western African countries:
Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon,
Liberia, Nigeria, and Sierra Leone
5. • USA:
• 2003: 6 countries reported: (contact with pet
prairie dogs. The pets were infected after being
housed near imported small mammals from Ghana)
• July 2021-Single case
• Nov 2021- Single case
• May 2022- Cluster of cases
• Israel- Sep 2018
• Singapore- May 2019
• UK
• Sept 2018
• Dec 2019
• May 2021
• May 2022
Outbreaks due to importation (Ref open who.org 2021)
As of 10 June 2022, 1285 laboratory confirmed cases and one probable
case have been reported to WHO from 28 countries in four WHO Regions
where monkeypox is not usual or had not previously been reported
Till date, India has not confirmed any case
6. Reasons for re-emergence
(Ref open who.org 2021)
• Closer Contact between humans and animals through deforestation, demographic changes, climatic
changes, hunting and population movement might account for the recent increase in the reported cases
and expansion into new geographical areas
• Civil unrest and population displacement can force inhabitants to seek alternate source of food including
consumption of wild animals, squirrels and rodents
7. Two Clades of Monkeypox virus genomes are in circulation
West African and Congo Basin (or Central African)
Overlap circulation was observed in in Cameroon, USA
• No significant mutations were observed in the genome
• But it is important to know the clade circulating considering the transmission and fatality
(Ref open who.org 2021)
8. • The virus of 2022 outbreak belongs
to the West African clade
• Closely related to viruses associated
with the exportation of monkeypox
virus from Nigeria to several
countries—the United Kingdom,
Israel, and Singapore—in 2018 and
2019
Phylogenetic analysis: 2022 Portugal, Europe outbreak
Ref: https://virological.org/t/first-draft-genome-
sequence-of-monkeypox-virus-associated-with-the-
suspected-multi-country-outbreak-may-2022-confirmed-
case-in-portugal/799
9. • Species having role in transmission:
• African Dormouse
• Rope Squirrel
• Gambian Pouched Rat
• Sooty Mangabey monkey
Reservoir of infection
(Ref open who.org 2021)
10. • Modes of transmission
• Unprotected contact with:
• Respiratory droplets
• Lesion material
• Body fluids
• Contaminated materials and surfaces
• Mother to fetus
• The virus can enter through:
• Respiratory tract
• Mucous membranes (eyes and mouth)
• Broken skin (e.g. animal bites)
Modes of Transmission
(Ref open who.org 2021)
11. Suspected case:
A person of any age presenting in a monkeypox non-endemic
country with an unexplained acute rash
AND
one or more of the following signs or symptoms
• Headache
• Acute onset of fever (>38.5oC)
• Lymphadenopathy (swollen lymph nodes)
• Myalgia (muscle pain/body aches)
• Back pain
• Asthenia (profound weakness)
AND
With no clinical pictures of other DDs
Probable case:
A person meeting the case definition for a suspected case
AND
One or more of the following:
• has an epidemiological link to a probable or confirmed case
of monkeypox in the 21 days before symptom onset
• reported travel history to a monkeypox endemic country in
the 21 days before symptom onset
• has had multiple or anonymous sexual partners in the 21
days before symptom onset
• has a positive result of an orthopoxvirus serological assay, in
the absence of smallpox vaccination or other known exposure
to orthopoxviruses
• is hospitalized due to the illness
Confirmed case:
A case meeting the definition of either a suspected or
probable case
AND
is laboratory confirmed for monkeypox virus by detection of
unique sequences of viral DNA either by real-time
polymerase chain reaction (PCR) and/or sequencing
Discarded case:
A suspected or probable case for which laboratory testing of
lesion fluid, skin specimens or crusts by PCR and/or sequencing
is negative for MPXV
Case Definitions
15. Complications and Long-term sequelae
Complications:
• Corneal infection and vision loss
• Secondary bacterial infections
• Abscess and airway obstruction
• Pneumonia
• Sepsis
• Encephalitis
• Miscarriage
• Death
Long term Sequelae
• Pockmarks
• Scarring or loss of pigmentation
• Corneal ulcers
• Blindness
High Risk Group
• Pregnant women
• Children
• Immunocompromised patients
• Health Care workers
16. Biosafety Levels & Risk group
BSL-1
• No or low individual and community risk
• Unlikely to cause human or animal disease
• Eg-?? E.coli, Bacillus subtilis
BSL-2
• Moderate individual risk, low community risk
• Can cause disease but unlikely to be a serious hazard
• Effective treatment and preventative measures are available
• Eg-?? Dengue, chikungunya, Measles, JE
BSL-3
• High individual risk, low community risk
• Usually causes serious human or animal disease but does not ordinarily spread.
• Effective treatment and preventive measures are available.
• Eg-?? KFD, Avian Influenza
BSL-4
• High individual and community risk
• Usually causes serious human or animal disease and can be readily transmitted.
• Effective treatment and preventative measures are not usually available
• Eg-?? KFD, Ebola, CCHF, Marburg, Hantaan
16
Monkeypox belongs to which Risk group?
17. Monkeypox virus belongs to Risk group-III in
Non-endemic areas
§ High individual risk, low community risk
§ Focal restricted outbreaks seen amongst close contacts
§ Usually causes serious human or animal disease but does not ordinarily spread
§ Serious disease with mortality is upto 14%, complications and sequelae
§ Spread is limited through droplet and close contacts with lesion and face to face
prolonged contact with case
§ Effective treatment and preventive measures are available
§ Jynneos (live attenuated modified Vaccinia Ankara) vaccine- But not readily available
(approved by US FDA in 2019)
§ Tecovirimat- Oral and iv drug approved by USFDA
§ Brincidofovir (approved by US FDA in 2021)
Being risk group-III and exotic pathogens
Handled only in High Containment Facilities
By trained staff
18. Personal Protective Equipment required for
Collecting the samples
• Coveralls/Gowns
• N-95 mask
• Head cap
• Booties/shoe-cover
• Face shield/safety goggles
• Double pair of gloves
Gowns Coveralls/Tyvek Suit
Donning and Doffing to be followed as
done as per COVID-19 samples collection
(WHO protocol)
19. Clinical Specimens to be collected
Week 2-4
[Rash phase]
Post 4 weeks
[Recovery phase]
• *Lesion roof- with scalpel or plastic scrapper
collected in plain tube
• *Lesion fluid with intradermal syringe
• *Lesion base scrapings with sterile polyester
swab collected in plain tube
• *Lesion crust in plain tube
• NPS/OPS in dry plain tube [without any bacterial
medium or VTM]
• Blood collected in SSGT
• Blood collected in EDTA (2-3ml)
• Urine in sterile urine container
• Blood collected in SSGT
• Urine in sterile urine
container
*The specimens from lesion should be collected from multiple sites
Recommended by WHO
NPS/OPS should not be collected in any medium
Should be Collected in dry plain tube
27. Laboratory Diagnosis
• Detect antibody/antigen against
an orthopoxvirus
• Not monkeypox virus specific
• Limited diagnostic value-Cross
Reactivity
1. PCR and real time PCR 2. Serology
Clinical Specimens: Lesion fluid, Lesion scrapings, Lesion roof, Lesion crust/scab and NPS/OPS
Test 1
PCR for Orthopox genus (Cowpox,
Camelpox, Buffalopox, Monekypox )
Test 2
Monekypox generic Real time PCR
960bp
If Positive
DNA sequencing of PCR product for
further confirmation
If Positive
Monekypox Strain specific real time PCR
(Congo basin and West Africa strain)
To be investigated for differential
diagnosis
If negative by PCR for Orthopox
genus/Monkey pox generic Real time PCR
References: 1.PCR Strategy for Identification and Differentiation of Smallpox and Other Orthopoxviruses. Journal of Clinical Microbiology, Aug. 1995, p. 2069–2076
2. Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA. Journal of Virological Methods,169, 2010, p223-227
Report positive for Monekypox
Virus isolation and Next generation sequencing will be used for
characterization of positive clinical specimens
And
O
p
t
i
o
n
a
l
28. What we have learned so far?
• Belonging to Orthopoxvirus genus, family Poxviridae
• Zoonotic disease
• Double-stranded DNA virus
• Found in 11 countries of Africa, but importation of cases are reported from 28 other countries
• Belongs to Risk group-III- Hence require high containment for handling
• All samples to be referred to ICMR-NIV Pune- BSL-4 lab
• Samples to be collected (primarily- lesion, OPS/NPS in plain tube, Serum, EDTA and Urine)
• PPE required are Coveralls/Gowns, N-95 mask, Head cap, Booties/shoe-cover, Face shield/safety goggles,
Double pair of gloves
• Transportation of specimens in triple packaging and preferably in dry ice
Vigilance and Preparedness is the key to detect and contain the outbreak
29. References and Guidelines
• National guideline for the Monkeypox by MoHFW-GOI-
https://main.mohfw.gov.in/sites/default/files/Guidelines%20for%20Management%20of%20Monkeypox%20
Disease.pdf
• WHO-Monkeypox disease- https://www.who.int/news-room/fact-sheets/detail/monkeypox
• Open WHO-Monkeypox Disease- https://openwho.org/courses/monkeypox-intermediate
• CDC-Monkeypox- https://www.cdc.gov/poxvirus/monkeypox/index.html
• Dangerous Goods Regulations (DGR) – IATA 2021-2022 WHO
• Multi-country monkeypox outbreak: situation update- https://www.who.int/emergencies/disease-
outbreak-news/item/2022-DON392
