ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
monkey pox infectious disease zoonotic disease
1. Orientation on Monkeypox
Date: 18th June 2022
Time: 5:00 PM
Venue: Zoom Meeting
1
Government of Andhra
Pradesh
APVVP
Dr. Selwyn Selva Kumar MD, DM,
Assistant Professor,
Department of Infectious Diseases,
CMC Vellore.
3. Introduction
• Human monkey pox virus (MPXV) is a double-
stranded DNA virus of the genus Ortho
poxvirus.
• Two genetic clades of the monkey pox virus -
West African and Central African (Congo
basin).
• Monkey pox infects a wide range of
mammalian species, but its natural host
reservoir remains unknown.
• Largest animal reservoir in rodents.
WHO. Human monkey pox 2019
PLoS One. 2010; 5(1): e8912.
4. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, et al. (2022) The changing epidemiology of human monkeypox—A potential threat? A
systematic review. PLOS Neglected Tropical Diseases 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010141
Introduction
5. Mode of transmission
• Primary animal to-human infection -Direct
contact (touch, bite, or scratch).
• Secondary human-to-human transmission
- large respiratory droplets or direct or
indirect contact with body fluids, lesion
material, and contaminated surfaces,
clothing or linens.
• There is no evidence to date that human-
to-human transmission alone can sustain
monkey pox infections in the human
population.
Am J Trop Med Hyg 2005;73:428–34.
6. Introduction- Clinical features
• The clinical presentation of MPX is similar to that
of smallpox.
• Less severe than smallpox with
1. lower fatality rate (30% Vs 10%)
2. Less scarification.
Most confirmed cases are younger than 40 years
with a median age of 31 years, Male ,MSM .
Infect Dis Clin N Am - (2019)
7. Clinical features
• The incubation period : 5 to 21 days.
• Duration of symptoms and signs at 2 to 5 weeks.
• The illness begins with nonspecific symptoms and signs - fever, chills, headaches,
lethargy, asthenia, lymph node swellings, back pain, and myalgia.
• Within 1 to 5 days after the onset of fever, rashes of varying sizes appear,
Enanthem >> then on the face >> body >>> hands >>>> legs and feet.
8. Monkey pox - Rash
Stages of evolution
1. Macules
2. Papules
3. vesicles
4. pustules
5. crusts and scabs
6. drop off and re-
epithelise
12. Complications
• Secondary bacterial infections
• Acute respiratory distress syndrome,
• Bronchopneumonia
• Encephalitis
• Corneal infection
• Gastroenteritis
There was an overall case fatality
rate of 8.7%, with a significant
difference between clades—
Central African 10.6% (95% CI:
8.4%– 13.3%) vs. West African
3.6% (95% CI: 1.7%– 6.8%)
13. Surveillance strategies
Aim is to rapidly identify cases and clusters of infections and the
sources of infections 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
Even one case in Non Endemic region is an Outbreak!
15. Suspected case
• A person of any age presenting in a monkey pox non-endemic country with
an unexplained acute rash
AND
One or more of the following signs or symptoms, since 15 March 2022:
• Headache
• Acute onset of fever (>38.5oC),
• Lymphadenopathy (swollen lymph nodes)
• Myalgia (muscle and body aches)
• Back pain
• Asthenia (profound weakness)
AND
Common causes ruled out
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
16. 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 monkey pox 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 ortho pox virus serological assay, in the absence
of smallpox vaccination or other known exposure to ortho pox viruses
• is hospitalized due to the illness
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
17. Confirmed case
• suspected or probable case and is laboratory confirmed for monkey pox
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 by PCR
and/or sequencing is negative for monkey pox virus.
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
18. Surveillance outline
• 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.
• Use Standard Case Definitions by all District Surveillance Units (DSUs) under
Integrated Disease Surveillance Programme (IDSP) and at Points of Entry (PoEs).
• A detailed investigation by the Rapid Response Teams need to be initiated
through IDSP.
• Send the samples as per the guidelines to the designated laboratories.
19. a) Targeted surveillance for probable case or clusters among MSM , FSW through
NACO.
b) Initiate contact tracing and testing of the symptomatic after the detection of the
probable/confirmed case.
Core Surveillance Strategy
a) Hospital based Surveillance: Dermatology clinics, STD clinics, medicine,
pediatrics OPDs etc.
b) 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
Surveillance outline
21. 1. Work up for close differentials
Chicken pox, measles, syphilis, scabies, bacterial skin infections, drug
reactions.
2. Use PPE while collecting sample.
28. Confirmation of MPXV infection
• Nucleic acid amplification testing (NAAT), using real-time or conventional
polymerase chain reaction (PCR).
• Detects unique sequences of viral DNA.
• PCR can be used alone, or in combination with sequencing.
• Certain protocol prefers 2 step detection, OPXV >> MPXV detection.
• Virus isolation is not recommended as a routine diagnostic procedure
WHO/MPX/Laboratory/2022.1
29. All the clinical specimens should be transported to the Apex laboratory of ICMR-NIV Pune routed through the
Integrated Disease Surveillance Programme network of the respective district/state
While it is preferable to perform MPXV specific confirmatory testing, positive detection using OPXV PCR assay is
considered sufficient for laboratory confirmation of suspected cases in non-endemic countries - WHO/MPX/Laboratory/2022.1
31. Management
• Patient isolation
• Protection of compromised skin and mucous membranes
• Rehydration therapy and Nutritional support
• Symptom alleviation
• Monitoring and treatment of complications
32. Isolation
• Isolate in single room
• Patient to wear a triple layer mask
• Skin lesions should be covered to the best extent possible (e.g. long
sleeves, long pants) to minimize risk of contact with others
• Isolation to be continued until all lesions have resolved and scabs
have completely fallen off
33.
34. Indications for antivirals
• Complications of MPX
• Requiring hospitalization
• High risk group
1. <8yrs
2. Pregnant/Lactating mother
3. Extensive skin disease
4. Immunocompromised
35. Antivirals – Monkey Pox
• Tecovirimat - VP37 Envelope Wrapping Protein Inhibitor
Adult dose: PO 600mg BD; IV 200mg BD for 2 weeks
• Cidofovir
• Brincidofovir
• Vaccinia Immune Globulin Intravenous (VIGIV)
36. Conclusion
• Though we have not reported any MPX cases so far, should be
prepared.
• Identify the risk group
• Majority are milder cases.
• MPX has low epidemic/pandemic potential, no need to PANIC!
