In a bid to determine the clade of the mpox (monkeypox) virus, the Ministry of Health and Population is preparing to send specimens from infected persons to the World Health Organisation’s collaborating centre in Thailand.
 |
| photo:TKP |
A clade is a subtype, genotype or group of viruses that originates from a common ancestor. So far, three clades of mpox viruses clade I, clade IIa and cladeIIb have been identified.
Officials say clade identification tells the virus’s
virulence and transmissibility of the virus, which is necessary to curb the
further spread of deadly disease. As the country lacks a system to carry out
virus sub-typing, it sought help from the UN health body.
“We will probably send the specimen taken directly from
the rash—skin fluid or crusts collected from the infected person—to the World
Health Organisation’s collaborating centre in Thailand for clade
identification,” said Dr Hemanta Chandra Ojha, an official at the Epidemiology
and Disease Control Division.
“Identification of the virus’ clade will help us to
figure out what extra measures are needed to mitigate the risks of further
spread.”
Mpox is a rare disease caused by infection with the mpox
virus. Last week, Nepal confirmed its second mpox case. A 36-year-old man from
Tanahun, who returned from Saudi Arabia on December 19, tested positive for the
disease.
The country confirmed its first case of mpox infection in
June last year when a 60-year-old foreign national tested positive.
Experts say clade I, which is present in the Congo basin,
causes up to 10 percent human mortality and is transmitted by rodents, although
human-to-human transmission has also been recorded. Clade IIa, which exists in
West Africa, has a low mortality rate, but clade IIb is currently spreading
globally through human transmission. Clade IIb was responsible for infection in
the first mpox case in Nepal.
According to Ojha, the health condition of the infected
person is normal, and he could be discharged from the hospital in a few days.
With the confirmation of the second mpox case in Nepal,
health authorities have stepped up surveillance measures to prevent a possible
outbreak of the deadly viral disease.
Along with stepping up screening of passengers entering
the country via the Tribhuvan International Airport, health authorities have
requested dermatologists throughout the country to refer suspected cases for
testing.
“We have also deployed health workers at the health desk
at Pokhara International Airport and screened passengers who arrived from China
for the dragon boat festival,” said Ojha. “We also conducted an orientation for
health workers serving in strategic locations.”
Public health experts in Nepal say that screening
suspects at health desks at international airports and land crossings is not
sufficient to prevent outbreaks, as the first symptoms of mpox can take between
five and 21 days for the first symptoms of mpox to appear, and not all cases
can be detected at health desks.
Monkeypox cases have been reported in neighbouring India,
with which Nepal shares a long, porous border. India has recorded at least 30
mpox infections since 2022.
Health experts say that even though mpox is usually mild
and most people recover within weeks, the risks should not be underestimated.
They stress the importance of precautions, saying that any disease seen in any
corner of the world can reach Nepal due to the high mobility of people.
Mpox has been a neglected public health problem in parts
of Africa for decades. The disease came to widespread attention after May 2022,
when countries outside Africa began reporting new cases.
Since then, mpox has spread globally. More than 100,000
people from 122 countries have already tested positive for the disease.
Its symptoms include fever, headache, swelling, body
aches, exhaustion, and itchy rashes on the face, hands, and feet.
As the disease primarily spreads through close
person-to-person contact, public health experts recommend self-isolation and
good hygiene to prevent transmission.
With the confirmation of the
second mpox case in Nepal, the Ministry of Health and Population has stepped up
surveillance measures to prevent a possible outbreak of the deadly viral
disease.
Nepal reported the latest
case on Friday. A 36-year-old man from Tanahun, who returned from Saudi Arabia
on Thursday, tested positive for the disease.
Nepal confirmed its first
case of mpox infection in June last year, when a 60-year-old foreign national
had tested positive.
“We have increased health
screenings of passengers entering the country from abroad, as per the
instruction of the Ministry of Health and Population,” said Kanchhi Maya
Twanju, a health worker deployed at the health desk set up at the Tribhuvan
International Airport. “We have been instructed to send passengers having fever
and those showing symptoms of mpox infection directly to hospitals.”
Mpox is a rare disease caused
by infection with the mpox virus and one in 10 infected persons can die. Most
common in remote parts of central and west Africa, the disease has now been
reported in at least 122 countries. Beyond Africa, monkeypox is spreading
chiefly in men who have sex with men, putting sexual health clinics on alert
for new cases.
Along with stepping up
screening of the passengers entering the country via TIA, health authorities
have requested dermatologists throughout the country to refer suspected cases
for testing.
“We have alerted
dermatologists about the risk of an outbreak of mpox virus in the country and
have requested them to refer suspected cases for testing,” said Dr Yadu Chandra
Ghimire, director of the Epidemiology and Disease Control Division. “We will
take additional measures following consultations with stakeholders, including
the World Health Organisation’s Nepal representatives.”
Public health experts in
Nepal say that screening suspects at health desks at international airports and
land crossings is not sufficient to prevent outbreaks since it usually takes
between five and 21 days for the first symptoms of mpox to appear, and not all
cases of infection can be detected at health desks.
Monkeypox cases have been
reported in neighbouring India, with which Nepal shares a long, porous border.
India has recorded at least 30 mpox infections since 2022.
Health experts say that even
if the rare viral infection is usually mild and most people recover within
weeks, the risks should not be underestimated. They stress precautions, saying
that every disease seen in any corner of the world can come to Nepal due to the
high mobility of people.
“We didn’t expect that the
infected person would come from Saudi Arabia, as there is no outbreak
currently,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at
Sukraraj Tropical and Infectious Disease Hospital. “This incident shows that
the deadly disease may come from any country, and we must remain vigilant and
prepare agencies concerned accordingly.”
Doctors say preventing an
outbreak of the deadly viral disease is not the sole responsibility of a single
health agency, and it is impossible to do so.
“Every agency and person,
including passengers, should shoulder the responsibility and take preventive
measures,” Pun stated.
Mpox has been a globally
neglected public health problem in parts of Africa for decades. The disease
came to widespread attention after May 2022, with countries outside Africa
reporting new cases.
Mpox has since spread
globally. More than 100,000 people from 122 countries have already tested
positive for the disease.
Its symptoms include fever, headache,
swelling, body pains, exhaustion, and itchy rashes on the face, hands, and
feet.
As the disease primarily
spreads through close person-to-person contact, public health experts recommend
self-isolation and good hygiene to avoid it.
Meanwhile, health officials
informed that the condition of the infected man is normal and he will remain in
hospital isolation for an additional two weeks.
They said that they are also
working to trace close contacts between the patients on the plane and the taxi
driver who took him to the hospital.
Nepal on Saturday confirmed
its first case of monkeypox infection.
According to the Ministry of
the Health and Population, a 60-year-old foreign national has tested positive
for monkeypox infection.
"Health condition of the
woman, who is a foreign national, is normal," said Dr Samir Kumar
Adhikari, joint spokesperson of the Health ministry. "She is under
observation of doctors at the isolation ward of a Kathmandu hospital."
The ministry refused to
disclose the nationality of the infected woman and the country she had been
last time.
According to Adhikari, the
woman keeps traveling to Nepal and other countries frequently.
Specimens of the woman’s body
fluids were tested at the National Public Health Laboratory, which confirmed
infection of the virus.
Monkeypox is a rare disease
caused by infection with the monkeypox virus and one in 10 infected persons can
die. Most common in remote parts of central and west Africa, the disease has
now been reported in at least 111 countries, including in Nepal. Its symptoms
include fever, headache, swelling, body pains, exhaustion, and itchy rash on
the face, hands, and feet.
As the disease primarily
spreads through close person-to-person contact, public health experts recommend
self-isolation and good hygiene to avoid it. The World Health Organization has
designated the disease as a public health emergency of international
concerns—which is the highest health alert.
More than 87,000 cases and
112 deaths from monkeypox have been reported in 2022, according to the UN
health body.
Public health experts say
that even if monkeypox infection is usually mild and most people recover within
weeks, authorities concerned should not underestimate the risks. They stress
taking precautions saying every disease seen in any corner of the world can
come to Nepal due to high mobility.
The Epidemiology and Disease
Control Division has alerted all agencies concerned about the growing risk of
the spread of mpox, also known as the monkeypox virus, in communities.
The division’s alert follows
Wednesday's declaration of a global public health emergency by the World Health
Organisation. The UN agency defines an international public health emergency as
an “extraordinary event” that poses a serious public health risk.
“We have also asked concerned
agencies and officials to step up surveillance measures and send people
suspected to have contracted the virus to the National Public Health Laboratory
for the test,” said Dr Yadu Chandra Ghimire, director of the division. “We also
held a discussion with the representative of the UN health body in Nepal and
other officials concerned about the potential risk of the mpox virus
spreading.”
Monkeypox is a rare disease
caused by infection with the monkeypox virus. It is the second time since the
UN health body declared mpox a global health emergency in two years, as the
virus has spread alarmingly in the African continents and is at risk of
entering other continents.
The WHO said that 524 people
died and more than 14,000 cases of infection have been reported this year alone
in Africa, which exceeded last year’s figure.
The mpox virus is transmitted
through close contact such as sex, skin-to-skin contact, and the respiratory
tract or mucous membranes.
Doctors say animal-to-human
transmission often occurs through bites, scratches or direct contact with
infected animals’ blood, body fluids or wounds. The virus causes flu-like
symptoms.
Nepal had confirmed mpox
infection in June last year after a 60-year-old foreigner tested positive for
monkeypox infection.
Public health experts say
that every disease seen in any corner of the world is possible to come to Nepal
due to the high mobility of its own people and foreign tourists. They say it is
relatively easier for people from any part of the globe to come to Nepal and
that it increases the risk of any disease seen in any part of the globe
arriving in Nepal.
“We cannot keep repeating the
same mistake. When Covid spread in China, we thought that since we did not have
a direct flight from disease-hit areas, the chance of the disease spreading to
Nepal was low, but this proved to be wrong,” said Dr Shrawan Kumar Mishra,
director at the provincial Public Health Laboratory of Madhesh Province. “Many
people from our country travel to Africa, and our UN peacekeepers also serve
there and return home. Anyone coming back from disease-hit countries must be
kept in isolation for three weeks.”
Experts say screening at the
health desks of international airports and land crossings alone is not enough
to prevent a possible outbreak of monkeypox in the country since symptoms
usually appear between five and 21 days after infection. Moreover, not everyone
will have visible symptoms on their skin or limbs. They say that asymptomatic
persons can also transmit the virus.
Symptoms of the mpox virus
include fever, headache, swelling, body pains, exhaustion, and itchy rashes on
the face, hands, and feet.
As the disease primarily
spreads through close person-to-person contact, public health experts recommend
self-isolation and good hygiene to avoid it.
Doctors say that even though
monkeypox infection is usually mild and most people recover within weeks, the
authorities concerned should not underestimate the risks.
Globally, more than 87,000
cases and 112 deaths from monkeypox were reported in 2022, according to the WHO
The UN health body said it is
working with countries and vaccine manufacturers on potential vaccine donations
and coordinating with partners through the interim Medical Countermeasures
Network to facilitate equitable access to vaccines, therapeutics, diagnostics
and other tools.
A World Health Organization
official stressed on Tuesday that mpox, regardless of whether it is the new or
old strain, is not the new Covid, as authorities know how to control its
spread.
“We can and must tackle mpox
together,” said Hans Kluge, WHO regional director for Europe, in a UN media
briefing.
“So will we choose to put the
systems in place to control and eliminate mpox globally? Or we will enter
another cycle of panic and neglect? How we respond now and in the years to come
will prove a critical test for Europe and the world,” he added.
Mpox, a viral infection that
causes pus-filled lesions and flu-like symptoms, is usually mild but can kill.
The clade 1b variety has
caused global concern because it seems to spread more easily through routine
close contact.
A case of the variant was
confirmed last week in Sweden and linked to a growing outbreak in Africa, the
first sign of its spread outside the continent.
The WHO declared the recent
outbreak of the disease a public health emergency of international concern
after the new variant was identified.
Kluge said that the focus on
the new clade 1 strain will also help in the fight against the less severe
clade 2 variety that has spreading globally since 2022, allowing Europe to
improve its response through better health advice and surveillance.
About 100 new cases of the
clade 2 mpox strain are now being reported in the European region every month,
added Kluge.
Mpox transmits through close
physical contact, including sexual contact, but unlike previous global
pandemics such as Covid-19, there is no evidence it spreads easily through the
air.
Health authorities need to be
on alert and flexible in case there are new, more transmissible clades or ones
that change their transmission route, but there are no recommendations for
people to wear masks, said WHO spokesperson Tarik Jasarevic.
The mpox outbreak in Africa
is yet another example of how infectious diseases perceived to be “someone
else’s problem”, and affecting mainly poor, developing countries, may suddenly
pose unexpected global threats. Other examples of neglected diseases include
the West Nile, Zika and Chikungunya viruses.
Mpox was discovered in 1958
(in captive monkeys, hence the original misnomer “monkeypox”) and the first
human case was identified in 1970. Then for decades it was largely neglected by
the scientific and public health communities, regarded as an uncommon infection
in remote rural areas in tropical Africa without relevance for the rest of the
world.
When a massive mpox outbreak
hit developed countries in 2022, increased research funding led to a surge in
scientific studies. On just one medical search engine, there’s been more
research produced since April 2022 than in the preceding 60 years.
The 2022-23 global mpox
outbreak happened despite repeated calls from African researchers for increased
global investment in diagnostic, therapeutic and infection prevention tools for
mpox. The WHO has now declared the current upsurge of mpox in central Africa a
public health emergency of international concern.
This is the highest alert
level for events that constitute a public health risk to other countries and
requires a coordinated international response. We are infectious disease
researchers who have worked on HIV, SARS-CoV-2 and other viral infections.
Mpox’s recent history is yet
another reminder that an infectious disease in one corner of the world should
not be regarded as someone else’s problem, as it can suddenly start to spread
fast and far. It also highlights global inequities in resource allocation and
access to vaccines, diagnostics and treatments. These were made available in
many industrialised countries and helped curb the global outbreak, but are
still largely lacking in most of Africa.
The 2022 outbreak
The disease has been renamed
“mpox” but the name of the virus, for now, remains “monkeypox” (MPXV). It is
closely related to the smallpox virus. MPXV was considered a zoonotic disease endemic
in parts of central and west Africa. It was acquired mainly through close
contact with wild mammals, especially handling bush meat, but there was no
sustained human-to-human transmission.
Only very occasionally were
cases seen outside the endemic areas, due to infected travelers or import of
infected small mammals. This changed abruptly in 2022: a massive, rapidly
evolving global outbreak caused over 99,000laboratory-confirmed cases in 116
countries. At its peak in August 2022, over 6,000 cases were reported each
week.
This outbreak came as a total
surprise: most cases were reported from non-endemic countries, mostly in men
who have sex with men who had become infected during recent sexual encounters.
Even though most cases were clinically not particularly severe and the death
toll stands at just over 200, the global outbreak was declared a public health
emergency of international concern by the World Health Organization on 23 July
2022.
Fortunately, case numbers
soon plummeted due to a combination of behavioural changes and vaccination in
at-risk groups. Modern vaccines and antiviral drugs with activity against mpox
were made available in many affected high-income countries.
These had been developed and
stockpiled in the US and Europe, mostly in preparation for a potential
bioweapon attack using a poxvirus. The global outbreak in 2022 was caused by
clade II of MPXV, which is endemic in west Africa and not as virulent as clade
I MPXV, which so far has only been seen in the Congo Basin.
That first mpox public health
emergency of international concern was declared over in May 2023. Clade II MPXV
infections are still occurring globally, but the worst seems over—for now.
Complacency would be misguided, as illustrated by the current mpox outbreak
that is gathering steam.
Upsurge in Africa
The African region is
experiencing an upsurge in mpox cases which started in 2023. As the continent
which includes the areas where mpox has been endemic for a long time, Africa
now presents a complex mosaic: Cases arising from the endemic, largely
zoonotic, pattern that used to be predominant in the past; cases linked to the
2022 global outbreak, for example in South Africa. Most worryingly, ever
increasing numbers of MPXV clade Ib infections reported from the Democratic
Republic of Congo.
New, more dangerous strain
The current clade I MPXV
(formerly called Congo Basin strain) is more virulent than the clade II (west
African) strain, resulting in a higher case fatality rate. The ongoing outbreak
has its epicentre in South Kivu province, eastern DRC, and has the potential to
fuel a large pandemic. It has a distinct epidemiological pattern with sustained
chains of human-to-human transmission, often via the sexual route. It may have
increased transmissibility (we don’t know yet). The virus which causes it is
the newly defined clade Ib lineage. It displays mutations that are the hallmark
of human-to-human spread that is estimated to have been happening since
September 2023. Case numbers are rising rapidly, even though many suspected
cases are likely not tested and thus not counted as confirmed. Complicating
matters, a commonly used test was found to miss infections with this lineage of
the virus.
It affects mostly adults. The
case fatality rate is higher than it was in the 2022 global outbreak. Already,
this outbreak has resulted in mpox cases occurring in several neighbouring
countries, including some (like Kenya) with no previous record of mpox.
The challenge is enormous.
The eastern DRC is an area beset by multiple problems. This includes natural
disasters, violence and infectious diseases including measles, cholera and
poliomyelitis for the DRC.
In recent years the
second-largest Ebola outbreak ever took place in the wider area and, despite
the availability of vaccines and treatments, posed considerable challenges.
What needs to happen
A recent article we
co-authored in The Lancet Global Health outlines what needs to be done to
contain this outbreak and prevent it from turning into an epidemic, possibly
even a pandemic.
Equitable access to
diagnostic tests, vaccines and antiviral treatments requires political
commitment and financial investments. Scientific investigations are needed to
learn more about exposure settings, transmission routes and clinical
presentations.
It’s important to find the
best ways to make these interventions. We have proposed the establishment of an
African-led, multidisciplinary, multi-country Mpox Research Consortium
(MpoxReC) in Africa.
It should conduct research
towards the elimination of mpox as a public health problem. There is no doubt
that a disease in one corner of the world can suddenly become a global heath
threat. It’s time the global health system woke up to this reality.
It has spread from Congo to
neighbouring countries, including Burundi, Kenya, Rwanda and Uganda, triggering
the action from the WHO.
The World Health Organisation
on Wednesday declared mpox a global public health emergency for the second time
in two years, following an outbreak of the viral infection in Democratic
Republic of Congo that has spread to neighbouring countries.
An emergency committee met
earlier on Wednesday to advise WHO Director-General Tedros Adhanom Ghebreyesus
on whether the disease outbreak constitutes a “public health emergency of
international concern,” or PHEIC.
PHEIC status is WHO’s highest
level of alert and aims to accelerate research, funding and international
public health measures and cooperation to contain a disease.
“It’s clear that a
coordinated international response is essential to stop these outbreaks and
save lives,” said Tedros.
Mpox can spread through close
contact. Usually mild, it is fatal in rare cases. It causes flu-like symptoms
and pus-filled lesions on the body.
The outbreak in Congo began
with the spread of an endemic strain, known as clade I. But a new variant,
clade Ib, appears to spread more easily through routine close contact,
including sexual contact.
It has spread from Congo to
neighbouring countries, including Burundi, Kenya, Rwanda and Uganda, triggering
the action from the WHO.
“The detection and rapid
spread of a new clade of mpox in eastern DRC, its detection in neighbouring
countries that had not previously reported mpox, and the potential for further
spread within Africa and beyond is very worrying,” Tedros added.
Tedros said on Wednesday that
WHO had released $1.5 million in contingency funds and plans to release more in
the coming days. WHO’s response plan would require an initial $15 million, and
the agency plans to appeal to donors for funding.
Earlier this week, Africa’s
top public health body declared an mpox emergency for the continent after
warning that the viral infection was spreading at an alarming rate, with more
than 17,000 suspected cases and more than 500 deaths this year, mainly among children
in Congo.
Professor Dimie Ogoina, chair
of WHO’s mpox emergency committee, said all members unanimously agreed that the
current upsurge of cases is an “extraordinary event,” with a record number of
cases in Congo.
Vaccines and behaviour change
helped stop the spread when a different strain of mpox spread globally,
primarily among men who have sex with men, and WHO declared an emergency in
2022.
In Congo, the transmission
routes need further study, WHO said. No vaccines are yet available, although efforts
are underway to change that and work out who best to target. The agency also
appealed to countries with stockpiles to donate shots.
The Philippines has detected
a new case of the mpox virus in the country, the first since December last
year, its health department said on Monday, adding it was awaiting test results
before being able to determine the strain.
The patient was a 33-year-old
Filipino male who had no travel history outside the Philippines, the Department
of Health (DOH) said.
“We are awaiting sequencing
results and will update once available,” its spokesperson Albert Domingo said
when asked about the strain.
The World Health Organization
on Wednesday declared mpox a global public health emergency, its highest form
of alert, following an outbreak in the Democratic Republic of Congo that had
spread to neighbouring countries.
A new form of the virus has
triggered global concern as it seems to spread easily through routine close
contact.
A case of the new variant was
confirmed on Thursday in Sweden and linked to a growing outbreak in Africa, the
first sign of its spread outside the continent.
Pakistan on Friday confirmed
at least one case of the mpox virus in a patient who had returned from a Gulf
country, but said they did not yet know the strain of the virus.
The new case in the
Philippines is the 10th laboratory-confirmed case the health department has
detected. Its first case was in July 2022.
“Symptoms started more than a
week ago with fever, which was followed four days later by findings of a
distinct rash on the face, back, nape, trunk, groin, as well as palms and
soles,” the Philippine DOH said in a statement.
The disease, caused by the
monkeypox virus, leads to flu-like symptoms and pus-filled lesions. It is
usually mild but can kill, children, pregnant women and people with weakened
immune systems, such as those with HIV, all at higher risk of complications.
Nepal reported its first case
of mpox, also known as monkeypox, in a 60-year-old woman two weeks ago. This
came shortly after the World Health Organization declared an end to it as a
public health emergency of international concern on May 11, 2023. Since then,
however, no further mpox cases have been reported here.
For the first time, mpox
showed sustained human-to-human transmission through sexual contact in the
United Kingdom and worldwide. So far, there is no evidence to suggest
transmission of mpox from monkeys or other animals to humans outside of Africa.
Hence, I propose to call it “sexually transmitted pox virus” or “STpox virus,”
as the patients develop “pox” or “skin eruption” after sexual contact. To avoid
negative effects on trade, travel, tourism, animal welfare and cultural,
national, social, regional, professional or ethnic groups, the WHO changed the
name of the virus from "monkeypox" to "mpox" on November
28, 2022.
Human mpox was first reported
in 1970 in the Democratic Republic of the Congo. However, it was named
monkeypox because it was first detected in 1958 in monkeys kept for research.
According to the WHO, the infection can spread through touch, kissing, sexual
contact, animals, and contaminated material like sheets, clothes and needles.
It can also transmit from pregnant mothers to their unborn babies and through
respiratory droplets or short-range aerosols from prolonged close contact.
Despite these potential transmission routes, there haven’t been any significant
outbreaks of monkeypox in any communities or countries.
In India, the community
spread of mpox was first reported in a patient in July 2022, with no travel
history to countries affected by this viral infection or known to be endemic.
However, no massive outbreak of mpox has been reported there since. According
to the Centers for Disease Control and Prevention (CDC) of the USA, as of June
21, 2023, a total of 22 confirmed cases of mpox, including one death, have been
reported in India. This suggests that through the above-mentioned routes
(except sexual contact), the mpox virus cannot easily spread between people.
People with multiple sexual
partners are at a higher risk of contracting the mpox virus. Studies have found
that the majority of mpox patients were found to be involved in sexual
activities, and the findings of genital, anal and oral mucosal lesions
supported the strong likelihood of sexual transmission. A recent study
published in the New England Journal of Medicine on August 25, 2022, revealed
that 98 percent of the patients were non-heterosexual, and 95 percent had a
history of close sexual contact. A large proportion of mpox cases diagnosed in
the UK were found among non-heterosexual men, making it advisable for them to
receive the vaccine to protect against this infection.
Mpox cases are unlikely to be
reported accurately, particularly in Asian countries. This may be due to
hesitations surrounding talking about genital or sexual health issues. As a
result, in Nepal, sexually transmitted infections (STIs) remain one of the main
public health problems. Likewise, every year, hundreds of Nepali youths
planning to go abroad for employment are found to be infected with STIs, such
as syphilis, during routine laboratory examinations. Most do not have a history
of hospital visits, even if symptoms appear. People may not go to health care
centres even after developing skin lesions (rashes) in and around genital and
anal areas.
Moreover, many
dermato-venerologists are unaware or reluctant to send samples of suspected
mpox cases to confirm the virus. Mpox usually recovers fully in 2–4 weeks
without hospitalisation for most mpox-infected patients. Several studies have
also shown that most hospitalised patients did not show serious health issues
due to mpox.
Mpox has been circulating in
humans in Africa for at least 50 years and continues to cause illness and
deaths, with a fatality rate as high as 11 percent. Despite this, WHO declared
it a public health emergency of international concern only after it spread in
high-income countries. Studies indicate that the current mpox virus has a lower
fatality rate than the one previously spreading in Africa. Therefore, the
reason for declaring mpox a public health emergency of international concern in
2022 seems unjustifiable.
Diseases in Africa do not
receive attention until they spill over to high-income countries. Moreover, the
West African clad (subtype Clade IIb), the causative agent of the current world
outbreak of mpox (spreading beyond Africa), was found to be far less clinically
severe than the original mpox virus version in Africa. Thus, mpox, currently
circulating worldwide, should be considered another dermato-venerology disease,
and there is no need to panic over this virus.
Nepal reported another
monkeypox or mpox case on Friday. A 36-year-old man from Tanahun, who returned
from Saudi Arabia on Thursday, tested positive for the deadly disease.
“Yes, samples of the suspect,
who has been admitted to the Sukraraj Tropical and Infectious Disease Hospital,
have returned positive results,” said Dr Yadu Chandra Ghimire. “We collected
the samples on Thursday and got a positive report today [Friday].”
Health authorities confirmed
the first case of monkeypox infection in June last year.
A 60-year-old foreign
national had then tested positive for the infection.
Monkeypox is a rare disease
caused by infection with the monkeypox virus and one in 10 infected persons can
die. Most common in remote parts of central and west Africa, the disease has
now been reported in at least 122 countries . Its symptoms include fever,
headache, swelling, body pains, exhaustion, and itchy rashes on the face,
hands, and feet.
As the disease primarily
spreads through close person-to-person contact, public health experts recommend
self-isolation and good hygiene to avoid it.
According to health
officials, the infected person, who is a migrant worker, was sent to the
Dhapasi-based Grande International Hospital soon after arrival.
Doctors at the hospital
suspected monkeypox infection, based on the symptoms, and referred the patient
to Sukraraj Hospital.
“He had rashes in his private
parts and blisters on hands and legs,” said a doctor at the hospital,
requesting anonymity as he is not authorised to speak to the media. “The
patient admitted to have had sexual contact in Saudi Arabia.”
Officials at the EDCD said
they will start contact tracing from Saturday.
“We have to trace close
contacts of the patient on the plane he travelled and the vehicle he used to go
to hospitals,” said Ghimire.
Public health experts say
that even if the rare viral infection is usually mild and most people recover
within weeks, the risks should not be underestimated. They stress precautions
saying that every disease seen in any corner of the world can come to Nepal due
to the high mobility of people.
Monkeypox has been a globally
neglected public health problem in parts of Africa for decades. The disease
came into widespread attention after May 2022, with countries outside Africa
reporting new cases.
Mpox has since spread
globally. More than 100,000 people from 122 countries have already tested
positive for the disease. India has recorded at least 30 mpox infections since
2022.
Beyond Africa, monkeypox is
spreading chiefly in men who have sex with men, putting sexual health clinics
on alert for new cases.
As the deadline to eliminate
malaria approaches, cases of new infections—both indigenous and imported—have
risen alarmingly in Nepal.
Nepal had committed to
achieving ‘malaria-free’ status by 2026. For this, the country needs to bring
down indigenous cases or local transmission to zero, achieve zero deaths
starting from 2023, and maintain zero indigenous cases for three consecutive
years.
However, the country has
failed to bring down indigenous cases to zero in both 2023 and 2024.
Instead, cases of
infections–both Indigenous and imported have risen alarmingly, which shattered
any prospects of eliminating the disease within the deadline.
“Only 16 cases of local
transmission or indigenous cases were confirmed in 2023, but we already have
more than 20 cases this year,” said Dr Gokarna Dahal, chief of the Vector
Control Section at the Epidemiology and Disease Control Division. “We had 649
imported cases in 2023, but in 2024, the number could reach 1,000.”
Malaria is caused by
Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly
parasites, according to the World Health Organisation.
Indigenous malaria cases are
locally transmitted, meaning the infected person does not have a history of
travel to a malaria-affected country. Officials say that the number of
indigenous cases of malaria infection could rise further, as concerned health
authorities have been verifying the reports.
“Now, it is impossible to
meet the malaria elimination target, as we could not stop local transmission,”
said Dr Yadu Chandra Ghimire, director of the division. “The new deadline for
disease elimination could be 2030, the final deadline set by the UN health
body.”
Officials say that open
borders, budget cuts in the health sector, and mosquitoes moving to higher
altitudes due to climate change have hindered Nepal’s malaria elimination goal.
They say that of the total
imported cases, over 80 percent came from India. Some cases were imported from
African countries. Nepali security personnel serving in UN peacekeeping
missions in conflict-hit African countries also get tested positive for
malaria.
Officials say the disease is
unlikely to be eliminated in Nepal unless India eliminates it first. They say
that due to proximity, and an open and porous border between Nepal and India
and unregulated travel of people of both countries, it is impossible to
eliminate malaria in Nepal, until the disease gets eradicated in the southern
neighbour.
Several other factors,
including cuts in the health budgets of government and aid agencies and shifts
in vectors transmitting malaria to the hills and mountains due to global warming,
also pose serious challenges to meeting the elimination target. Apart from
this, most health facilities across the country lack entomologists, who are
necessary for conducting surveillance.
Malaria has also been
reported in mountain districts of Mugu, Bajura, and Humla, which were
considered non-endemic in the past.
Officials say carrying out
surveillance in the hill and mountain districts is more challenging than in the
Tarai districts due to geographical difficulties.
According to Health Ministry
officials improved surveillance measures could be a reason for the detection of
more cases of infections.
Malaria-related deaths had
stopped since 2016, but five years later, in 2021, the country recorded one
death from the disease.
Officials at the health
ministry said that until recent years, Plasmodium Vivax, a protozoan parasite,
had been responsible for most of the malaria cases in the country, which caused
relatively less severe diseases.
However, cases of Plasmodium
falciparum, which most often cause severe and life-threatening malaria, have
been rising. The parasite is common in many countries in Africa and the Sahara
desert.
Over 1,500 children under
five years of age from Banke district have been found suffering from
malnutrition–either moderately or severely–in the last five months. The number
could be even higher, as not all the children of the age group have been
screened.
“The number of the diagnosed
cases were reported by the health facilities, where ailing children were taken
for treatment or reported by female community health volunteers,” said Angad
Bahadur Shahi, chief of the Health Office, Banke. “A separate screening
programme has been started, which will tell the exact scenario.”
Malnutrition is considered a
silent health crisis in Nepal. The country has made significant progress in
reducing stunting among children under five, which fell from 57 percent in 2001
to 25 percent in 2022, according to the Nepal Demographic and Health
Survey-2022.
However, the progress is not
the same in all provinces. More than 16 percent of the children under five
years in Lumbini Province [Banke district is part of Lumbini Province] suffer
from wasting—the most immediate, visible, and life-threatening form of
malnutrition.
Child health experts say a
sharp rise in moderately and severely acute malnutrition cases in Banke is
alarming, which could hinder attempts to reduce malnutrition and overall hunger
problems. The increase in the problems will also hinder the attempts to achieve
the United Nations-backed Sustainable Development Goals (SDGs).
SDGs, a follow-up on the
Millennium Development Goals (MDGs), aim to end poverty, hunger and all forms
of inequality in the world by 2030. Nepal has set targets to meet those goals.
The country needs to reduce stunting
to 15 percent from the existing 25 percent by 2030 to meet the SDGs targets,
wasting to 4 percent from the current eight percent and underweight to 10
percent from the existing 19 percent.
Wasting or underweight for
one’s height in children, if not treated properly and on time, is associated
with a higher mortality risk, according to the World Health Organisation.
“Severe acute malnutrition is
a medical emergency, and such children need immediate hospital admission and
treatment,” said Dr Shyam Raj Upreti, a child health expert who is also the
former director general at the Department of Health Services. “Detection of
moderately acute malnutrition means the problems have started recently.”
He said these indicators show
that efforts to rein in existing malnutrition problems and end them permanently
are insufficient.
Malnutrition plays a major
role in the under-five mortality rate. The problem also hinders children’s
mental development and eventually affects the country’s economic health by
weakening intellectual capacity, reducing productivity in adulthood, and
increasing vulnerability to diseases, according to experts.
Health authorities have taken
various measures to address malnutrition problems, including distributing
ready-to-use food and running nutrition rehab homes in 24 federal and
provincial hospitals. Severely acute malnourished children get admitted and
treated in those centres.
Experts stressed addressing
moderately acute malnutrition problems, which are likely to become severe if
not treated timely.
“Many people consider
malnutrition only a health problem, but it is a multisectoral problem, which
needs a multisectoral approach to deal with,” said Upreti. “Treating severely
malnourished children does not stop the problems. We need to address the
poverty of their families.”
Experts said non-health
interventions—awareness drives, improved financial conditions of people, their
education levels, and sanitation conditions—could go a long way in improving
health indicators, including nutrition status.
“We have made a multisectoral
nutrition plan to address the existing malnutrition problems,” said Lila Bikram
Thapa, chief of the Nutrition Section at the Family Welfare Division under the
Department of Health Services. “Sincere efforts of all concerned stakeholders
can address the existing problems.”
Malnutrition affects the
physical as well as mental growth of children, which ultimately affects the
country’s economic health, according to experts.
Germany has detected its
first case of the new mpox variant, the Robert Koch Institute for public health
said on Tuesday, adding that it viewed the risk to the wider population as low.
The patient is a 33-year-old
man who was isolated after being admitted to hospital for treatment on Oct. 12,
the health ministry in the western state of North Rhine-Westphalia said.
The case was detected in
Cologne, the ministry said in a statement.
The results of more detailed
testing showed on Oct. 18 that the patient had the clade 1b variant, a new form
of the virus that is linked to a global health emergency declared by the World
Health Organization in August.
The current outbreak
originated in the Democratic Republic of Congo and has spread to neighbouring
countries.
The patient in Germany is
thought to have picked up the virus in an east African country, the state
ministry said.
"The RKI currently
considers the risk to the health of the general population in Germany to be
low," the RKI said, adding it was monitoring the situation closely and
would adapt its assessment if necessary.
The RKI noted close physical
contact was required for transmission.
The first sign of the virus'
spread outside the African continent came on Aug. 15 when global health
officials confirmed an infection with a new strain of the mpox virus in Sweden.
Two patients in Norway have
been diagnosed with the clade 2 variety of the mpox virus, the Oslo
municipality said on Tuesday. Clade 2 is a less severe form of mpox than the
clade 1b strain.
Dozens of feverish patients
lay on thin mattresses on the floor of a makeshift mpox isolation ward in east
Democratic Republic of Congo, as overstretched hospital workers grappled with
drug shortages and lack of space to accommodate the influx.
Congo is the epicentre of an
mpox outbreak that the World Health Organization declared to be a global public
health emergency last month.
Vaccines are set to arrive
within days to fight the new strain of the virus, while Congo’s President Felix
Tshisekedi has allowed a first $10 million disbursement to fight the outbreak.
But at the hospital complex
in the town of Kavumu, where 900 symptomatic patients have been taken in over
the past three months, health workers are desperate for support.
“We run out of medicine every
day,” said head doctor Musole Mulamba Muva.
“There are many challenges we
struggle to overcome with our local means,” he said, noting that donations from
international organisations rapidly dwindled.
Last week there were 135
patients in the mpox ward, children and adults combined, crammed between three
large plastic tents pitched into damp earth without a floor cover.
Relatives that usually
provide the bulk of meals in underfunded public facilities such as the Kavumu
Hospital were banned from visiting the mpox ward to avoid contamination.
“We do not have anything to
eat,” said Nzigire Lukangira, the 32-year-old mother of a hospitalised toddler.
“When we ask for something to
lower our children’s temperature, they do not give us anything,” she said,
coaxing honey into her daughter’s mouth.
The head of Congo’s mpox
response team, Cris Kacita, acknowledged that parts of the vast central African
country lacked medicine and that dispatching donations, including 115 tonnes of
medicine from the World Bank, was a priority.
TRADITIONAL REMEDIES
Mpox causes flu-like symptoms
and pus-filled lesions and, while usually mild, it can kill. Children, pregnant
women and people with weakened immune systems are all at higher risk of
complications.
Like other mothers in the
Kavumu mpox ward, Lukangira had started improvising with traditional remedies
to ease her baby’s pain. They dipped their fingers in potassium bicarbonate or
salty lemon juice and popped their children’s blisters. Adult patients did the
same to themselves.
Most cases came from the town
itself and surrounding villages. Two other makeshift mpox wards have been set
up in the area.
Local health ministry
representative, doctor Serge Munyau Cikuru, called on the government to
continue pushing for vaccines.
Kacita said high-risk
contacts and nine priority areas had already been identified for the first
vaccination stage.
There were 19,710 suspected
cases of mpox reported since the start of the year in Congo by August 31,
according to the health ministry. Of those, 5,041 were confirmed and 655 were
fatal.
.jpg)
.jpg)
.jpg)
.jpg)
.jpg)
.jpg)
0 Comments