Minutes of an International Weekly Meeting held by HCFI Dr KK Aggarwal Research Fund

Topic: Monkey Pox & Covid-19 Update

21^st May, 2022, Saturday; 9.30-10.30am

• Monkey pox is a zoonotic viral disease primarily found in West and Central Africa and presents with flu like viral symptoms and a palmar rash.
• This virus was first identified in monkeys. It typically spreads through close contact and has in past spread very fast outside of Africa. These cases are now seen in other countries such as Belgium, France Germany, Italy, Netherlands, Spain, Portugal, UK, Sweden, US, Canada, Australia is definitely alarming. It usually causes a mild viral illness and has a very distinctive bumpy rash.
• The CDC has reported that it was first discovered in 1958 when two outbreaks of pox like disease occurred in colonies of monkeys that were kept for research. Thats why it was called monkey pox. The first human case of monkey pox was reported in 1970 in Democratic Republic of Congo during the period of intensified efforts to eliminate small pox.
• Since then, monkey pox has been reported in humans in other central and western African countries.
• As of May 2022, the CDC collaborating with Massachusetts Department of Public health was investigating a situation of a US resident who tested positive for monkey pox on return from Canada on May 18th.They are also tracking multiple clusters of monkey pox in early to mid-May in several countries. It’s not clear how these clusters were exposed to monkey pox but cases include people who self-identified as men who had sex with men & CDC is urging health care providers in the US to be alert with people with rash, illnesses that are consistent with monkey pox. This is not a STD, but is transmitted through close contact.
• Monkey pox virus spreads via large respiratory droplets, which cannot travel more than a few feet. Prolonged face to face contact is required for transmission, which can also occur through direct contact with bodily fluids, lesion and fomites (contaminated clothing, linen etc.)
• Animal to human transmission may occur through bite or scratch.
• Reservoir host is still unknown though African rodents are suspected to play a part in transmission. The virus that causes monkey pox has been recovered twice from animal in nature. In the first instance in 1985 the virus was recovered from an ill African rodent (squirrel) in the Democratic Republic of Congo. In the second instance in 2012 the virus was recovered from dead infant mangabey (a wild monkey) in Taï National Park, Côte d’Ivoire.
• Monkey pox is related to the small pox virus and immunity to small pox is protective against monkey pox. In 1980, small pox was eradicated in all humans and vaccination against small pox has been stopped. Therefore, monkey pox human cases are on the rise. As herd immunity to small pox is lost, whether through vaccination or through infection, susceptibility to the monkey virus increases.
• Infection with monkey pox virus starts like flu-like illness with fever, headache, muscle ache, swollen lymph nodes and a rash, which looks like red dots on mouth, face and then spreads to arms and legs. Over the next 4-5 days these spots turn into fluid-filled blisters that are often tender to touch, become doughnut shape and begin to crust over within 2 weeks. The R0 factor for monkey pox virus is 1.02 so it’s not very transmissible as measles or Covid.
• Most cases are mild and the secondary infection of these blisters might cause morbidity associated with this illness.
• There is no proven treatment for monkey pox but small pox vaccine, antivirals, vaccinia immunoglobulins can be used. The small pox vaccine Jynneos can be used. This is a live attenuated non-replicating vaccine.
• Same mode of precautions that are used for Covid-19 like social distancing, hand sanitizers, sterilizing surfaces have to be followed.
• The information regarding this virus is still evolving, but there is a need to be on high alert.
• Several viral diseases are emerging; we are still with the pandemic, but we are also seeing several cases of hepatitis in children.

Covid-19 Update

• US Update: We have started to drop our guards and the pandemic is not yet over. The numbers are going up again. In the US we have crossed over one million deaths, 81 million people recovered in the last 7 days in US. There is a cluster of cases in the east coast, mid-west and in Florida. This is because there are more international travelers in these areas. This is by far the most contagious virus on the planet. There is an increase in omicron BA.1 transmission, which is 3-folds greater than delta. BA.2 is 30% more transmissible than BA1. Now BA.2.12.1, which is 25% more transmissible than BA.2. There is almost no BA.1.1; it has been replaced by BA 2.12.1, which is now dominant strain. We need to work on a multipronged approach to address the pandemic: nasal vaccines to induce mucosal immunity (IgA) to the virus, variant-proof vaccines and more and better drugs.
• South Africa Update: Last week, the cases varied between 4k-10k. Mortality is very low. Recovery rate is 96%. Active cases are still hovering between 25-30k. People are not wearing masks outdoors, only indoors. Sanitizing is not seen in most shopping centers. Children above 12 are getting vaccinated. Mostly unvaccinated people and senior citizens are being infected and requiring hospitalization. Vaccination is progressing slowly. The focus should be on elderly people 60 years and above, who are at high risk. People are not getting tested. There is no monkey pox case in South Africa and no dengue either.
• Pakistan Update: The situation is very good; there are very few cases. The positivity rate is 0.4%. Everything is going on normally. Very few people are wearing masks.
• India Update: The numbers are going down. Last week it was between 2300 and 2800. The recovery rate is 98.7%.There is complete normalcy in life. Government policy of covid-appropriate behavior is still there but people are not following. Immunization is very slow; 198 crore vaccine doses have been given. People are hesitant to take booster dose. mRNA vaccine trials are going on.
• Bangladesh Update: Almost everything is normal. Yesterday there were 50 cases. Positivity rate is less than 1%. Probably people are not going for testing. Vaccination is satisfactory. No covid deaths for last one month. Officially mask mandate is still there but not followed. Masking is mandatory for domestic flights. There was an increase in dengue cases earlier but now stable.
• Hong Kong Update: The situation is a bit stable. Past one week there were 250 cases daily, about 40 cases were imported. We dont have significant number of BA.4 and BA.5. There is a risk of a sixth wave, if there are imported mutant strains. The government has relaxed rules because of the stable situation. Vaccination rate is over 92% for first dose and 80% for 2nd dose. Vaccination for 3rd dose is 50-60%.

Participants

Member National Medical Associations

Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO

Dr Marthanda Pillai, India Member World Medical Council, Advisor CMAAO

Dr Mvuyisi Mzukwa, South Africa

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Qaiser Sajjad, Pakistan

Dr Md Jamaluddin Chowdhury, Bangladesh

Invitees

Dr Monica Vasudev, USA

Dr Wong Janti Susanna

Dr Jeanel Goh

Dr EC Ng

Dr Ng Qin Xiang

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal